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.

The Neuro-Ophthalmology of Texas, P.L.L.C. uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of The University Eye Institute.

How The Neuro-Ophthalmology of Texas, P.L.L.C. May Use or Disclose Your Health Information For Treatment. The Neuro-Ophthalmology of Texas, P.L.L.C. may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as an optometrist, physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions. If you have been referred into our facility from a healthcare provider outside of Neuro-Ophthalmology of Texas, P.L.L.C., that referring doctor may have sent information about you in advance to help in our treatment of you. We will provide your referring healthcare provider with copies of your record or reports that will assist him/her in your treatment and health care after you have completed your management from our facility.

For Payment. The Neuro-Ophthalmology of Texas, P.L.L.C. may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operations. The Neuro-Ophthalmology of Texas, P.L.L.C. may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to: evaluate the performance of our staff; assess the quality of care and outcomes in your cases and similar cases; learn how to improve our facilities and services; and determine how to continually improve the quality and effectiveness of the health care we provide.

Appointments. The Neuro-Ophthalmology of Texas, P.L.L.C. may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. You or a family member may be contacted by postcard and/or by telephone at the number you have provided for contact to remind you of an upcoming appointment.

Notification. The Neuro-Ophthalmology of Texas, P.L.L.C. may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care of your general condition. You have the right to restrict who we may disclose information to.

Marketing. The Neuro-Ophthalmology of Texas, P.L.L.C. in compliance with both Federal and State restrictions cannot disclose your health information to 3rd parties for marketing purposes unless an authorization to do so is obtained from you in advance. However, the Neuro-Ophthalmology of Texas, P.L.L.C. may directly market to you by face-to-face or by mail for research opportunities, services, procedures or materials offered by the Neuro-Ophthalmology of Texas, P.L.L.C. that may be of benefit to you. If you do not wish to receive this information, you have the right to be removed from our mailing list.

Required by law. The Neuro-Ophthalmology of Texas, P.L.L.C. may use and disclose information about you as required by law. For example, The Neuro-Ophthalmology of Texas, P.L.L.C. may disclose information for the following purposes: for judicial and administrative proceedings pursuant to legal authority; to report information related to victims of abuse, neglect or domestic violence; and to assist law enforcement officials in their law enforcement duties;

Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

Decedents. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.

Research. The Neuro-Ophthalmology of Texas, P.L.L.C. may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research. You may be contacted by telephone or by mail asking to participate in specific studies at Neuro-Ophthalmology of Texas, P.L.L.C. or receive general information about research opportunities.

Health and Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law. Government Functions. Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services. Workers’ Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation. Other uses. Other uses and disclosures will be made only with your written authorization and you may revoke the authorization except to the extent The Neuro-Ophthalmology of Texas, P.L.L.C. has taken action in reliance on such.

Your Health Information Rights. You have the right to: request a restriction on certain uses and disclosures or your information as provided by 45 C.F.R. §164.522; however, The Neuro-Ophthalmology of Texas, P.L.L.C. is not required to agree to a requested restriction; obtain a paper copy of the notice of information practices upon request; inspect and obtain a copy of your health record as provided for in 45 C.F.R. §164.524; request that your health record be amended as provided in 45 C.F.R. §164.526; request communications of your health information by alternative means or at alternative locations; and receive an accounting of disclosures made of your health information as provided by 45 C.F.R. §164.528.

Complaints. You may complain to The Neuro-Ophthalmology of Texas, P.L.L.C. and to the Department of Health and Human Services (Office of Civil Rights) if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.

Obligations of Neuro-Ophthalmology of Texas, P.L.L.C. The Neuro-Ophthalmology of Texas, P.L.L.C. is required by law to: maintain the privacy of protected health information; provide you with this notice of its legal duties and privacy practices with respect to your health information; abide by the terms of this notice; notify you if we are unable to agree to a requested restriction on how your information is used or disclosed; accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and The Neuro-Ophthalmology of Texas, P.L.L.C. reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains. Revised notices will be made available to you by upon your next visit. You may always view and download any updated version by accessing our website at: http://www.neuroeye.com/

Contact Information:
If you have any questions or complaints, please contact:
Privacy Officer
Neuro-Ophthalmology of Texas, P.L.L.C.
2617C West Holcombe Blvd #575
Houston, Texas 77025
Office: 713-942-2187

This notice is effective as of Janruary 1, 2006.

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