HIPAA Notice of Privacy Practices

Notice of Privacy Practices

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law.

It also describes your rights to access and control your protected health information. “Protected health information: is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.

HIPAA Officer for Physicians Quality Care is Tracey Glisson, Jackson Administrator. Please feel free to contact her to discuss any questions you have about your HIPAA issues.

Tracey Glisson
Jackson Administrator
Physicians Quality Care, LLC
PO Box 12197
Jackson, TN 38308

Uses and disclosures of Protected Health Information

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law.


We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with that third party. For example, we would disclose your protected health information, as necessary, to a home healthy agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.


Your protected information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations

We may use or disclose, as needed, your protected health information in order to support the business activities of your physicians practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical student, licensing and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients in our office. In addition, we may use a sign in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We may use or disclose your protected health information in the following situation without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Disease: Health Oversight: Abuses or Neglects: Food and Drug Administration requirement: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: research: Criminal Activity: Military Activity and National Security: Workers Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Heath and Human Services to investigate or determine our compliance with the requirement of Sections 164.500.

We will share you protected health information with third party “business associates” that perform various activities (e.g., billing, or transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information we will have a written contract that contains terms that will protect the privacy of your protected health information. We may use or disclose your protected health information as necessary to provide you with information about treatment alternatives or other health related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you information about products or services that we believe may be beneficial to you. You may contact our privacy contact to request that these materials not be sent to you.

Your Rights

Following is a statement of your rights with respect to your protected health information.

  • You have the right to request a restriction of your protected health information
    This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restrictions to apply.
    Your physician is not required to agree to a restriction that you may request. If a physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to sue another Healthcare Professional.

  • You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
    We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will request an explanation form you as to the basis for the request. Please make this request in writing to our Privacy Contact.

  • You have the right to receive an accounting of certain disclosures we have made, if any of your protected health information.
    This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in the Notice of Privacy Practices. We are required to abide by the terms of this Notice of Privacy Practices. WE may change the terms of our notice at any time. Then new notice will be effective for all protected health information that we maintain at this time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that revised copy be sent to you in the mail or asking for one at the time of your next appointment.