Accredited by
The Joint Commission

Medical Records

The Health Information Management Department at Cypress Creek Hospital is dedicated to maintaining your medical records and keeping your health information private and secure in accordance with federal and state regulations. Information about your health is private and it should remain private. That is why Cypress Creek Hospital is required by federal and state law to protect and maintain the privacy of your health information. We call it “Protected Health

Information” (PHI). The basis for federal privacy protection is the Health Insurance Portability and Accountability Act (HIPAA) and its regulations, known as the “Privacy Rule” and “Security Rule” and other federal and state privacy laws.

Frequently Asked Questions for Medical Records related issues:

Q: How can I obtain a copy of my medical record?
Simply follow these steps:

  1. Download the Authorization to Release/Obtain Confidential Information form.

  2. Complete the authorization form (must be a patient or patient’s guardian/legal representative)

  3. Obtain a copy of picture ID.

  4. Mail, deliver or fax completed authorization form and copy of picture id to:

Cypress Creek Hospital
Attn: Medical Records Department
17750 Cali Drive
Houston, Texas 77090

Fax: 281.586.5923 

Once your records are processed, you will be notified of any fee’s and may pick them up in person at the location above or they can be mailed to your home address after payment is received. If you pick up your records in person, you will be required to present photo identification. You may send a representative to obtain your records only if they are listed on the authorization form under information to be used or disclosed by. It is required for your representative to provide a copy of your photo identification and provide their photo identification as well.

Q: Who do my medical records belong to?
Your medical record is the property of Cypress Creek Hospital and is kept by the hospital for patient care purposes. Although these records are maintained for your benefit, the physical records (paper or electronic) are the property of the hospital.

Q: Who may request medical records?
You may request copies of your own medical records, the medical records of a minor child, or the medical records of someone for whom you are the legal guardian or hold a Durable Power of Attorney for Healthcare. Proof of legal guardianship or a Durable Power of Attorney for Healthcare must be provided. A Durable Power of Attorney for Healthcare is only effective in the event a patient is unable to act on their own behalf and that has been determined by a physician. A spouse or child of a deceased patient can request the medical records of the deceased if he/she is the executor or administrator of the deceased patient's estate. Probate Court documents naming the requestor as the executor or administrator must be provided. Where there is no estate or an estate will not be probated, Probate Court documents releasing the estate from probate and naming the requestor as the personal representative must be provided.

Q: What is my health information used for?

A: For treatment. During the course of your treatment, we use and disclose your PHI.

For example, if we test your blood in our laboratory, a technician will share the report with your doctor. Or, we will use your PHI to follow the doctor’s orders for an x-ray, surgical procedure or other types of treatment related procedures.

  • The disclosure is for the purpose of carrying out payment or health care operations and is not required by law; and
  • The PHI pertains solely to a healthcare item or service that you, or someone else other than the health plan (insurer) has paid us for in full.

In other situations, we are not required to abide by your request. If we do agree to your request, we must abide by the agreement.

We may also use or disclose your PHI:

  • When required by law, for example when ordered by a court.
  • For public health activities including reporting a communicable disease or adverse drug reaction to the Food and Drug Administration.
  • To report neglect, abuse or domestic violence.
  • To government regulators or agents to determine compliance with applicable rules and regulations.
  • In judicial or administrative proceedings as in response to a valid subpoena.
  • To a coroner for purposes of identifying a deceased person or determining cause of death, or to a funeral director for making funeral arrangements.
  • For purposes of research when a research oversight committee, called an institutional review board, has determined that there is a minimal risk to the privacy of your PHI.
  • For creating special types of health information that eliminate all legally required identifying information or information that would directly identify the subject of the information.
  • In accordance with the legal requirements of a Workers’ Compensation program.
  • When properly requested by law enforcement officials, for instance in reporting gunshot wounds, reporting a suspicious death or for other legal requirements.
  •  If we reasonably believe that use or disclosure will avert a health hazard or to respond to a threat to public safety including an imminent crime against another person.
  • For national security purposes including to the Secret Service or if you are Armed Forces personnel and it is deemed necessary by appropriate military command authorities.
  •  In connection with certain types of organ donor programs.

Q: I need my medical records sent to a healthcare provider:

A:  Copies of medical records are provided to your physician at no charge for continuum of care. You will need to complete a written authorization form to have your medical records faxed or mailed to your provider. You will need to include the name, address and/or fax number of the healthcare provider in the appropriate section of the authorization form.

