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Office Policies



Office Policies

  1. Prescription Policy
  2. Preventive Services Policy
  3. Notice of Privacy Policies


Patient's Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can gain access to this information. Please review this notice carefully.

This practice uses and discloses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of the care that you receive. This notice describes our privacy practices. You can request a copy of this notice at any time. For more information about this notice or our privacy practices and policies, please contact Fulshear Family Medicine.

Treatment, Payment, Healthcare Operations


We are permitted to use and disclose your medical information to those involved in your treatment. For example, your care may require the involvement of your primary care physician or another specialist. When we refer you to a specialist, we will share some or all of your medical information with that physician to facilitate the delivery of your care.


We are permitted to use and disclose your medical information to bill and collect payment for the services provided to you. For example, we may complete a claim form to obtain payment from your insurer or HMO. The form will contain medical information, such as a description of the medical services provided to you, that your insurer or HMO needs to approve payment.

Healthcare Operations

We are permitted to use or disclose your medical information for the purposes of healthcare operations, which are activities that support this practice and ensure that quality care is delivered. For example, we may engage the services of a professional to aid the practice in its compliance programs. This person will review billing and medical files to ensure that we maintain our compliance with regulations and the law.

Disclosures That Can Be Made Without Your Authorization

There are situations in which we are permitted by law to disclose or use your medical information without your written authorization or an opportunity to object. In other situations, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization in writing to stop future uses and disclosures. However, any revocation will not apply to disclosures or uses already made or taken in reliance on that authorization.

Public Health, Abuse or Neglect, and Health Oversight

We may disclose your medical information for public health activities. Public health activities are mandated by federal, state or local government for the collection of information about disease, vital statistics (such as birth and death) or injury by a public health authority. We may disclose medical information, if authorized by law, to a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. We may disclose your medical information to report reactions to medications, problems with products, or to notify people of recalls of products they may be using.

We may also disclose medical information to a public agency authorized to receive reports of child abuse or neglect. Texas law requires physicians to report child abuse or neglect. Regulations also permit the disclosure of information to report abuse or neglect of elders or the disabled.

We may disclose your medical information to a health oversight agency for those activities authorized by law. Examples of these activities are audits, investigations, licensure applications and inspections, which are all government activities undertaken to monitor the healthcare delivery system and compliance with other laws, such as civil rights laws.

Legal Proceedings and Law Enforcement

We may disclose your medical information in the course of judicial or administrative proceedings in response to an order of the court (or the administrative decision maker) or other appropriate legal process. Certain requirements must be met before the information is disclosed.

If asked by a law enforcement official, we may disclose your medical information under limited circumstances, provided that the information:

  • Is released pursuant to a legal process, such as a warrant or subpoena
  • Pertains to a victim of a crime and you are incapacitated
  • Pertains to a person who has died under circumstances that may be related to criminal conduct
  • Is about a victim of crime and we are unable to obtain the person's agreement
  • Is released because of a crime that has occurred on these premises
  • Is released to locate a fugitive, missing person, or suspect

We may also release information if we believe the disclosure is necessary to prevent or lessen an imminent threat to the health or safety of a person.

Worker's Compensation

We may disclose your medical information as required by the Texas Worker's Compensation Law.


If you are an inmate or under the custody of law enforcement, we may release your medical information to the correctional institution or law enforcement official. This release is permitted to allow the institution to provide you with medical care, to protect your health or the health and safety of others, or for the safety and security of the institution.

Military, National Security and Intelligence Activities, Protection of the President

We may disclose your medical information for specialized governmental functions, such as separation or discharge from military service, requests as necessary by appropriate military command officers (if you are in the military), authorized national security and intelligence activities, as well as authorized activities for the provision of protective services for the President of the United States, other authorized governmental officials or foreign heads of state.

