To make an appointment call us at:
Tomball Office:       281-290-8188
South Loop Office: 713-808-9781
Bryan Office:         979-383-2074
Lufkin Office:        936-229-3621

Patient Policies and Procedures

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. This notice also reveals our policies and procedures regarding your financial obligations to the practice.  Please review it carefully. 

 

Our Pledge to You 

Everhealth is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with the Notice of our legal duties and privacy practices with respect to protected health information. Everhealth is required by law to abide by the terms of this Notice.  If you have any questions, please contact our Privacy Officer, whose contact information is listed further below on this page. 

 

Changes to this Notice 

We reserve the right to change the terms of this notice and to make new notice provisions effective for all protected health information (PHI) that we maintain.  We will provide you with a copy of any revisions of this Notice of Information Practices at the time of your next visit, or at your last known address if there is a need to use or disclose any PHI of the patient. Copies may also be obtained at any time at our offices. 

 

How We May Use and Disclose Medical Information about You            

We may use and disclose PHI for Treatment, Payment and healthcare Operations (TPO).  Examples of these include, but are not limited to: requested preschool, or sports physicals, referral to nursing homes, 

foster care homes, home health agencies and/or referral to other providers for treatment.  Payment examples include, but are not limited to: insurance companies for claims including coordination of benefits with other insurers and collection agencies.  Healthcare operations include, but are not limited to, internal quality control and assurance including auditing of records. We are permitted or required to use or disclose PHI  without your consent or authorization in certain circumstances.  Two examples are  public health requirements (community health surveillance or investigation) or court orders. We also may call your home or other designated location and leave a message on voice mail or in person in reference to any items that assist the practice in carrying out TPO, such as appointment reminders, insurance items and any call pertaining to your clinical care, including laboratory results among others.  We may mail any items that assist the practice in carrying out TPO, such as appointment reminders and other correspondence as long as they are marked Personal and Confidential. We may e-mail you appointment reminders and patient statements. 

 

Other Uses of Medical Information 

We will not make any other use or disclosure of your PHI without your  written authorization.  Such authorization may be revoked at any time.  Revocation must be written.  We will abide by the terms of this Notice currently in effect at the time of the disclosure. 

 

Your Rights Regarding Medical Information about You 

You, your guardian or personal representative  has the right to object to  the use of your health information for directory purposes.   You, your guardian or personal representative has the right to request to inspect and obtain copies of your medical record.   You, your guardian or personal representative has the right to request amendments be made to your 

medical record. You, your guardian or personal representative  has the right to request to receive confidential communications of PHI by alternative means or alternative locations.  Such request must be in writing 

and the practice must accommodate reasonable requests. You, your guardian or  personal representative  has the right to request restrictions as to how your health information may be used or disclosed to carry out TPO.  We are not required to agree to the restrictions requested, but if we do agree, we must abide by those restrictions 

 

 

Permission to Authorize Treatment 

You have a right to choose who may gain access to  your personal health information, billing and/or appointment record. The name of the person(s) you give permission to correspond with us regarding appointments, billing and insurance and medical treatment and to receive information about you must be on file at Everhealth.  In order to obtain information by telephone, the party calling the practice must share your identifier with the staff. 

 

Patient Financial Agreement

I agree it is my responsibility to provide Everhealth with the correct billing information and I consent to the payment of medical benefits to Everhealth and associated medical providers.  I hereby authorize Everhealth to release any medical information to insurance companies and appropriate third parties as determined by Everhealth.  A photocopy of these authorizations is to be considered as valid as the original until revoked by me in writing. Payment is due at the time of service.  I agree that I am financially responsible for all charges made to my account whether or not an insurance company, attorney, or other third party payer is involved with payment.  I am responsible for all payment amounts. If you are unable to keep a scheduled appointment, and fail to notify our office within 24 hours of your appointment, a $25.00 charge will be placed on your account.  Once this charge is incurred we will be unable to schedule any future appointments for you until the balance has been paid. 

 

Acknowledgment and Acceptance of Policies & Procedures

I acknowledge receipt and acceptance of the above stated polices and procedures of Everhealth. I also acknowledge that if I am not in agreement with the fore stated policies it is my responsibility to respond in writing within five (5) business days.   

 

Revised: November 2011

 

New Patient Links:

Frequently Asked Questions

Preparing for your First Visit

To make an appointment call us at:
Tomball Office:      281-290-8188
South Loop Office: 713-808-9781
Bryan Office:          979-383-2074
Lufkin Office:         936-229-3621