Access: You have the right to review and receive a copy of your medical information used to make decisions about your care, with limited exceptions. The medical information generally includes medical and billing records but not psychotherapy notes or information created for the purposes of use in civil, criminal, or administrative proceedings. There may be a fee for the cost of copying, mailing or other supplies related to your request.
You may request that we provide copies in a format other than paper copies. We will provide the format you request unless we cannot practicably do so. If we maintain your medical information in an electronic format, we will provide you with the requested information in an electronic format unless otherwise requested by you. To make a written request to obtain access to your medical information, you may obtain a form to request access or a copy of your medical information from the memorialhermann.org web page and mail the completed form to 920 Frostwood Suite 1.103, Houston, TX 77024 or make a request through the My Memorial Hermann patient portal.
If you are denied access to review or receive a copy, you may request that denial be reviewed. The licensed healthcare professional conducting the review will be chosen by Memorial Hermann. The licensed healthcare professional conducting the review will not be the person denying your request.
Accounting of Disclosures: You have the right to receive list of disclosures of your medical information covering six (6) years prior to the date you asked. We will include disclosures except those authorized by you or those made for treatment, payment, or health care operations purposes. You must request this accounting in writing. We will provide one accounting of disclosures per year for free but may charge a reasonable, cost-based fee for additional accountings within 12 months.
You may obtain the Accounting of Disclosure form on the memorialhermann.org web page and mail the completed form to 920 Frostwood Suite 1.103, Houston TX 77024.
Restrictions: You have the right to request that we place restrictions on our use or disclosure of your medical information. We are not required to agree to these restrictions; however, we will agree to your request not to disclose your medical information to a health plan for a particular item or service if the disclosure is to be made for payment or health care operation purposes and is not otherwise required by law, and you have paid for the item or service in full. If we agree to your restriction request, we will abide by our agreement (except in an emergency). You must make this request in writing.
Confidential Communications: You have the right to request that we communicate with you about your medical information by alternative means or to alternative locations. You must make your request in writing. We must accommodate your request if: it is reasonable; specifies the alternative means or location; and provides a satisfactory explanation of how payments will be handled under the alternative means or location you request.
Amendment: You have the right to request that we amend your medical information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the information, the information is accurate and complete, is not part of the designated record set, or for certain other reasons (e.g., psychotherapy notes and other information that would not be considered to be a part of your medical record). If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be appended to the information you want amended. If we accept your request to amend the information, we will make reasonable efforts to inform others; (including people you name) of the amendment and to include the changes in any future disclosures of that information.
Electronic Notice: If you view this Joint Notice on our web site or by electronic mail (e-mail), you are also entitled to receive a copy of this Joint Notice in written form. Please ask for a written copy at the time of your visit or by contacting us as listed in the Questions or Concerns section of this Joint Notice.
Notice of a Breach: If there is a breach involving the privacy or security of your unsecured medical information, we will notify you, the Office for Civil Rights and other enforcement agencies, as necessary and appropriate. We will take steps to address the issue and mitigate any damages that the breach may have caused.