THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
Clover Family and Psychiatry Clinic is committed to protecting the privacy of your medical information. This Notice of Privacy Practices explains how we may use and disclose your protected health information (PHI), your rights regarding that information, and our legal responsibilities.
Protected health information includes information that identifies you and relates to your physical or mental health, healthcare services, or payment for those services.
How We May Use and Disclose Your Health Information
- Treatment – We may use and share your health information to provide, coordinate, or manage your healthcare and related services. This may include sharing information with other healthcare providers involved in your care.
- Payment –We may use and disclose your health information to bill and receive payment from health plans, insurance companies, or other payers for services provided to you.
- Healthcare Operations – We may use your health information for clinic operations such as quality assessment, staff training, licensing, audits, and general business management.
Other Permitted Uses and Disclosures
We may also use or disclose your health information in the following situations, as allowed or required by law:
- Public health activities
- Health oversight activities
- Law enforcement purposes
- Judicial or administrative proceedings
- To prevent a serious threat to health or safety
- As required by federal, state, or local law
Uses and Disclosures Requiring Your Authorization
We will not use or disclose your health information for purposes outside those described in this Notice without your written authorization. You may revoke your authorization at any time in writing, except to the extent we have already acted upon it.
Your Rights Regarding Your Health Information
You have the right to:
- Request access to your medical records
- Request corrections to your health information
- Request restrictions on certain uses or disclosures
- Request confidential communications (e.g., alternative mailing address or phone number)
- Receive a list of disclosures of your health information
- Receive a paper copy of this Notice at any time
To exercise any of these rights, please contact our office using the information below.
Our Responsibilities
We are required by law to:
- Maintain the privacy and security of your protected health information
- Provide you with this Notice of Privacy Practices
- Follow the terms of this Notice
- Notify you promptly if a breach occurs that may compromise your information
Changes to This Notice
We reserve the right to change this Notice at any time. Any changes will apply to all health information we maintain. Updated versions will be available in our office and on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Clover Family and Psychiatry Clinic
8035 West Airport Blvd, Suite 119
Houston, TX 77071
📞 Phone: 346-502-3406
📧 Email: info@cloverfamilyclinic.com
You may also file a complaint with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
Contact Information
If you have questions about this Notice or your privacy rights, please contact:
Clover Family and Psychiatry Clinic
📞 Phone: 346-502-3406
📠 Fax: 346-502-3462
📧 Email: info@cloverfamilyclinic.com
