17189 I-45 South, Suite 235
The Woodlands, TX 77385
www.overthemoonpeds.com
Privacy Officer: Michelle Suhendra, MD
(832) 539-7532
When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
Ask us to correct your medical record
Request confidential communications
Ask us to limit what
we use or share
— We are not required to agree to your request, and we may say “no” if it would affect your care.
— We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you feel your rights are violated
For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
In the case of fundraising:
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run your organization
Example: We use health information about you to manage your treatment and services.
Bill for your services
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share
your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
Do research
Comply with the law
Respond to organ and tissue donation requests
Work with a medical examiner or funeral director
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
Respond to lawsuits and legal actions
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of
your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
•
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
Get an electronic or paper copy of your medical record
Ask us to correct your medical record
Request confidential communications
Ask us to limit what
we use or share
— We are not required to agree to your request, and we may say “no” if it would affect your care.
— We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you feel your rights are violated
Effective Date: 11/02/2020
Privacy Officer: Michelle Suhendra, MD
hello@overthemoonpeds.com
(832) 539-7532
OFFICE ADDRESS
HOURS OF OPERATION
By Appointment Only
TELEPHONE + FAX
EMAIL (please do not use for medical questions)
A leading professional pediatric company.
Serving The Woodlands, TX, Houston and beyond.
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Monday to Friday
8:30am - 5:00pm
Saturday
Closed
Sunday
Closed
Woodlands TX 77385, and surrounding areas including
Woodlands: 77380, 77381, 77382, 77384, 77385, 77354, 77375, 77389
Spring: 77396, 77373, 77379, 77386, 77387, 77388, 77391, 77393
Conroe: 77301, 77302, 77303, 77304, 77305, 77316, 77318, 77356, 77384, 77385
Magnolia: 77354, 77355
Tomball: 77375, 77377
Humble: 77338, 77347, 77396