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HIPAA Acknowledgement

HIPAA Acknowledgement

Health by Design Medical Group

Effective Date: April 14, 2025
Revision Date: February 13, 2026

Important notice

This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

Introduction

Protecting the privacy of your medical information is a fundamental part of our commitment to patient care and reflects our physicians' professional obligations.

We are required by law to:

  • Maintain the privacy of your Protected Health Information ("PHI")

  • Provide you with this Notice of our legal duties and privacy practices

  • Follow the terms of this Notice currently in effect

Please review this Notice carefully. We are required to obtain your acknowledgement that you have received and understand it.

If you have any questions, please contact our Privacy Officer (details below). You are entitled to request a copy of this Notice at any time.

Uses and Disclosures of Protected Health Information Without Authorization

We may use or disclose your Protected Health Information without your authorization in the following circumstances:

1. Treatment

We may share your medical information with other healthcare providers (e.g., specialists) to coordinate and manage your care.

2. Payment

We may disclose your information to insurance providers or payors to obtain payment for services rendered.

3. Healthcare Operations

We may use or share your information to operate our practice efficiently, including:

  • Billing and administrative services

  • Quality improvement

  • Internal operations

4. Texas-Specific Provisions

For Texas residents, beginning September 1, 2012:

  • We may disclose PHI for insurance or HMO functions as defined by law

  • For disclosures not otherwise permitted by law, we will obtain specific authorization (written or verbal, documented in your record)

Additional Permitted Uses and Disclosures

We may also use or disclose your information without authorization in the following situations:

1. Artificial Intelligence (AI) Use

We may use AI-assisted technologies to help collect, analyze, or summarize health information.

These tools:

  • Do not replace clinical judgment

  • Are always reviewed by qualified providers

  • Do not independently make medical decisions

2. Health Information Exchange (HIE)

We may participate in electronic Health Information Exchanges to:

  • Share medical records securely with other providers

  • Improve care coordination and safety

3. As Required by Law

We will disclose PHI when required by federal, state, or local law.

4. Public Health Activities

We may report information to authorized agencies for:

  • Disease prevention and control

  • Injury reporting

  • Vital statistics (e.g., births, deaths)

5. Abuse, Neglect, or Domestic Violence

We may disclose information if necessary to report suspected abuse or prevent serious harm.

6. Health Oversight Activities

We may provide information to regulatory or oversight agencies for:

  • Audits

  • Investigations

  • Inspections

7. Judicial and Administrative Proceedings

We may disclose information in response to court orders, subpoenas, or legal processes, limited to what is necessary.

8. Law Enforcement

We may disclose information:

  • To locate suspects or missing persons

  • Regarding certain injuries or crimes

  • If a crime occurs on our premises

9. Decedents

We may disclose PHI to:

  • Identify deceased individuals

  • Assist funeral directors

10. Organ and Tissue Donation

We may share information to facilitate donation and transplantation.

11. Research

We may disclose PHI for approved research where privacy protections are in place.

12. Serious Threat to Health or Safety

We may disclose information to prevent or reduce serious risks.

13. Specialized Government Functions

We may disclose information for:

  • Military and veterans' services

  • National security

  • Protective services

14. Workers' Compensation

We may disclose information as required for work-related injury claims.

Your Rights Regarding Your Health Information

You have the following rights:

1. Right to Request Restrictions

You may request limits on how your information is used or shared.

We are not required to agree, but if we do, we will comply except in emergencies.

2. Right to Confidential Communications

You may request communication via:

  • Alternative methods

  • Different locations

We will accommodate reasonable requests.

3. Right to Access Your Records

You may request copies of your medical or billing records, except for:

  • Psychotherapy notes

  • Legal preparation materials

  • Certain lab data

Requests are typically fulfilled within 30 days. Fees may apply.

Texas residents: Electronic records must be provided within 15 days when requested in writing.

4. Right to Request Amendments

You may request corrections to your records.

We may deny requests if:

  • The information is accurate and complete

  • It was not created by us

  • It is not part of accessible records

You may submit a written statement of disagreement if denied.

5. Right to Accounting of Disclosures

You may request a list of disclosures made, excluding:

  • Treatment, payment, and operations

  • Authorized disclosures

  • Certain legal exceptions

One free request per year. Additional requests may incur a fee.

How We Communicate With You

We may contact you via:

  • Phone calls

  • Email

  • SMS/text messaging

  • Voicemail

Communications may include:

  • Test results

  • Appointments

  • Prescriptions

  • Billing information

We may also send appointment reminders and updates about relevant services.

By signing the acknowledgement, you consent to these communications. You may opt out of specific methods at any time by informing our staff.

Filing a Complaint

If you believe your privacy rights have been violated, you may:

  • Contact our Privacy Officer (details below)

  • File a complaint with the U.S. Department of Health & Human Services

We will not retaliate against you for filing a complaint.

To file with HHS: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

Privacy Officer Contact Information

Jerry Garcia
Chief Privacy Officer
Health by Design Medical Group
3503 Paesanos Parkway, Suite 101
San Antonio, TX 78231
Phone: (210) 492-8922
Fax: (210) 479-2010
Email: jerry.garcia@healthbydesign.com

Changes to This Notice

We may revise this Notice from time to time. The most current version will always be available in our office upon request.

We design onsite, virtual, and executive health care programs built around life-changing outcomes and long-term partnerships.

Email

hello@healthbydesign.com

Phone

(866) 412-6503

Address

3503 Paesanos Parkway, Suite 101
San Antonio, Texas 78231

Fax

(210) 479-2010

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