Protected health information, or PHI, is individually identifiable health information that is transmitted by, or maintained in, electronic media or any other form or medium. This information must relate to:

• The past, present, or future physical or mental health or condition of an individual
• Provision of health care to an individual
• Payment for the provision of health care to an individual

If the information identifies or provides a reasonable basis to believe it can be used to identify an individual, it is considered individually identifiable health information.

Under HIPAA’s Privacy Rule, uses and disclosures of protected health information (PHI) by covered entities can be divided into four categories:

• Core uses and disclosures, for which no permission is required – although an optional consent can be employed – which includes routine treatment, payment, and other health care operations
• Those that require supplemental authorization such as most kinds of research, and some kinds or marketing and fundraising
• Those that require an opportunity to agree or object, but no written authorization
• Those that do not require an opportunity to agree or object

No. Your signature simply indicates that you were given the Notice of Privacy Practices (NPP). If you choose not to read the NPP or sign the form, there will be no impact on the care or service you receive.

You don't have to sign anything. HIPAA requires that we, as your health care provider, provide this notice (NPP) and make a good faith effort to document that you have received it.

If you choose not to sign, it will have no impact on your care or service.

Clinical staff will be happy to answer any basic questions you have. If you have questions that they cannot answer, you can contact the UT Southwestern Privacy Officer at 214-648-6003.

The Health Insurance Portability and Accountability Act (HIPAA), a federal law enacted in 1996, requires that health providers take certain steps to protect the privacy and security of patient health information. The privacy part of the law went into effect on April 14, 2003. The NPP document and the on-page NPP summary describe how UT Southwestern protects your health information.

Your care will not change. The law formalizes many patient privacy practices that UT Southwestern has routinely followed for some time.

UT Southwestern University Hospitals (William P. Clements Jr. University Hospital and Zale Lipshy Pavilion – William P. Clements Jr. University Hospital) manage the compliance of this process separately from UT Southwestern Ambulatory Services clinics. If you are a patient at either hospital, the admissions staff will ask that you sign a form that combines the NPP with the consent for admission. It is possible that you will be asked to sign a separate acknowledgment form if you are later seen at a clinic.

You may sign the acknowledgment form again, or you may inform them that you previously signed the form at another clinic. If you receive care at other clinics or hospitals that are not affiliated with UT Southwestern, expect that they will ask you to accept and sign their NPP form.

UT Southwestern has always protected the privacy and confidentiality of your health care and has treated your health information accordingly. The new HIPAA law formalizes these privacy requirements, so that in addition to being a good practice, they are now spelled out as law.

This is not a legal document, but you will need to sign the form for your minor children or elderly parents if you are the designated legal representative. Should you or your child or elderly parent have questions or need help understanding the notice, you may contact UT Southwestern’s Privacy Officer at 214-648-6003.

The NPP is available in Spanish. It can be found at all clinics and at many locations in Clements University Hospital and Zale Lipshy Pavilion.

This form is a statement that you received a notice regarding UT Southwestern’s privacy and confidentiality practices. It has nothing to do with how we handle your billing, registration, or treatment.

Please contact the UT Southwestern Privacy Officer at 214-648-6003.