Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THE PRACTICE) MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Revised October 2021 as required by the privacy regulations created because of the Health Insurance Portability and Accountability Act of 1996 (HIPPA) We may use and disclose your PHI in the following ways: The following categories describe the different ways in which we may use and disclose your PHI.
Treatment: Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine test) and we may use the results to help us reach a diagnosis. We might use your PHI to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice – including, but not limited to, our doctors and nurses– may use or disclose your PHI to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children, or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.
Payment: Our practice may use and disclose your PHI to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.
Health care operations: Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.
Appointment reminders: Our practice may use and disclose your PHI to contact you and remind you of an appointment.
Treatment options: Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
Health-related benefits and services: Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
Release of information to family/friends: Our practice may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information.
Disclosures required by law: Our practice will use and disclose your PHI when we are required to do so by federal, state, or local law.
Use and disclosure of your PHI in certain special circumstances: The following categories describe unique scenarios in which we may use or disclose your identifiable health information.
Public health risks: Our practice may disclose your PHI to public health authorities that are authorized by law to collect information such as: Maintaining vital records, such as births and deaths; Reporting child abuse or neglect; Preventing or controlling disease, injury or disability, and notifying a person regarding potential exposure to a communicable disease.
Health oversight activities: Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions civil, administrative, and criminal procedural or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
Lawsuits and similar proceedings: Our practice may use and disclose your PHI in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena or other lawful process by another party involved in the dispute, but only if we have tried to inform you of the request or to obtain an order protecting the information the party has requested.
Law enforcement.: We may release PHI if asked to do so by a law enforcement official for certain purposes.
Deceased patient: Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information for funeral directors to perform their jobs. Any PHI related to an individual who has been deceased 50 years or more, is no longer protected.
Organ and tissue donation: Our practice may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation.
Research: Our practice may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when an Internal Review Board or Privacy Board has approved the research project and its privacy protections.
Psychotherapy Notes: Most uses, and disclosures of psychotherapy notes, uses and disclosures of protected health information for marketing purposes, and disclosures that constitute a sale of protected health information require authorization, as well as a statement that other uses and disclosures not described in the NPP will be made only with authorization from the individual.
Fundraising: Should you receive fundraising or marketing information; you have the right to “opt out” of receiving any fundraising or marketing communications.
Prohibition Against Sale: Our practice is prohibited from the sale of Protected Health Information without the express written authorization of the individual.
Our commitment to your privacy:
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information, or PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practice that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time. Additionally, the practice is required to notify you of certain unauthorized access, acquisition or use of your medical information as required under the HIPPAA regulations. The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will always post a copy of our current Notice in our offices in a visible location, and you may request a copy of our most current Notice at any time. If you have questions about this Notice, please contact: DALLAS PAIN SPECIALISTS PPLC, MAHESH MOHAN, MD, PAIN MANAGEMENT 13052 DALLAS PARKWAY SUITE 220 FRISCO, TEXAS 75033 PHONE: 214-618-4011 FAX: 214-618-0181 Your rights regarding your PHI: You have the following rights regarding the PHI that we maintain about you: 1. Confidential communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at ad certain location. For instance, you may ask that we contact you at home, rather than your work. To request a type of confidential communication, you must make a written request to: Privacy Officer, 13052 Dallas Parkway, Suite 220, Frisco, Texas 75033, or you may call 214-618-4011, specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request. 2.Requesting restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family, except in situations where you request that we restrict disclosure of you medical information to a health plan and the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law to be disclosed and the medical information solely pertains to an item or service you, or another individual on your behalf, has paid the practice in full. We are not required to agree to your request, however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you. To request a restriction in our use or disclosure of your PHI, you must make your request in writing to Privacy Officer, 13052 Dallas Parkway, Suite 220, Frisco, Texas 75033, or you may call 214-618-4011. Your request must describe in a clear and concise fashion: The information you want restricted; Whether you are requesting to limit our practices’ use, disclosure, or both; and to whom you want the limits to apply. Additionally, if you have paid out-of-pocket and in full for services, you have the right to request the restriction of certain disclosures to a health plan. 3. Inspection and copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Privacy, 13052 Dallas Parkway, Suite 220, Frisco, Texas 75033 or you may call 214-618-4011, in order to inspect and/or obtain a copy of your PHI. Our practice may charge a fee for the costs of copying, mailing, labor, and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews. 4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to, 13052 Dallas Parkway, Suite 220, Frisco, Texas 75033, or you may call 214-618-4011. