Privacy Policy


Notice of Privacy Policy

THIS NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION (PHI) MAY BE USED AND DISCLOSED BY THE SOUTH HOUSTON RETINA (SHR) AND HOW TO OBTAIN ACCESS TO YOUR PHI.

We understand that your medical information is personal and valuable to you. We strive to protect our patients’ privacy. We are required by law to maintain the privacy of our patients’ protected health information (“PHI”). We are also required to provide notice of our legal duties and privacy practices with respect to PHI and to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this Notice and to make a new Notice effective for all PHI we maintain. As our patient, we create paper and electronic medical records about your health, our care for you, and the services and/or items we provide to you as our patient. We need this record to provide for your care and to comply with the current legal requirements.

We are required by law to:

  • Ensure that your PHI is kept private;
  • Provide you with a Notice of our Privacy Practices and your legal rights with respect to protected health information about you; and
  • Follow the conditions of the Notice that is currently in effect.

This Notice of Privacy Practices is provided to you consistent with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This notice describes how SHR may use or disclose your PHI and with whom that information may be shared. This notice also describes your rights to access and amend your PHI.

This notice describes our Practice’s policies, which extend to:

  • Any health care professional authorized to enter information into your chart 
  • All areas of the Practice (front desk, administration, billing, and collection, etc.);
  • All employees, staff and other personnel that work for or with our Practice;
  • Our business associates (including a billing service, or facilities to which we refer patients), on-call physicians, and so on.

The following are examples of permitted uses and disclosures of your PHI. 

Required Uses and Disclosures

Treatment – SHR will use and disclose your PHI to provide, coordinate, or manage your health care and related services in a DOS health unit/clinic. This may also include other health care provider(s) who, at your request, become involved with the management of your care or related services. For example, doctors, nurses, and other staff members involved in your care will use and disclose your PHI to coordinate your care or to plan a course of treatment for you. This can include pharmacists when PHI necessitates the information on other drugs which have been prescribed to identify potential interactions.

In emergencies, we will use and disclose your PHI to provide the treatment you require. 

Payment – Your PHI will be used, as needed, to obtain payment for your health care services, including services recommended for determining eligibility for benefits, and utilization reviews. For example, we may disclose information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you.

Health Care Operations– SHR may use or disclose your PHI to support the daily activities related to health care. For example, we may use and disclose medical information about you so that we can run SHR more efficiently and make sure that all our patients receive excellent care. We may use your PHI to conduct an evaluation of the treatment and services provided or to review staff performance. We may disclose your PHI for education and training purposes to doctors, nurses, technicians, medical students, residents, fellows and others.

SHR may disclose PHI to a health oversight agency for activities such as audits, investigations, and inspections. These health oversight agencies might include other healthcare agencies that oversee a health care system, benefit programs, other regulatory programs, and/or civil rights laws.

Required by Law – SHR may use or disclose your PHI Required by Law. We will disclose medical information about you when required to do so by federal, state, or local law.

Public Health – SHR may disclose PHI to a public health authority that is permitted by law to collect or receive the information. The disclosure may be necessary to do the following. We may use and disclose medical information about you when necessary to prevent a serious threat either to your specific health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. These include but not limited to:

  • Prevent or control disease, injury, or disability.
  • Report births and deaths.
  • Report reactions to medications or problems with products.
  • Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
  • Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
  • Notify a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.

U.S. Food and Drug Administration (FDA) – SHR may disclose your PHI to a person or company required by the FDA to do the following:

  • Report adverse events, product defects or problems, and/or biologic product deviations
  • Track products
  • Enable product recalls
  • Make repairs or replacements.

Coroners, Funeral Directors, and Organ Donations – SHR may disclose PHI to coroners or medical examiners for identification, to determine the cause of death, or for the performance of other duties authorized by law. SHR may also disclose PHI to funeral directors as authorized by law.

National Security – SHR may disclose your PHI to authorized Federal officials for conducting national security, intelligence activities, and protective services.

Workers’ Compensation – SHR may disclose your PHI to comply with workers’ compensation laws and other similar legally established programs.

Parental Access – Some state laws concerning minors permit or require disclosure of PHI to parents, guardians, and/or persons acting in a similar legal status. When care occurs in the U.S., SHR will act in accordance with the law of the state where the treatment was provided. SHR has the right to refuse to disclose information to a parent when it is felt such disclosure might be harmful to the child.

