(702) 369-0200 Appointment Request

Victoria Eye Center, PA, Victoria Surgery Center, Inc.,
Victoria Vision Center, LLC
NOTICE OF PRIVACY PRACTICES
Effective September, 2013
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION
PLEASE READ IT CAREFULLY
The Health Insurance Portability & Accountability Act of
1996 (“HIPAA”) is a Federal program that requests that all
medical records and other individually identifiable health
information used or disclosed by us in any form, whether
electronically, on paper, or orally are kept properly confidential.
This Act gives you, the patient, the right to understand and
control how your personal health information (“PHI”) is used.
HIPAA provides penalties for covered entities that misuse
personal health information.
As required by HIPAA, we prepared this explanation of how
we are to maintain the privacy of your health information and
how we may disclose your personal information.
We may use and disclose your medical records only for each
of the following purposes: treatment, payment and health care
operation.
 Treatment means providing, coordinating, or managing
health care and related services by one or more
healthcare providers. An example of this would include
referring you to a retina specialist.
 Payment means such activities as obtaining
reimbursement for services, confirming coverage,
billing or collections activities, and utilization review.
An example of this would include sending your
insurance company a bill for your visit and/or verifying
coverage prior to a surgery.
 Health Care Operations include business aspects of
running our practice, such as conducting quality
assessments and improving activities, auditing
functions, cost management analysis, and customer
service. An example of this would be new patient
survey cards.
 The practice may also disclose your PHI for law
enforcement and other legitimate reasons although we
shall do our best to assure its continued confidentiality
to the extent possible.
We may also create and distribute de-identified health
information by removing all reference to individually identifiable
information.
We may contact you, by phone or in writing, to provide
appointment reminders or information about treatment
alternatives or other health-related benefits and services, in
addition to other fundraising communications, that may be of
interest to you. You do have the right to “opt out” with respect to
receiving fundraising communications from us.
The following use and disclosures of PHI will only be made
pursuant to us receiving a written authorization from you:
 Most uses and disclosure of psychotherapy notes;
 Uses and disclosure of your PHI for marketing
purposes, including subsidized treatment and health care
operations;
 Disclosures that constitute a sale of PHI under HIPAA;
and
 Other uses and disclosures not described in this notice.
You may revoke such authorization in writing and we are
required to honor and abide by that written request, except to the
extent that we have already taken actions relying on your
authorization.
You may have the following rights with respect to your PHI.
 The right to request restrictions on certain uses and
disclosures of PHI, including those related to disclosures
of family members, other relatives, close personal
friends, or any other person identified by you. We are,
however, not required to honor a request restriction
except in limited circumstances which we shall explain
if you ask. If we do agree to the restriction, we must
abide by it unless you agree in writing to remove it.
 The right to reasonable requests to receive confidential
communications of Protected Health Information by
alterative means or at alternative locations.
 The right to inspect and copy your PHI. A fee may be
associated.
 The right to amend your PHI.
 The right to receive an accounting of disclosures of your
PHI.
 The right to obtain a paper copy of this notice from us
upon request.
 The right to be advised if your unprotected PHI is
intentionally or unintentionally disclosed.
If you have paid for services “out of pocket”, in full, and you
request that we not disclose PHI related solely to those services to
a health plan, we will accommodate your request, except where
we are required by law to make a disclosure.
We are required by law to maintain the privacy of your
Protected Health Information and to provide you the notice of our
legal duties and our privacy practice with respect to PHI.
This notice if effective as of September, 2013 and it is our
intention to abide by the terms of the Notice of Privacy Practices
and HIPAA Regulations currently in effect. We reserve the right
to change the terms of our Notice of Privacy Practice and to make
the new notice provision effective for all PHI that we maintain.
We will post and you may request a written copy of the revised
Notice of Privacy Practice from our office.
You have recourse if you feel that your protections have
been violated by our office. You have the right to file a formal,
written complaint with office and with the Department of Health
and Human Services, Office of Civil Rights. We will not retaliate
against you for filing a complaint.
Feel free to contact the Practice Compliance Officer for more
information, in person or in writing.
Phone: (361) 578-0234 or 1-800-833-0234
Victoria Eye Center, PA * 107 James Coleman Dr.
Victoria, TX 77904
Victoria Surgery Center, Inc. * 105 James Coleman Dr.
Victoria, TX 77904
Victoria Vision Center, LLC * 107 James Coleman Dr.
Victoria, TX 77904

If you have a general question or would like to
request an appointment, please use our online
form, or call us at (361) 578-0234.

Privacy Policy
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