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Patient Privacy

Notice of Privacy Practices: Effective 05/31/2020

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. Changes on This Notice Will Not Be Honored. You will be asked to acknowledge that you have received our Notice of Privacy Practices.

We understand that information about you and your health is very personal. Therefore, we strive to protect your privacy as required by law. We will only use and disclose your protected health information (“PHI”) as allowed by law.

We are committed to providing quality compassionate healthcare. We train our entire staff to be sensitive about privacy and to respect the confidentiality of your PHI.

We are required by law to maintain the privacy of our patients’ PHI and to provide you with notice of our legal duties and privacy practices with respect to your PHI. We are required to abide by the terms of this Notice (“Notice”) so long as it remains in effect. We reserve the right to change the terms of this Notice as necessary and to make the new Notice effective for all PHI maintained by us. You may receive a copy of any revised notice at any of our offices.

 The terms of this Notice apply to Bay Colony Pediatrics, and its physicians, nurse practitioners, licensed professionals, employees, interns, and trainees seeing and treating patients at Bay Colony Pediatrics offices. If you have questions regarding the coverage of this Notice, or if you would like to obtain a copy of this Notice, please contact our office, as described below.


The following categories describe the ways we may use or disclose your PHI without your consent or authorization. For each category, we will give you illustrative examples.

Uses and Disclosures for Treatment, Payment and Health Care Operations.

Treatment: We use and disclose your PHI as necessary for your treatment. For example, a doctor treating you for an injury asks another doctor about your overall health condition.

 Payment: We will make uses and disclosures of your PHI as necessary for payment purposes. For example, we give information about you to your health insurance plan to arrange payment for services provided to you.

Health Care Operations: We will use and disclose your PHI for health care operations. For example, we use health information about you to manage your treatment and services.

Health Information Exchanges: Bay Colony Pediatrics may participates in initiatives to facilitate this electronic sharing, including but not limited to Health Information Exchanges (HIEs) which involve coordinated information sharing among HIE members for purposes of treatment, payment, and healthcare operations. Patients may opt-out of some of these electronic sharing initiatives, such as HIEs. Bay Colony Pediatrics will use reasonable efforts to limit the sharing of PHI in such electronic sharing initiatives for patients who have opted out. If you wish to opt-out, please contact the Privacy Official as described below.

Persons Involved In Your Care. Unless you object, we may, in our professional judgment, disclose to a member of your family, a close friend, or any other person you identify, your PHI, to facilitate that person’s involvement in caring for you or in payment for your care. We may use or disclose your PHI to assist in notifying a family member, personal representative or any other person that is responsible for your care of your location and general condition. We may also disclose limited PHI to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

Appointments and Services. We may use your PHI to remind you about appointments or to follow up on your visit.

Health Products and Services. We may, from time to time, use your PHI to communicate with you about treatment alternatives and other health-related benefits and services that may be of interest to you.

Research. We may use and disclose your PHI, including PHI generated for use in a research study, as permitted by law for research, subject to your explicit authorization and/or oversight by an Institutional Review Board (IRB), committees charged with protecting the privacy rights and safety of human subject research, or a similar committee. In all cases where your specific authorization has not been obtained, your privacy will be protected by confidentiality requirements evaluated by such a committee. For example, the IRB may approve the use of your health information with only limited identifying information to conduct outcomes research to see if a particular procedure is effective.

Business Associates. We contract with certain outside persons or organizations to perform certain services on our behalf, such as auditing, accreditation, information technology services, etc. At times it may be necessary for us to provide your PHI to one or more of these outside persons or organizations. In such cases, we require these business associates, and any of their subcontractors, to appropriately safeguard the privacy of your information.

Other Uses and Disclosures. We are permitted or required by law to make certain other uses and disclosures of your PHI without your consent or authorization. Subject to conditions specified by law, we may release your PHI:

  • for any purpose required by law;

  • for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations;

  • to certain governmental agencies if we suspect child abuse or neglect; or if we believe you to be a victim of abuse, neglect, or domestic violence;

  • to entities regulated by the Food and Drug Administration, if necessary, to report adverse events, product defects, or to participate in product recalls;

  • to your employer when we have provided health care to you at the request of your employer for purposes related to occupational health and safety. In most cases you will receive notice that your PHI is being disclosed to your employer;

  • if required by law to a government oversight agency conducting audits, investigations, inspections and related oversight functions;

  • in emergency circumstances, such as to prevent a serious and imminent threat to a person or the public;

  • if required to do so by a court or administrative order, subpoena or discovery request. In most cases you will have notice of such release;

  • to law enforcement officials, including for purposes of identifying or locating suspects, fugitives, witnesses, or victims of crime, or for other allowable law enforcement purposes;

  • to coroners, medical examiners, and/or funeral directors;

  •  if necessary, to arrange an organ or tissue donation from you or a transplant for you;

  •  if you are a member of the military for activities set out by certain military command authorities as required by armed forces services. We may also release your PHI, if necessary, for national security, intelligence, or protective services activities; and

  • if necessary for purposes related to your workers' compensation benefits.

