Human Resources Department
Our Privacy Commitment
The City of Houston self-insured medical group health plans (the Plans) are designed to protect the privacy of your health information. On this page, you can access the Privacy Notice, as well as the forms regarding your access to and control of the handling of your Protected Health Information (PHI).
PHI includes any information regarding your health care and treatment, that is personally identifiable to you, and that is transmitted or maintained by the Plans, regardless of the form (oral, written, electronic). This includes information and identifiable factors such as your name, age, and address.
Please retrieve the Privacy Notice, review it carefully, and keep a copy for your records. If you are unable to access the Privacy Notice for any reason, or prefer that a hard copy to be mailed to you.
Documents and Forms
- Notice of Privacy Practices (pdf)
- Notice of Privacy Practices - Spanish (pdf)
- HIPAA Personal Representative Request (pdf)
- HIPAA Request for Accounting (pdf)
- HIPAA Request for Confidential Information (pdf)
- HIPAA Request Not to Disclose PHI (pdf)
- HIPAA Request to Correct or Amend Record (pdf)
- HIPAA Request to Inspect PHI (pdf)
Forms should be submitted to the Privacy Officer at PrivacyOfficer@houstontx.gov, and can also be faxed to 713.837.9486, or mailed to:
City of Houston Human Resources Department
611 Walker, 4th Floor
Houston, Texas 77002