CONSEQUENCES OF NON-DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION

Providing your PHI to SHR is voluntary: however, failure to disclose medical information required from you by SHR may affect SHR’s ability to provide treatment or, in the case of medical clearance adjudications, may result in denial of medical clearance.

ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE

You will be asked to provide a signed acknowledgment of receipt of this notice. The intent is to create awareness of possible uses and disclosures of your PHI and privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgment. If you decline to provide a signed acknowledgment, SHR will continue to provide treatment, and SHR will use and disclose your protected health information for treatment, payment, and health care operations consistent with Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and this Notice of Privacy Practices.

We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we may receive from you in the future. We will post a copy of the current notice in the Practice. The notice will contain on the first page, in the top right-hand corner, the date of last revision and effective date. In addition, each time you visit the Practice for treatment or health care services you may request a copy of the current notice in effect. SHR will abide by the terms of this privacy notice but may revise it to conform to any changes in Medical Records at which time SHR will issue an updated Notice of Privacy Practices. Any changes to this notice will be made available on the SHR website.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice, contact our privacy manager, who will direct you on how to file an official complaint. All complaints must be submitted in writing, and all complaints shall be investigated, without repercussion to you.

You may reach our privacy manager at (832) 727-1771 for further information about the complaint process. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

We must obtain your written authorization before using and disclosing the following:

  • Use and disclosure of medical information for marketing.
  • Disclosures that constitute a sale of medical information
  • Other uses and disclosures of medical information not covered by this notice or the laws that apply to us.

If you have provided us with your permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we provided to you.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

By law, we must provide access to your health information to you, with limited exceptions.

Under the privacy rules, you have the right to access your standard PHI by utilizing the Authorization to Release Medical Records document, which can be requested from SHR in writing. 

Inspections and Copies – You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records.

This right does not include the inspection and copying of information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law prohibiting access to protected health information.

Requesting Restrictions – You may ask SHR not to use or disclose any part of your PHI. The request must be made in writing to SHR. In your request, you must clearly describe (1) what information you want restricted; (2) whether you want to restrict use, disclosure, or both; (3) to whom you want the restriction to apply, and (4) an expiration date for the restriction.

SHR is not required to agree to a requested restriction but will give due consideration to such requests.

Amendment – You may ask SHR to amend your health information if you believe it to be incorrect or incomplete, and you may request an amendment for as long as the information is kept by SHR. Please submit your detailed request to SHR. You must provide a reason that supports your request for amendment. If there are factual errors (wrong birth date, wrong blood type, etc.), SHR will correct these.

SHR may not agree to the amendment and could deny your request if it is determined that the current information is a) accurate and complete or b) the information was not created by SHR. If you disagree with the statement in the record, SHR will append/add your statement to the record; however, the original document will not be changed.

Inspection and Copies – Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes your own medical and billing records but does not include psychotherapy notes. Upon proof of an appropriate legal relationship, records of others related to you or under your care (guardian or custodial) may also be disclosed.

To inspect and copy your medical record, you must submit your request in writing to our privacy manager. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies (tapes, disks, etc.) associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that our Compliance Committee reviews the denial. Another licensed health care professional chosen by the Practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome and recommendations from that review.

The right to an Electronic Copy of Electronic Medical Records –  If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request if it is readily producible in such form or format. 

If the Protected Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

  • The right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment, and health care operations or for which you provided written authorization. To request this accounting, you must submit your request in writing. Your request must state a time period not longer than six (6) years back and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
  • The right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care (a family member or friend). For example, you could ask that we not use or disclose information about a particular treatment you received.

We are not required to agree to your request and we may not be able to comply with your request. If we do agree, we will comply with your request except that we shall not comply, even with a written request, if the information is exempted from the consent requirement or we are otherwise required to disclose the information by law.

To request restrictions, you must make your request in writing. In your request, you indicate:

  • what information you want to limit;
  • whether you want to limit our use, disclosure or both; and
  • to whom you want the limits to apply, (e.g., disclosures to your children, parents, spouse, etc.)

Right to restrict disclosure to a health plan. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or healthcare operations, and we will honor that request.

The right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail, that we do not leave a voicemail or e-mail, or the like. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish us to contact you.

The right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

Right to Get a Notice of a Breach. You have the right to be notified of a breach of any of your unsecured Protected Health Information.

If you have any questions regarding the information contained in this notice, please contact our privacy manager at (832) 717-1771.

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