This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please
review it carefully!
With your consent,
the practice is permitted by federal privacy laws
to make uses and disclosures of your health information
for purposes of treatment, payment, and health care
operations. Protected health information is the information
we create and obtain in providing our services to
you. Such information may include documenting your
symptoms, examination and test results, diagnoses,
treatment, and applying for future care or treatment.
It also includes billing documents for those services.
Example of uses of
your health information for treatment purposes:
A nurse obtains treatment information about you and
records it in a health record. During the course
of your treatment, the doctor determines a need to
consult with another specialist in the area. The
doctor will share the information with such specialist
and obtain input.
Example of use of
your health information for payment purposes:
We submit a request for payment to your health insurance
company. The health insurance company requests information
from us regarding medical care given. We will provide
information to them about you and the care given.
Example of Use of
Your Information for Health Care Operations:
We obtain services from our insurers or other business
associates such as quality assessment, quality improvement,
outcome evaluation, protocol and clinical guidelines
development, training programs, credentialing, medical
review, legal services, and insurance. We will share
information about you with such insurers or other
business associates as necessary to obtain these
services.
Your Health Information
Rights
The health record we maintain and billing records
are the physical property of the practice. The information
in it, however, belongs to you. You have a right
to:
We reserve the right
to amend, change, or eliminate provisions in our
privacy practices and access practices and to enact
new provisions regarding the protected health information
we maintain. If our information practices change,
we will amend our Notice. You are entitled to receive
a revised copy of the Notice by calling and requesting
a copy of our "Notice" or by visiting our office and picking up a copy.
To Request Information
or File a Complaint
If you have questions, would like additional
information, or want to report a problem regarding
the handling
of your information, you may contact Dr. Sandra
Felefli at 281-379-3790.
Additionally, if you
believe your privacy rights have been violated,
you may file a written complaint at our office
by delivering
the written complaint to Dr. Sandra Felefli.
You may also file a complaint by mailing it
or
e-mailing
it to
the Secretary
of Health
and Human Services
whose street address is Office for Civil Rights, U.S. Department of Health & Human Services, 1301 Young
Street - Suite 1169, Dallas, Texas 75202.
Other Disclosures
and Uses
Notification
Unless you object, we may use or disclose your protected
health information to notify, or assist in notifying,
a family member, personal representative, or other
person responsible for your care, about your location,
and about your general condition, or your death.
Communication with
Family
Using our best judgment, we may disclose to a family
member, other relative, close personal friend, or
any other person you identify, health information
relevant to that person's involvement in your care
or in payment for such care if you do not object
or in an emergency.
Food and Drug Administration
(FDA)
We may disclose to the FDA your protected health
information relating to adverse events with respect
to products and product defects, or post-marketing
surveillance information to enable product recalls,
repairs, or replacements.
Workers Compensation
If you are seeking compensation through Workers Compensation,
we may disclose your protected health information
to the extent necessary to comply with laws relating
to Workers Compensation.
Public Health
As required by law, we may disclose your protected
health information to public health or legal authorities
charged with preventing or controlling disease,
injury, or disability.
Abuse & Neglect
We may disclose your protected health information
to public authorities as allowed by law to report
abuse or neglect.
Correctional Institutions
If you are an inmate of a correctional institution,
we may disclose to the institution, or its agents,
your protected health information necessary for
your health and the health and safety of other
individuals.
Law Enforcement
We may disclose your protected health information
for law enforcement purposes as required by law,
such as when required by a court order, or in cases
involving felony prosecutions, or to the extent
an individual is in the custody of law enforcement.
Health Oversight
Federal law allows us to release your protected health
information to appropriate health oversight agencies
or for health oversight activities.
Judicial/Administrative
Proceedings
We may disclose your protected health information
in the course of any judicial or administrative proceeding
as allowed or required by law, with your consent,
or as directed by a proper court order.
Other Uses
Other uses and disclosures besides those identified
in this Notice will be made only as otherwise authorized
by law or with your written authorization and you
may revoke the authorization as previously provided.
Website
If we maintain a website that provides information
about our entity, this Notice will be on the website.