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion; (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information. 5. Breach Notification. Should an unsecured breach of your Protected Health Information occur, all affected individuals have the right to be notified. 6. Accounting of disclosures. All our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI for purposes not related to treatment, payment, or operations. Use of your PHI as part of the routine patient care in our practice is not required to be documented – for example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim. To obtain an accounting of disclosures, you must submit your request in writing to, 13052 Dallas Parkway, Suite 220, Frisco, Texas 75033, or you may call 214-618-4011. All requests for an “accounting of disclosures” must state a time, which may not be longer than six (6) years from the date of disclosure. The first list you request within a 12-month period is free of charge, but our practice may charge you for any additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs. 7. Electronic Copies. Our practice maintains its records in electronic format. Therefore, if you request copies of your records, they can be released to you in electronic format if they are requested by you. 8. Right to a paper copy of this notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Privacy Officers 13052 Dallas Parkway, Suite 220, Frisco, Texas 75033, or you may call 214-618-4011. Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact, 13052 Dallas Parkway, Suite 220, Frisco, Texas 75033, or you may call 214-618-4011. All complaints must be submitted in writing. You will not be penalized for filing a complaint. Right to provide an authorization for other uses and disclosures Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Again, if you have any questions regarding this notice or our health information privacy policies, please contact, 13052 Dallas Parkway, Suite 220, Dallas, Texas 75033, or you may call 214-618-4011. Serious threats to health or safety. Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Military. Our practice may disclose your PHI if you are a member of U.S. intelligence and national security activities authorized by law. Inmates. Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Worker’s compensation. Our practice may release your PHI for worker’s compensation and similar programs. Other. Other uses and disclosures will be made only with your written authorization, and you may revoke the authorization except to the extent the practice has taken action in reliance on such. Examples of uses and disclosures which require your authorization include uses or disclosures (i) of psychotherapy notes except in certain circumstances, (ii) for certain marketing purposes, and (iii) in the case of the sale of your PHI to a third party
Terms and Conditions
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2. Use License
Permission is granted to temporarily download one copy of the materials (information or software) on Dallas Pain Specialists, web site for personal, non-commercial transitory viewing only. This is the grant of a license, not a transfer of title, and under this license you may not: modify or copy the materials; use the materials for any commercial purpose, or for any public display (commercial or non-commercial); attempt to decompile or reverse engineer any software contained on Dallas Pain Specialists web site; remove any copyright or other proprietary notations from the materials; or transfer the materials to another person or “mirror” the materials on any other server. This license shall automatically terminate if you violate any of these restrictions and may be terminated by Dallas Pain Specialists at any time. Upon terminating your viewing of these materials or upon the termination of this license, you must destroy any downloaded materials in your possession whether in electronic or printed format.
The materials on Dallas Pain Specialists web site are provided “as is”. Dallas Pain Specialists makes no warranties, expressed or implied, and hereby disclaims and negates all other warranties, including without limitation, implied warranties or conditions of merchantability, fitness for a particular purpose, or non-infringement of intellectual property or other violation of rights. Further, Dallas Pain Specialists does not warrant or make any representations concerning the accuracy, likely results, or reliability of the use of the materials on its Internet web site or otherwise relating to such materials or on any sites linked to this site.
In no event shall Dallas Pain Specialists or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption,) arising out of the use or inability to use the materials on Dallas Pain Specialists Internet site, even if Dallas Pain Specialists authorized representative has been notified orally or in writing of the possibility of such damage. Because some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages, these limitations may not apply to you.
5. Revisions and Errata
The materials appearing on Dallas Pain Specialists web site could include technical, typographical, or photographic errors. Dallas Pain Specialists does not warrant that any of the materials on its web site are accurate, complete, or current. Dallas Pain Specialists may make changes to the materials contained on its web site at any time without notice. Dallas Pain Specialists does not, however, make any commitment to update the materials.
Dallas Pain Specialists has not reviewed all the sites linked to its Internet web site and is not responsible for the contents of any such linked site. The inclusion of any link does not imply endorsement by Dallas Pain Specialists of the site. Use of any such linked web site is at the user’s own risk.
8. Governing Law
Any claim relating to Dallas Pain Specialists web site shall be governed by the laws of the State of the clinic without regard to its conflict of law provisions. General Terms and Conditions applicable to Use of a Web Site.
