HIPAA Notice of Privacy Practices
Effective Date: 17th Feb, 2026
THIS NOTICE OUTLINES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED, AND YOUR RIGHTS REGARDING THIS INFORMATION. PLEASE REVIEW CAREFULLY.
Purpose of This Notice
ER of Fort Worth is committed to protecting your privacy. Federal law requires us to maintain the confidentiality of your health information and provide this explanation of our practices. This Notice applies to all records created or maintained at: 4561 Heritage Trace Parkway, Suite 117, Fort Worth, Texas 76244.
We use electronic health records to manage your care and may securely share your health information with doctors, labs, insurance companies, or other healthcare partners involved in your treatment.
We will follow these practices while this Notice is in effect. We reserve the right to change our privacy practices and update this Notice. Changes apply to existing and future health information. The current version is always available at our facility and on eroffortworthtx.com.
What Constitutes Protected Health Information?
Protected Health Information (PHI) encompasses identifiable information about your health, care received here, or payment for services. This covers your medical history, exam findings, test results, diagnoses, care plans, and billing records.
How Your Information Is Used
For Your Treatment
Health information allows us to deliver quality emergency care. Relevant details are shared with physicians, nursing staff, technicians, and others treating you. If specialized care is needed elsewhere, we coordinate with receiving facilities.
Example: If you present with severe abdominal pain, your lab results and imaging may be shared with a surgeon or admitting hospital.
For Payment Processing
Your information supports billing and collection activities—verifying coverage, submitting claims, and addressing payment issues with insurers.
Example: Your insurer receives claims containing diagnostic information, services rendered, and treatment details.
For Operational Activities
Records support quality maintenance activities including outcome reviews, staff training, audits, and accreditation compliance.
Example: Charts may be analyzed to evaluate treatment effectiveness and protocol adherence.
Disclosures Made Without Your Consent
Law permits or requires disclosure under these circumstances:
- Legal Mandates: Compliance with federal, state, local laws, court orders, or subpoenas.
- Public Health: Reporting to health authorities for disease prevention, injury documentation, or adverse reaction tracking.
- Abuse/Neglect: Reporting suspected child abuse, elder abuse, or domestic violence to appropriate agencies.
- Oversight Functions: Audits, investigations, and inspections by healthcare oversight bodies.
- Legal Matters: Response to court orders or subpoenas with appropriate protections.
- Law Enforcement: Crime victim identification, death reporting, or responses to lawful requests.
- Threat Mitigation: When necessary to prevent serious, imminent harm to individuals.
- Donation Programs: Organ procurement organizations, eye banks, or tissue donation entities for potential donors.
- Death Investigations: Medical examiners or coroners for identification or death determination.
- Workplace Injuries: Workers’ compensation programs for work-related conditions.
- Military: Armed forces personnel as military command requires.
- Government Activities: National security, intelligence, or protective service operations.
Correctional Settings: Officials responsible for inmate health and safety.
When Written Authorization Is Needed
Disclosures beyond those above require your written authorization. Withdraw authorization anytime via written request to our Privacy Office. Prior disclosures remain unaffected. Psychotherapy notes, compensated marketing, and sale of information always require specific written authorization.
Your Rights
Obtaining Your Records: Request record copies in writing to our Privacy Office. Reasonable fees for copying and mailing may apply. Texas law mandates response within 15 business days.
Requesting Amendments: Request corrections to inaccurate or incomplete information. Denials occur if information was created elsewhere, is not maintained by us, or is accurate. Written disagreement statements may be added to denied requests.
Requesting Restrictions: Ask for limits on treatment, payment, or operational disclosures, or on sharing with family members. We may decline most requests. We must honor requests to withhold information from insurers for fully self-paid services.
Communication Methods: Specify preferred contact methods and locations. Reasonable requests are accommodated.
Disclosure History: Request accounting of disclosures from the past six years, excluding treatment, payment, operations, and authorized disclosures. First request annually is free; subsequent requests may incur fees.
Paper Copy: Obtain a paper copy of this Notice anytime.
Breach Alerts: Receive notification if your unsecured information is breached, including incident details, information involved, protective measures, our response, and contact information.
Our Duties
ER of Fort Worth must:
- Safeguard your health information’s privacy and security
- Provide this Notice of legal duties and practices
- Adhere to this Notice
- Notify you when restriction requests cannot be honored
- Accommodate reasonable communication preferences
- Alert you to breaches of unsecured health information
Filing Complaints
Complaints about privacy violations may be filed with us or the U.S. Department of Health and Human Services. Filing a complaint will not result in retaliation.
Facility Contact
ER of Fort Worth Privacy Office 4561 Heritage Trace Parkway, Suite 117 Fort Worth, Texas 76244
Phone: (817) 945-4200
Email: info@eroffortworthtx.com
Federal Contact
U.S. Department of Health and Human Services Office for Civil Rights 1301 Young Street, Suite 106 Dallas, TX 75202
Website: https://www.hhs.gov/ocr/about-us/contact-us/index.html
Questions About This Notice?
If you’ve any questions or need further information about this notice or your privacy rights, please contact ER of Fort Worth’s Privacy Office using the above details.
Effective from the date above until replaced.
This notice is posted in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Texas Medical Records Privacy Act, Chapter 181 of the Texas Health and Safety Code.