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132 Hospital Drive Angleton, Texas 77515 Notice of Privacy Practice Under the Federal & State Law, your medical information is protected and confidential. This information is obtained from applications for health care coverage, surveys, claims for payment filed by health care providers, referrals made by health care providers and your medical records. Other sources of medical information include group health plan administrators, employers and business partners such as third-party administrators, consultants and other entities engaged in obtaining healthcare information. Consent: Your written consent to obtain, use and disclose your medical information for the purpose of routine treatment, payment, and healthcare operations will be obtained prior to any disclosure. Your medical information may be disclosed to any healthcare provider(s) that is personally involved in your care at the hospital. Healthcare Operations: Your medical information bay be used and disclosed for the purpose of quality review assessments, audits, business planning, legal services or administrative services. We may disclose medical information to any Business Associate that we have contracted with to perform the agreed service(s); however, a Business Associate Agreement shall be signed prior to any review of this information, which will include the specific qualification of the use of the record. Your Rights: Your health record is the physical property of the hospital you have the following rights for your health information:  Review and Copy of your medical information maybe reviewed upon written request. However, we may deny your request based on Federal & State Law.A copy fee may be charged for copies of your health information based on the approved AMA copy fees.Request for amendments include a written reason for the requested as well as any medical or billing information you feel is incorrect or incomplete. This request can be denied by the hospital, however notification will be provided at that time.Request of all disclosures made by the hospital can be provided based on the written request of the patient. This information maybe for a period of 6 years from the date of the request and may not include dates prior to April 14, 2003.Disclosure Restrictions may be made in writing restricting all medical information from being disclosed. This request maybe denied by the hospital.Confidential Communication – you have the right to request that communication regarding your medical information be communicated with you about medical matters in a certain way or at a certain location. This request must be in writing.Revoke – you have the right to revoke your authorization.Compliance: If you have any concerns that your privacy rights have been violated, you may file a complaint with the hospital by contacting the Privacy Officer or with the U.S. Department of Health and Human Services. All complaints must be in writing. Privacy Practices: We reserve the right to change this notice and the revised or changed notice and practices based on Federal and State Laws governing a patient’s privacy practice. Privacy policies and procedures have been developed to ensure the privacy of your medical information. Procedures are based on appropriate, administrative technical and physical safeguards necessary to maintain confidentiality of medical information. Psychiatric information is limited to those individuals that have a legitimate business need for that information. |
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| 132 E. Hospital Drive Angleton, Texas 77515 (979) 849-7721 | |||||||||