Your Authorization. Except as outlined above, we will not use or disclose your PHI for any other purpose unless you have signed a form authorizing the use or disclosure. The form will describe what information will be disclosed, to whom, for what purpose, and when. You have the right to revoke your authorization in writing, except to the extent we have already relied upon it. These situations can include:

  •  uses and disclosures of psychotherapy notes;

  • uses and disclosures of PHI for marketing purposes, including marketing communications paid for by third parties;

  • uses and disclosures of PHI specially protected by state and/or Federal law and regulations;

  • uses and disclosures for certain research protocols;

  • disclosures that constitute a sale of PHI.

Confidentiality of Alcohol and Drug Abuse Patient Records, HIV-Related Information, and Mental Health Records. The confidentiality of alcohol and drug abuse treatment records, HIV related information, and mental health records maintained by us is specifically protected by the State of Texas and/or Federal law and regulations. Generally, we may not disclose such information unless you consent in writing, the disclosure is allowed by a court order, or in limited and regulated other circumstances.




Access to Your PHI. Generally, you have the right to access, inspect, and/or receive paper and/or electronic copies of the PHI that we maintain about you. Requests for access must be made in writing and be signed by you or, when applicable, your personal representative. We may charge you for a copy of your medical records in accordance with a schedule of fees under federal and state law. You may obtain the appropriate form from our office. You may also access much of your health information using the patient portal.


Amendments to Your PHI. You have the right to request that PHI that we maintain about you be amended or corrected. Requests for amendment must be made in writing and be signed by you or, when applicable, your personal representative and must state the reasons for the amendment/correction request. We are not obligated to make all requested amendments but will give each request careful consideration. If we grant your amendment request, we may also reach out to other prior recipients of your information to inform them of the change. Please note that even if we accept your request, we may not delete any information already documented in your medical record.


Accounting for Disclosures of Your PHI. You have the right to receive an accounting of certain disclosures made by us of your PHI except for disclosures made for purposes of treatment, payment, and health care operations or for certain other limited exceptions. This accounting will include only those disclosures made in the six years prior to the date on which the accounting is requested. Requests must be made in writing and signed by you or, when applicable, your personal representative. The first accounting in any 12- month period is free; you will be charged a reasonable, cost-based fee for each subsequent accounting you request within a 12-month period.

Restrictions on Use and Disclosure of Your PHI. You have the right to request restrictions on certain uses and disclosures of your PHI for treatment, payment, or health care operations. We are not required to agree to your restriction request, unless otherwise described in this notice, but will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event we have terminated an agreed upon restriction, we will notify you of such termination. Such requests must be made in writing and signed by you and, when applicable, your personal representative.

Restrictions on Disclosures to Health Plans. You have the right to request a restriction on certain disclosures of your PHI to your health plan. We are only required to honor such requests for restriction when you or someone on your behalf, other than your health plan, pay for the health care item(s) or service(s) in full. Such requests must be made in writing and signed by you and, when applicable, your personal representative.

Confidential Communications. You have the right to request communications regarding your PHI from us by alternative means or at alternative locations and we will accommodate reasonable requests by you. You, or when applicable, your personal representative must request such confidential communication in writing to each department to which you would like the request to apply.

Breach Notification. We are required to notify you in writing of any breach of your unsecured PHI without unreasonable delay, but in any event, no later than 60 days after we discover the breach.

Paper Copy of Notice. As a patient, you have the right to obtain a paper copy of this Notice. You can also find this Notice on our website at


Complaints. If you believe your privacy rights have been violated, you may file a complaint in writing with the Privacy Official at the address below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C. All complaints must be made in writing and in no way will affect the quality of care you receive from us.

For further information. If you have questions or wish to exercise any choices described in this Notice, you may contact us by mail, telephone, or by email:

Bay Colony Pediatrics

Attention: S. Ramchandra

2251 FM646, Suite 155

Dickinson, TX

Telephone 281-614-2445

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