Research, Organ Donation, Coroners, Medical Examiners and Funeral Directors

When a research project and its privacy protections have been approved by an Institutional Review Board or privacy board, we may release medical information to researchers for research purposes. We may release medical information to organ procurement organizations for the purpose of facilitating organ, eye or tissue donation if you are a donor. Also, we may release your medical information to a coroner or medical examiner to identify you when deceased or a cause of death. Further, we may release your medical information to a funeral director where such a disclosure is necessary for the director to carry out his/her duties.

Required by Law

We may release your medical information where the disclosure is required by law.

Your Rights Under Federal Privacy Regulations

The United States Department of Health and Human Services created regulations intended to protect patient privacy as required by the Health Insurance Portability and Accountability Act (HIPAA). Those regulations create several privileges that patients may exercise. We will not retaliate against a patient that exercises his or her HIPAA rights.

Requested Restrictions

You may request that we restrict or limit how your protected health information is used or disclosed for treatment, payment or healthcare operations. We do NOT have to agree to this restriction, but if we do agree, we will comply with your request except under emergency circumstances.

To request a restriction, submit the following in writing:
(a) the information to be restricted,
(b) what kind of restriction you are requesting, i.e., on the use of information, disclosure of information or both, and
(c) to whom the limits apply. Please send this request to Fulshear Family Medicine.

You may also request that we limit disclosure to family members, other relatives or close personal friends that may or may not be involved in your care.

Receiving Confidential Communication by Alternative Means

You may request that we send communications of protected health information by alternative means or to an alternative location. This request must be made in writing to Fulshear Family Medicine. We are required to accommodate only reasonable requests. Please specify exactly how you want us to communicate with you and/or the alternative contact/address information.

Inspection and Copies of Protected Health Information

You may inspect and/or copy health information that is within the designated record set, which is information that is used to make decisions about your care. Texas law requires that requests for copies be made in writing, and we ask that requests for inspection of your health information also be made in writing. Please send these requests to Fulshear Family Medicine.

We can refuse to provide some of the information you ask to inspect or ask to be copied if the information:

  • Includes psychotherapy notes
  • Includes the identity of a person who provided information if it was obtained under a promise of confidentiality
  • Is subject to the Clinical Laboratory Improvements Amendments of 1988
  • Has been compiled in anticipation of litigation

We can refuse to provide access to or copies of some information for other reasons, provided that we give a review of our decision on your request. Another licensed healthcare provider who was not involved in the prior decision to deny access will conduct that review.

Texas law requires that we are ready to provide copies or a narrative within 15 days of your request. We will inform you of when the records are ready or if we believe access should be limited. If we deny access, we will inform you in writing.

HIPAA permits us to charge a reasonable cost-based fee. The Texas State Board of Medical Examiners (TSBME) has set limits on fees for copies of medical records that under some circumstances may be lower than the charges permitted by HIPAA. In any event, the lower of the two fees will be charged.

Amendment of Medical Information

You may request an amendment of your medical information in the designated record set. Any such request must be made in writing to Fulshear Family Medicine. We will respond within 60 days of your request. We may refuse to allow an amendment if the information:

  • Wasn't created by this practice or the physicians in the practice
  • Is not part of the designated record set
  • Is not available for inspection because of an appropriate denial
  • Is accurate and complete

Even if we refuse to allow an amendment, you are permitted to include a patient statement about the information in your medical record. If we refuse to allow an amendment, we will inform you in writing. If we approve the amendment, we will inform you in writing, allow the amendment to be made, and inform others that we know have the incorrect information.

Accounting of Certain Disclosures

The HIPAA privacy regulations permit you to request, and us to provide, an accounting of disclosures that are other than for treatment, payment, healthcare operations, or made via an authorization signed by you or your representative. Please submit any request for an account to Fulshear Family Medicine. Your accounting of the disclosures within a 12-month period will be free. For additional requests within that period, we are permitted to charge for the cost of providing the list. If there is a charge, we will notify you and you may choose to withdraw or modify your request before any costs are incurred.

Appointment Reminders, Treatment Alternatives and Other Health-Related Benefits

We may contact you by telephone, mail, email or all of these methods to remind you of appointments or provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.