Notice of Privacy Practices
TSO Custer Creek
3501 Custer Pkwy, Suite 105, Richardson, Texas, 75080.
Phone: 469-929-2900. https://www.custercreektso.com
Valenta Carter O.D.
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. If you have any questions please contact our office.
NOTICE OF PRIVACY PRACTICES OUR LEGAL DUTY We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the rights to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. In the event we make a material change in our privacy practices, we will change this Notice and provide it to you. You may request a copy of our Notice any time. For more information about our privacy practices, or for additional copies of this Notice, please contacts us using the information listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION We use and disclose health information about you for the following:
TREATMENT: We may use or disclose your health information to an optician, ophthalmologist, or other healthcare providers providing treatment to you for: a) the provision, coordination, or management of health care and related services by health care providers; b) consultation between health care providers relating to a patient; c) the referral of a patient for health care from one health care provider to another or d) recall information.
PAYMENT: We may use and disclose your health information to obtain payment for services we provide to you. This may include: a) billing and collection activities and related data processing; b) actions by a health plan or insurer to obtain premiums or to determine or fulfill its responsibilities for coverage and provision of benefits under its health plan or insurance agreement, determinations of eligibility or coverage, adjudication or subrogation of health benefit claims; c) medical necessity and appropriateness of care reviews, utilization review activities; and d) disclosure to consumer reporting agencies of information relating to collection of premiums or reimbursement.
HEALTHCARE OPERATIONS: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include things such as quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance conducting training programs, accreditation, certification, licensing or credentialing activities.
TO YOU, YOUR FAMILY AND FRIENDS: We must disclose your health information to you, as described in the Patients Rights section of this Notice. In our professional judgment, we may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare.
PERSONS INVOLVED IN CARE: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.
REQUIRED BY LAW: We may use or disclose your health information when we are required to do so by law, including judicial and administrative proceedings.
ABUSE OR NEGLECT: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or possible victim of other crimes.
NATIONAL SECURITY: We may disclose to military authorities the health information of Armed Force personnel under certain circumstances. We may disclose to authorized federal officials’ health information required for lawful intelligence, and other national security activities.
APPOINTMENT REMINDER AND TREATMENT ALTERNATIVES: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters) or information about treatment alternatives or other health-related benefits and services that may be interest to you.
PATIENT RIGHTS ACCESS: You have the right to review or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this Notice. We will charge you a reasonable cost –based fee for expenses such as copies and staff time. You may also request access by sending us a letter to the address at the end of this Notice. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we will prepare a summary or an explanation of your health information for a fee. Contact us using the information listed at the end of this Notice for a full explanation of our fee structure.
DISCLOSURE ACCOUNTING: You have the rights to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations, where you have provided an authorization and certain other activities, for the last 6 years. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
RESTRICTIONS: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
QUESTIONS AND COMPLAINTS: If you want more information about our privacy practices or have any questions or concerns, please contact us. We support the right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
TSO Custer Creek
3501 Custer Pkwy Ste 105
Richardson, TX 75080