Gold Eye Clinic Palestine and Laser & Surgery Center, PLLC


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.


We are obligated to protect the privacy of any medical or other personal information that is provided to us that can identify you.  This information is called “protected health information” or “PHI”.  The Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires us to:  (I) maintain the privacy of medical information provided to us; (ii) provide notice of our legal duties and privacy practices; and (iii) abide by the terms of our Notice of Privacy Practices currently in effect.

It is our goal to safeguard your PHI.  We use internal systems, policies and procedures to maintain the accuracy of patient information and to protect it from unintended disclosure, loss, misuse, or alteration.  Patient information is accessible by appropriate personnel who have a need to know the information to perform their job.  This Notice applies to all Gold Eye Clinic and Palestine Laser & Surgery Center locations.  We are responsible to provide training to educate our personnel regarding HIPAA. 

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 right 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.  Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request and on our web site.


In the ordinary course of treatment, payment, and health care services, you will be providing us with personal information such as:

  • Your name, address, and phone number, etc.
  • Information relating to your medical history.
  • Information concerning your doctor, nurse, or other medical providers.
  • Information regarding third party payers, including insurance.
  • Information from other agencies (such as:  Texas Commission for the Blind, Texas Rehabilitation, Prevent Blindness, and TWC).

In addition, we will gather certain medical information about you and will create a record of the care provided to you.  Some information also may be provided to us by other individuals or organizations such as referring physicians, your other doctors, your health plan, and close friends or family members.


We may use and disclose personal and identifiable health information about you for a variety of purposes.  All of the types of uses and disclosures of information are described below, but not every use or disclosure in a category is listed.

Required Disclosures.  We are required to disclose health information about you to the Secretary of Health and Human Services, upon request, to determine our compliance with HIPAA and to you, in accordance with your right to access and right to receive an accounting of disclosures, as described below.

Treatment.  We may use health information about you in your treatment.  Those who may obtain your PHI for treatment include, but are not limited to:  hospitals, pharmacies, physicians, nurses, technicians, labs, opticians, and optometrists.   We do not create or maintain psychotherapy notes at this practice.

Payment.  We may use and disclose health information about you as needed to obtain payment from your insurance company.  For example, we may need to give payer information about your current medical condition to determine eligibility, coverage, benefits, medical necessity, and pre-certification.  

Health Care Operations.   We may use and disclose information about you for the general operation of our business.  For example, we sometimes arrange for auditors or other consultants to review our practices, evaluate our operations, and tell us how to improve our services.  Or, for example, we may use and disclose your health information to review the quality of services provided to you. 

Public Policy Uses and Disclosures.  There are a number of public policy reasons why we may disclose information about you that are described below.

We may disclose health information about you when we are required to do so by federal, state, or local law.

We may disclose protected health information about you in connection with certain public health reporting activities.

We may disclose protected health information (PHI) about you in connection with certain public health reporting activities.  For instance, we may disclose such information to a public health authority authorized to collect or receive PHI for the purpose of preventing or controlling disease, injury or disability, or at the direction of a public health authority, to an official of a foreign government agency that is acting in collaboration with a public health authority.   Public health authorities include state health departments, the Center for Disease Control, the Food and Drug Administration, the Occupational Safety and Health Administration and the Environmental Protection Agency, to name a few.

We are also permitted to disclose protected health information to a public health authority or other government authority authorized by law to receive reports of child abuse or neglect.  Additionally, we may disclose protected health information to a person subject to the Food and Drug Administration’s power for the following activities: to report adverse events, product defects or problems, or biological product deviations; to track products; to enable product recalls; repairs or replacements; to conduct post marketing surveillance.  We may also disclose a patient’s health information to a person who may have been exposed to a communicable disease or to an employer to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether an individual has a work-related illness or injury.

We may disclose a patient’s health information where we reasonably believe a patient is a victim of abuse, neglect or domestic violence and the patient authorizes the disclosure or it is required or authorized by law.

We may disclose health information about you in connection with certain health oversight activities of licensing and other health oversight agencies which are authorized by law. Health oversight activities include audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal, or administrative proceedings or actions or any other activity necessary for the oversight of1)the health care system, 2) governmental benefit programs for which health information is relevant to determining beneficiary eligibility, 3) entities subject to governmental regulatory programs for which health information is necessary for determining compliance with program standards, or 4) entities subject to civil rights laws for which health information is necessary for determining compliance.

