Notice of Privacy Practice

This Notice Describes How Medical Information About You May Be Used, Disclosed and How You Can Get Access To This Information. PLEASE REVIEW IT CAREFULLY.

Our Pledge Regarding Medical Information.

We understand that medical information about you and your health is personal. We are committed to protecting medical information in a reasonable and appropriate manner. We create a record of the care and the services you receive at Central Texas Pain Center and Pain Specialists of Austin. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by our Practice. This notice will tell you about the ways in which we may use and disclose medical information about you, your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

  • make sure that medical information that identifies you is kept private;
  • give you this notice of our legal duties and practices concerning medical information about you; and
  • follow the terms of this notice that is currently in effect.

How We May Use and Disclose Medical Information About You. The following describes the ways we may use and disclose health information that identifies you (“Health Information”). Except for the purposes described below, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing our Privacy Officer.

  • For Treatment. We can use your health information and share it with other professionals who are treating you.
  • For Payment. We can use and share your health information to bill and get payment from health plans or other entities.
  • For Health Care Operations. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
  • Appointment Reminders, Treatment Alternatives, and Health Related Benefits and Services. We can share and disclose Health Information to contact you to remind you that you have an appointment with us. We may also use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.
  • Individuals Involved In Your Care or Payment for Your Care. When appropriate, we can share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend.
  • Research. Under certain circumstances, we can share and disclose Health Information for research. Before we use or disclose Health Information for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information.
  • As Required By Law. We can share and disclose Health Information about you when required to do so by federal, state or local laws.
  • To Advert a Serious Threat to Health or Safety. We can share and disclose Health Information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  • For All Other Uses and Disclosures. All other uses and disclosures of information not contained in this Notice of Privacy Practices will not be disclosed without your authorization.
  • Organ and Tissue Donation. We can share health information about you with organ procurement organizations.
  • Workers’ Compensation, Law Enforcement and Other Government Agencies. We can share health information about you for workers’ compensation, for law enforcement purpose and healthcare oversight agencies for activities authorized by the law, or special government functions such as military, national security and presidential protection.
  • Public Health Risks. We can share Health Information about you for certain situations:
    • to prevent or control disease;
    • to report births and deaths;
    • to report child abuse or neglect;
    • to report reactions to medications or problems with products;
    • to notify people of recalls of products that they may be using;
    • notify a person who may have been exposed to a disease or may be at risk.
  • Lawsuits and Legal Disputes. We can share health information about you in response to a court or administrative order, or in response to a subpoena.
  • Comply with the Law. We will share information about you if state or federal laws require it, including with Health and Human Services should it want to see we are complying with federal privacy law.
  • Coroners, Medical Examiners and Funeral Directors. We can share Health Information to a coroner, medical examiner or funeral director when an individual dies.

Uses and Disclosures That Require Us To Give You An Opportunity To Object and Opt Out.

In these cases you can tell us what we can share:

  1. Share information with your family, close friends, or others involved in your care.
  2. Share information in a disaster relief situation
  3. Include your information in a hospital directory
  4. Contact you for fundraising efforts. We may contact you, but you can tell us not to contact you again.

Your Written Authorization Is Required For Other Uses And Disclosures.

In these cases we never share your information unless you have given us written permission:

  1. Marketing Purposes
  2. Sale of your information
  3. Sharing of psychotherapy notes

If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. But any disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.

Your Rights.

To ensure patients are aware of their rights and responsibilities, the rights and responsibilities are posted in a prominent place and/or provided in pamphlet form for patient review.

Each patient treated has the right to:

a. Be treated with respect, consideration and dignity.
b. Respectful care given by competent personnel with consideration of their privacy concerning their medical care.
c. Receive care in a safe setting and free from all forms of abuse or harassment.
d. Be given the name of their attending physician, the names of all other physicians directly assisting in their care, and the names and functions of other health care persons having direct contact with the patient.
e. Be given the opportunity to participate in decisions involving their health care, except when such participation is contraindicated for medical reasons.
f. Have records pertaining to their medical care treated as confidential and, except where authorized by law, patient shall be given the opportunity to approve or refuse their release.
g. Know what rules and regulations apply to their conduct as a patient.
h. Expect emergency procedures to be implemented without necessary delay.
i. Be informed on Advanced Directives.
j. Absence of clinically unnecessary diagnostic or therapeutic procedures.
k. Expedient and professional transfer to another facility when medically necessary and to have the responsible person and the facility that the patient is transferred to notified prior to transfer.
l. Treatment that is consistent with clinical impression or working diagnosis.
m. Good quality care and high professional standards which are continually maintained and reviewed. An increased likelihood of desired health outcomes.
n. Full information in non-technical language concerning appropriate and timely diagnosis, treatment, prognosis and preventive measures; if it is not medically advisable to provide this information to the patient, the information should be given to the responsible person on his/her behalf.
o. Receive a second opinion concerning the proposed surgical procedure, if requested.
p. Accessible and available health services; information on after-hour and emergency care.
q. Give an informed consent to the physician prior to the start of a procedure.
r. Be advised of participation in a medical care research program or donor program; the patient should give consent prior to participation in such a program; a patient may also refuse to continue in a program that has previously given informed consent to participate in.
s. Receive appropriate and timely follow-up information of abnormal findings and tests.
t. Receive appropriate and timely referrals and consultation.
u. Receive information regarding “continuity of care”.
v. Refuse drugs or procedures and have a physician explain the medical consequences of the drugs or procedures.
w. Appropriate specialty consultative services made available by prior arrangement.
x. Medical and nursing services without discrimination based upon age, race, color, religion, sex, national origin, handicap, disability, or source of payment.
y. Have access to an interpreter whenever possible.
z. Be provided with, upon written request, access to all information contained in their medical record.

      • Accurate information regarding the competence and capabilities of the organization.
      • Receive information regarding methods of expressing suggestions or grievances to the organization.
      • Appropriate information regarding the absence of malpractice insurance coverage.
      • Change primary or specialty physicians if other qualified physicians are available.
      • Health Services provided are consistent with current professional knowledge.

Information regarding fees for services and payment policies.


A. Each patient treated has the responsibility to: a. Provide full cooperation with regards to instructions given by his/her surgeon, anesthesiologist, and operative care (pre and post). Behave respectfully towards healthcare professionals, staff, patients, and family/friends.

  • b. Provide complete and accurate information to the best of his/her knowledge regarding health, medications, allergies, etc.
    c. Provide staff with all medical information that may have a direct effect on the provider.
    d. Provide staff with all information regarding third-party insurance coverage.
    e. Fulfill financial responsibility, for all services received, as determined by the patient’s insurance carrier.
    f. Follow the treatment plan given by his/her provider.
    g. Provide a responsible adult to transport him/her home from the facility and remain with him/her for 24 hours, if required.

You may contact the following entities to express any concerns, complaints or grievance you may have:

Compliance: Elena Fuentes, RN, CASC, VP of Operations
Ph: 855.876.7246 Email:

STATE: Texas Department of State Health Services
P.O. Box 149347, Austin, TX 78714-9347
Compliance Hotline: 888-973-0022

Medicare Ombudsman: (800) MEDICARE

AAAHC: AAAHC Institute for Quality Improvement 5250 Old Orchard Road, Suite 250 Skokie, IL 60077 847-853-6060

The role of the Medicare Ombudsman is to help you receive information and understand your Medicare Options and apply your Medicare Rights for your protection.