This notice is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Please review it carefully.
Our Commitment to Your Privacy
The practice of Ilyas K. Colombowala, MD, FACC, FHRS ("we," "us," or "our") is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI), provide you with this notice of our legal duties and privacy practices, and follow the terms of this notice currently in effect. Protected health information is information about you — including demographic data — that may identify you and relates to your past, present, or future physical or mental health condition, the provision of health care to you, or the payment for that health care.
How We May Use and Disclose Your Health Information
The following describes the ways we may use and disclose your health information. Not every use or disclosure will be listed; however, all uses and disclosures will fall within one of the categories described below.
Treatment
We may use and disclose your health information to provide, coordinate, or manage your health care and related services. This includes sharing information with other physicians, nurses, technicians, medical students, or other personnel who are involved in your care. For example, we may share your health information with a referring physician, a consulting specialist, a hospital, a laboratory, or a pharmacy.
Payment
We may use and disclose your health information for billing and collection activities and to obtain payment for the health care services we provide to you. For example, we may share information with your health insurance plan to obtain prior authorization for a procedure or to determine whether your plan will cover a proposed treatment. We may also share information with billing and collections entities.
Health Care Operations
We may use and disclose your health information for our internal health care operations. These activities include, but are not limited to, quality assessment and improvement, employee review activities, training of medical students, licensing and credentialing, and conducting or arranging for other business activities.
Appointment Reminders and Health-Related Communications
We may use your health information to contact you to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services that may be of interest to you.
Family Members and Close Friends
We may disclose your health information to a family member, close friend, or other person you identify as being involved in your care or payment for your care. We may also disclose information about you to an entity assisting in a disaster relief effort. If you are present and able, we will give you the opportunity to object to such disclosures. If you are not present or are unable to object, we will use our professional judgment to determine whether the disclosure is in your best interest.
As Required by Law
We will disclose your health information when required to do so by federal, state, or local law.
Special Situations
We may also use or disclose your health information in the following circumstances:
- Public Health Activities: Reporting diseases, injuries, births, deaths, and other matters as required by public health authorities
- Abuse or Neglect: Reporting known or suspected abuse, neglect, or domestic violence to government authorities as permitted or required by law
- Health Oversight Activities: Disclosures to health oversight agencies for activities authorized by law, including audits, investigations, and inspections
- Judicial and Administrative Proceedings: In response to a court order, subpoena, discovery request, or other lawful process
- Law Enforcement: For law enforcement purposes as permitted or required by law, such as reporting certain types of wounds, identifying or locating a suspect or missing person, or reporting a crime on our premises
- Coroners, Medical Examiners, and Funeral Directors: For identification purposes, determining cause of death, or as otherwise necessary for them to carry out their duties
- Organ and Tissue Donation: To organizations that handle organ procurement or transplantation, if you are an organ donor
- Research: Under certain circumstances, and subject to approval by an institutional review board or privacy board, for research purposes
- Threats to Health or Safety: To prevent or lessen a serious and imminent threat to the health or safety of a person or the public
- Workers' Compensation: As authorized by and necessary to comply with workers' compensation laws
- Military and Veterans: As required by military command authorities, if you are a member of the armed forces
- National Security and Protective Services: For intelligence, counterintelligence, and other national security activities, or for the protection of the President or other authorized persons
- Correctional Institutions: If you are an inmate of a correctional institution, we may disclose health information necessary for your health care, the health and safety of others, or the safety of the institution
Uses and Disclosures Requiring Your Written Authorization
Except as described above, we will not use or disclose your health information without your written authorization. Uses and disclosures not described in this notice will be made only with your written authorization. You may revoke your authorization at any time, in writing, except to the extent that we have already taken action in reliance on your authorization. Specifically, we are required to obtain your written authorization for the following:
- Most uses and disclosures of psychotherapy notes, if maintained
- Uses and disclosures of your health information for marketing purposes
- Disclosures that constitute a sale of your health information
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your health information that we maintain in our records, including medical and billing records. You must submit your request in writing to our office. We may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request in certain limited circumstances; if we do, you may request a review of the denial.
Right to Request Amendment
If you feel that health information we maintain about you is incorrect or incomplete, you may ask us to amend the information. You must submit your request in writing and provide a reason for the amendment. We may deny your request if we did not create the information, if the information is not part of the records we maintain, if the information is not available for inspection, or if the information is already accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an accounting of certain disclosures we have made of your health information. This accounting will not include disclosures made for treatment, payment, or health care operations, or disclosures you authorized in writing. Your request must be submitted in writing and specify a time period of no longer than six years prior to the date of your request.
Right to Request Restrictions
You have the right to request a restriction on the health information we use or disclose about you for treatment, payment, or health care operations. You may also request a limit on the information we disclose to someone involved in your care or the payment for your care. We are not required to agree to your request, except in the case where the disclosure is to a health plan for purposes of payment or health care operations, and the information pertains solely to a health care item or service for which you have paid in full out of pocket.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we contact you only at your work address or via a specific phone number. Your request must be made in writing and must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice
You are entitled to receive a paper copy of this Notice of Privacy Practices at any time. You may ask us to give you a copy of this notice by contacting our office.
Right to Be Notified of a Breach
You have the right to be notified in the event that we discover a breach of your unsecured protected health information. We will provide notification as required by law.
Changes to This Notice
We reserve the right to change the terms of this notice and to make the revised notice effective for all health information we already have about you, as well as any information we receive in the future. We will post a copy of the current notice on our website and in our office. The notice will contain the effective date on the first page.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services Office for Civil Rights. To file a complaint with our office, contact us using the information below. To file a complaint with the Office for Civil Rights, visit www.hhs.gov/ocr/privacy/hipaa/complaints or call 1-877-696-6775.
You will not be penalized or retaliated against for filing a complaint.
Contact Us
For questions about this notice, to request a copy of this notice, or to exercise any of the rights described above, please contact our Privacy Officer at:
Ilyas K. Colombowala, MD, FACC, FHRS
13325 Hargrave Rd, Suite 280
Houston, TX 77070
Phone: (832) 478-5067