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Medical Records

Medical Records

Cypress Creek Hospital securely maintains medical records in accordance with federal and state regulations. Your health information is private, which is why 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 about Medical Records:

Simply follow these steps:

  • Download the Authorization to Release/Obtain Confidential Information form.
  • Complete the authorization form (must be a patient or patient’s guardian/legal representative).
  • Obtain a copy of your photo ID.
  • Mail, deliver, or fax the completed authorization form and a copy of the photo 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 fees and may then pick up a copy of your medical records in person at the hospital or have them mailed to your home address after payment is received. If you pick up your records in person, you will be required to present your photo ID. 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.” Your representative must provide a copy of both their and your photo ID.

Your medical records are the property of Cypress Creek Hospital and are 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.

You may request copies of the medical records of yourself, your minor child, or 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 if a physician determines the patient is unable to act on their own behalf.

A spouse or child can request the medical records of a deceased patient if he or 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. If 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.

We use and disclose your PHI during treatment. For example: if we test your blood, a laboratory technician will share the report with your doctor. We also use PHI to follow doctor orders for x-rays, surgical procedures, and other treatment-related procedures.

Disclosures are used to carry out payment and health care operations and are not required by law. The PHI pertains solely to a healthcare item or service that you or someone else other than the health plan (insurer) has paid in full. In other situations, we are not required to abide by your request. If we 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 such as 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 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 public safety threat 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.

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 must 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, occcupational, and respiratory therapy reports may be considered pertinent.
  • You may fax your request to 281-586-5923.

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.

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.

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.

Your medical records do not contain billing statements. Our business office can provide you with this information at 281-586-7600.

To protect our patient’s privacy, we do not fax or email medical records to patients.

The only information the HIM Department releases verbally is the patient’s date of admission.

Know Your Rights

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.

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. 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.

You have the right to receive confidential communications of PHI from the hospital at a location 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.

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.

You have the right to inspect and copy your PHI (or 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.

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

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

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.