Notice of Privacy Practices

This document describes how your protected health information may be used and disclosed and under what circumstances your authorization may not be required. This document also describes your rights related to use and disclosures of your health information and Health Services’ responsibility to protect your health information. Please review it carefully.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We must follow the privacy practices described in this notice and give you a copy of it.
  • We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We will not use or share your information other than as described in this document unless you tell us in writing that we can. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Your Rights

  • You can ask us, in writing, to contact you in a specific way (for example, through home or office phone or email) or to send mail to a different address than the one we have on file. We will say “yes” to all reasonable requests.
  • You can ask, in writing, to receive a paper or electronic copy of your medical record and other health information we have about you. You must submit a “Consent to Release Medical Information” form before we will release any information. We have 30 days to provide this information. In certain circumstances, we may deny your request. As a general rule, you do not have the right to access your own psychotherapy notes or information we may have compiled for legal proceedings. This information is kept separately from billing and medical records. If you are denied a copy of your medic al records (with the exception of any psychotherapy notes), you may ask that the denial al be reviewed.
  • If you believe any health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment as long as the health information originated in UA Little Rock Health Services. We will not amend records forwarded to UA Little Rock Health Services from an outside provider.  To request an amendment, you must submit a “Request for Medical Record Correction/Amendment Form.” We may say “no” to your request if the request does not include a reason to support the request, but we’ll tell you why in writing within 60 days. You have the right to submit a rebuttal and request the rebuttal be made a part of your medical record.
  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you submit your written request. The list will include who we shared your information with and why. We’ll include all of the disclosures except for those about treatment, payment, healthcare operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. To obtain this list, you must submit a “Request of Accounting Disclosures.”
  • You can ask us not to use or share certain health information for treatment, payment, or healthcare operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If we do agree, we will comply with your request unless such information is needed to provide you emergency treatment or we are required by law to use or disclose the information.
  • If you pay for a service or treatment out-of-pocket in full, you can ask us not to share that information for the purpose of payment with your health insurance carrier. We will say “yes” unless a law requires us to share that information.
  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Disclosures that require your authorization

  • We will not use or disclose your health information (including reasons for visits or outcomes of visits) to your parent(s), guardian(s), other family members, or friends. If you want us to share information with certain individuals, we must have it in writing. The request must include specific names of who you give us permission to talk to and their phone number. In emergency situations, a verbal authorization will be accepted and documented in your medical record.  If you are unable to verbalize authorization, the healthcare provider may disclose certain information if it’s determined necessary for your care, treatment, and safety.
  • All research projects, other than those used for healthcare operations, must be approved by the UA Little Rock Institutional Review Board (IRB).  Health Services will always ask for your written permission if a researcher wants access to your name, address, or other information that reveals who you are.  Research results will NEVER include protected health information, only data and statistics.

Disclosures that DO NOT require your authorization

  • For Treatment: UA Little Rock healthcare providers may use your medical history to decide what treatment is best for you. The healthcare providers may also tell another provider about your condition so he/she can help determine the most appropriate care for you. Other personnel in Health Services may share information about you and disclose information to people who do not work for Health Services in order to coordinate your care, i.e., phoning in prescriptions, submitting outsource labs, verifying insurance benefits, and submitting insurance claims.
  • Workers’ Compensation: We are required to release health information relating to all workers’ compensation visits. If the AR Workers’ Compensation Commission asks for your complete record (all notes from previous visits, even those not related to a workers’; comp visit), we are required to release it.
  • For Payment: If we bill your insurance company for treatment and services received, we will provide the insurance company with information about the treatment and service you received so they will pay us.
  • For Health Care Operations: We may use and disclose your health information for general operating purposes – to make sure that you and our other patients receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use your health information to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.
  • To Avoid Harm: We may disclose health information about you when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person.
  • Required By Law: We will disclose health information when required to do so by federal, state, or local law (i.e. in response to a court order, subpoena, warrant, summons or other similar process).
  • Public Health Risks: We may disclose health information to a public health authority, or to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition. We also may disclose personal health information in regard to reactions to food, medications, products, or product defects as required by the FDA.

If you feel we have violated your privacy rights, you may send an email to or a letter through the U.S. Postal Service addressed to:
Charlotte Beck
Assistant Director, Health Services / HIPAA Privacy Officer
2810 South University Ave., DSC 102
Little Rock, AR 72204

You can also file a complaint with the Director of Health Services, Mike Kirk, at or the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or by visiting

CHANGES TO THIS NOTICE:  We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. The new notice will be available upon request, both in our office and on our website.