Jack M. Thomas, M.D. Privacy Notice

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

We understand that the privacy of your personal information is important to you. As your physician, we believe your right to privacy is a fundamental part of your treatment; as such, we want you to understand our privacy practices and procedures. Should you have any questions, regarding these policies please do not hesitate to ask our privacy officer Karen Biles who can be reached at 903-454-7555 or contact us via e-mail.

Information We Collect About You
We collect personal information about you and your family as part of our registration process, during the course of your care, and from other heath care entities you utilize such as hospitals, laboratories, other physicians, imaging facilities and your insurance company. This personal information includes items such as your name, address, phone number, birth date, social security number, employer, health history, insurance policy and coverage information. During the course of your treatment, we will collect health information regarding diagnosis, treatment plans, progress and any test results or films.

How Your Information is Used
The personal and health information gathered may be used and disclosed with your general consent for purposes of treatment, payment or routine healthcare operations. This means we may send your information to other physicians or facilities involved in your treatment as well as to your insurance company. Any other uses of your information require a signed authorization by you, the patient or guardian. Dr. Jack M. Thomas does not sell patient information to marketing or pharmaceutical companies. In certain cases of public health interest we may be required to disclose certain information to local, state or national health organizations or government agencies.

Safeguarding Your Personal and Health Information
We are required by law to (1) make sure that medical information that identifies you is kept private (2) provide you with our privacy policy (3) follow the terms laid out in the privacy policy. As a means of protecting your privacy, we restrict access to your personal and health information only to those employees who require the information to complete their jobs and provide quality service to you. Dr. Jack M. Thomas maintains physical, electronic and procedural safeguards to comply with state and federal regulations that guard your personal and health information. If you feel your privacy has been violated you have the right to file a complaint with the Department of Health and Human Services. The complaint in no way influences your course of treatment with Dr. Jack M. Thomas.

Change to Our Privacy Policy
All new patients will receive a copy of our privacy policy. Dr. Jack M. Thomas occasionally reviews the privacy policy and reserves the right to amend it without further notice. Copies are available at the front desk prior to each visit if you want to review changes.

Your Right to Restrict Use of Information
You have the right to request restrictions to our uses or disclosures of your personal or health information, although we are not required to agree to those restrictions. Once your request has been processed it will remain in effect until you request a change.

Revised 08/13/04