This practice website is offered to you conditioned on your acceptance without modification of the terms, conditions, and notices contained herein. Your use of this practice website constitutes your agreement to all such terms, conditions, and notices.
Collection of your Personal Information
We are committed to protecting your privacy and developing technology that gives you safe online experience. This Statement of Privacy applies to our practice’s website and governs data collection and usage. By using this website, you consent to the data practices described in this statement.
This practice reserves the right to change the terms, conditions, and notices under which this practice website is offered, including but not limited to the charges associated with the use of this practice website.
Links to Third Party Sites
This practice website may contain links to other websites (“Linked Sites”). The Linked Sites are not under the control of this practice and this practice is not responsible for the contents of any Linked Site, including without limitation any link contained in a Linked Site, or any changes or updates to a Linked Site. This practice is not responsible for webcasting or any other form of transmission received from any Linked Site. This practice is providing these links to you only as a convenience, and the inclusion of any link does not imply endorsement by this practice of the site or any association with its operators.
No Unlawful or Prohibited Use
As a condition of your use of this practice website, you warrant to this practice that you will not use this practice website for any purpose that is unlawful or prohibited by these terms, conditions, and notices. You may not use this practice website in any manner which could damage, disable, overburden, or impair this practice website or interfere with any other party’s use and enjoyment of this practice website. You may not obtain or attempt to obtain any materials or information through any means not intentionally made available or provided for through this practice website.
Use of Communication Services
This practice website may contain bulletin board services, chat areas, news groups, forums, texts/SMS, instant messaging, ChatBot, communities, personal web pages, calendars, and/or other message or communication facilities designed to enable you to communicate with the public at large or with a group (collectively, “Communication Services”), you agree to use the Communication Services only to post, send and receive messages and material that are proper and related to the particular Communication Service. By way of example, and not as a limitation, you agree that when using a Communication Service, you will not:
– Defame, abuse, harass, stalk, threaten or otherwise violate the legal rights (such as rights of privacy and publicity) of others.
– Publish, post, upload, distribute or disseminate any inappropriate, profane, defamatory, infringing, obscene, indecent or unlawful topic, name, material or information.
– Upload files that contain software or other material protected by intellectual property laws (or by rights of privacy of publicity) unless you own or control the rights thereto or have received all necessary consents.
– Upload files that contain viruses, corrupted files, or any other similar software or programs that may damage the operation of another’s computer.
– Advertise or offer to sell or buy any goods or services for any business purpose, unless such Communication Service specifically allows such messages.
– Conduct or forward surveys, contests, pyramid schemes or chain letters.
– Download any file posted by another user of a Communication Service that you know, or reasonably should know, cannot be legally distributed in such manner.
– Falsify or delete any author attributions, legal or other proper notices or proprietary designations or labels of the origin or source of software or other material contained in a file that is uploaded.
– Restrict or inhibit any other user from using and enjoying the Communication Services.
– Violate any code of conduct or other guidelines which may be applicable for any particular Communication Service.
– Harvest or otherwise collect information about others, including e-mail addresses, without their consent.
– Violate any applicable laws or regulations.
This practice has no obligation to monitor the Communication Services. However, this practice reserves the right to review materials posted to a Communication Service and to remove any materials in its sole discretion. This practice reserves the right to terminate your access to any or all of the Communication Services at any time without notice for any reason whatsoever. Materials uploaded to a Communication Service may be subject to posted limitations on usage, reproduction and/or dissemination. You are responsible for adhering to such limitations if you download the materials.
All contents or any work-product of this website are owned by respective owners and any 3rd party is not authorized to copy the content or any work-product.
The names of actual companies and products mentioned herein may be the trademarks of their respective owners. The example companies, organizations, products, people and events depicted herein are fictitious. No association with any real company, organization, product, person, or event is intended or should be inferred. Any rights not expressly granted herein are reserved.
Should you have any questions or concerns regarding our terms & conditions, please contact us:
by phone (214) 618-4010 or by registered mail at 13052 Dallas Pkwy, Ste 220. Frisco, TX 75033.
*For any medical procedure, patients respond to treatment differently, hence each patient’s results may vary.
**In case of a life threatening emergency, immediately call 911.
***Information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content contained on or available through this site is for general information purposes only.
****By using this website and sending us your information, you are giving us permission to contact you by electronic and non-electronic means. We also track the conversions and collect user data to improve marketing.
*****If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact us.