Pertinent information that will be disclosed to your health care provider for continuum of care will include, as applicable:

  • Face Sheet, Discharge Summary, History and Physical, Consultation(s), Operative Report(s), Pathology Report(s), and Diagnostic Test Results. (If specifically requested, Physical, Occupational, and Respiratory Therapy Reports may be considered pertinent.)
  • You may fax your request to 281.586.5923 

Q: I need to have my medical records sent to Social Security:

A: There is no charge for providing your records to Social Security Administration for disability claims. The record request for social security disability claims must be accompanied by a supporting letter from the Social Security Administration.

Q: I need to obtain a copy of my medical records for personal use:

A: There is a charge for obtaining copies of your record according to the number of pages reproduced and source of data, such as computer, microfilm or paper.

Q: How are these fees for obtaining medical records determined?
Fees are set by the State of Texas and are revised annually. If you have any questions, please contact the Texas Department of State Health Services, Facility Licensing Group, at 512-834-6648 or for additional information click on the following link: visit the State of Texas website.

Q: Can you provide me with billing statements from my hospital visit?
A: Your medical records do not contain billing statements. Our Business Office can provide you with this information. You will need to contact the Business Office t at 281-586-7600.

Q: Why am I unable to receive fax copies of my records at my home or office?
To protect our patient’s privacy, we do not fax or email medical records to patients.

Q: Can I receive any medical record information verbally?
The only information the HIM Department releases verbally is the patient’s date of admission.

Know Your Rights:

Your right to know who else sees your PHI:

You have the right to request an accounting of certain disclosures we have made of your PHI over the past six years, but not before April 14, 2003. We are not required to account for all disclosures, including those made to you, authorized by you or those involving treatment, payment and health care operations as described above. There is no charge for an annual accounting, but there may be charges for additional accountings. We will inform you if there is a charge and you have the right to withdraw your request, or pay to proceed.

Right to amend your PHI:

If you disagree with your PHI within our records, you have the right to request, in writing, that we amend your PHI when it is a record that we created or have maintained for us. We may refuse to make the amendment and you have a right to disagree in writing. If we still disagree, we may prepare a counter-statement. Your statement and our counter-statement must be made part of our record about you.

Right to confidential communication:

You have the right to receive confidential communications of PHI from the hospital at a location that you provide. Your request must be in writing, provide us with the other address and explain if the request will interfere with your method of payment.

Right to revoke authorization:

You may revoke, in writing, the authorization you granted us for use or disclosure of your PHI. However, if we have relied on your consent or authorization, we may use or disclose your PHI up to the time you revoke your consent.

Right to inspect and copy:

You have the right to inspect and copy your PHI (or to an electronic copy if the PHI is in an electronic medical record), if requested in writing. We may refuse to give you access to your PHI if we think it may cause you harm, but we must explain why and provide you with someone to contact for a review of our refusal.

Right to be notified of breach:

You have the right to be notified following a breach of unsecured PHI.

Right  to obtain a paper copy of this notice:

You have the right to obtain a paper copy of this notice upon request, even if you have agreed to receive the Notice electronically.

Cypress Creek Hospital accepts most major insurance plans, including Medicare, Medicaid and TRICARE®. Please call (281) 586-5956 for up-to-date insurance information.

Help Us Know You Better

Quality, accessibility and communication are keys to a successful treatment experience at our facility. We appreciate your referral to Cypress Creek Hospital and it is our intent to keep you informed about the status of your patient throughout the treatment process, subject to appropriate confidentiality standards. Success is always a team effort, and as a team, we are dedicated to a collaborative, highly communicative process with our referral and support network. We strive for inclusion and information sharing with referring professionals, the patient and their family members.

When you make a referral to our facility, please communicate that any pertinent clinical information. Additionally, communicate your relationship to the patient, so that our admissions team can appropriately ensure that you receive the feedback and the patient signs a release of information.

As always, if you have any feedback regarding our facility, please contact us.

Help is Just a Phone Call Away

We cannot offer diagnosis, counseling or recommendations online, but an Assessment and Referral Specialist is available 24 hours a day, 7 days a week at (281) 586-7600. If you are currently experiencing an emergency, please dial 911 or go to the nearest emergency room.


© Cypress Creek Hospital
17750 Cali Drive, Houston, Texas 77090
Physicians are on the medical staff of Cypress Creek Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Cypress Creek Hospital. The facility shall not be liable for actions or treatments provided by physicians.
Model representations of real patients are shown. Actual patients cannot be divulged due to HIPAA regulations.