We may disclose your health information for marketing purposes.

We may disclose your health information as required by law, including in response to a warrant, subpoena, or other order of a court or administrative hearing body or to assist law enforcement to identify or locate a suspect, fugitive, material witness or missing person. Disclosures for law enforcement purposes also permits us to make disclosures about victims of crimes and the death of an individual, among others.          

We may release a patient’s health information (1) to a coroner or medical examiner to identify a deceased person or determine the cause of death and (2) to funeral directors.  We also may release your health information to organ procurement organizations,transplant centers, and eye or tissue banks, if you are an organ donor.

We may release your health information to workers’ compensation or similar programs, which provide benefits for work-related

injuries or illnesses without regard to fault.

Health information about you also may be disclosed when necessary to prevent a serious threat to your health and safety or the health

and safety of others.           

We may use or disclose certain health information about your condition and treatment for research purposes where an Institutional

Review Board or a similar body referred to as a Privacy Board determines that your privacy interests will be adequately protected in

the study.  We may also use and disclose your health information to prepare or analyze a research protocol and for other research


We may elect to utilize a Health Information Exchange.

If you are a member of the Armed Forces, we may release health information about you for activities deemed necessary by military command authorities.  We also may release health information about foreign military personnel to their appropriate foreign military authority.

We may disclose your protected health information for legal or administrative proceedings that involve you.

We may release such information upon order of a court or administrative tribunal.  We may also release protected health information in the absence of such an order and in response to a discovery or other lawful request, if efforts have been made to notify you or secure a protective order.

If you are an inmate, we may release PHI about you to a correctional institution where you are incarcerated or to law enforcement officials in certain situations such as where the information is necessary for your treatment, health or safety, or the health or safety of others.

Finally, we may disclose PHI for national security and intelligence activities and for the provision of protective services to the President of the United States and other officials or foreign heads of state.

Our Business Associates.  We sometimes work with outside individuals and businesses that help us operate our business successfully. We may disclose your health information to these business associates so that they can perform the tasks that we hire them to do and they must promise that they will respect the confidentiality of your PHI.  The activities that our business associates perform include, but are not limited to:  computer and systems support, production of account invoices or statements, internal audits, investigations, licensures, and inspections required for compensation, government programs and laws, accreditation organizations and professional medical liability insurance carrier.   

Disclosures to Persons Assisting in Your Care or Payment for Your Care.  We may disclose information to individuals involved in your care or in the payment for your care.  This includes people and organizations that are part of your "circle of care" -- such as your spouse or children, your other doctors, or an aide who may be providing services to you.  We may also use and disclose health information about a patient for disaster relief efforts and to notify persons responsible for a patient’s care about a patient’s location, general condition or death.   Generally, we will obtain your verbal agreement before using or disclosing health information in this way.  However, under certain circumstances, such as in an emergency situation, we may make these uses and disclosures without your agreement.

Appointment Reminders.  We may use and disclose your PHI to provide you with appointment reminders (such as voicemail messages, e-mail message, postcards, or letters).

Treatment Alternatives.  We may use and disclose your personal health information in order to tell you about or recommend possible treatment options, alternatives or health-related services that may be of interest to you.


Written Authorization

We are required to obtain written authorization from you for any other uses and disclosures of medical information other than those described above.  If you provide us with such permission, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose personal information about you for the reasons covered by your written authorization, except to the extent we have already relied on your original permission.

We will not use your health information for marketing/fundraising communications without your written authorization.

Authorization is required for disclosures that constitute a sale of PHI as well as a statement for other uses.

Verbal Agreement

We may rely upon verbal agreements from you to use or disclose your PHI in certain limited circumstances.  Verbal agreements permit us to communicate with your family members, your personal representative, or another person responsible for your care.  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 health care.  For instance, following your surgery, the staff may give discharge instructions to your family or the responsible adult who brought you in for your surgery.  Other instances where this might apply would be while being examined by the physician or if your family member calls in for you or on your behalf.  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, or other similar forms of health information.


You have the right to a copy of this notice in paper form.  You may ask us for a copy at any time.  You may also obtain a copy of this notice at our web site

You have the right to ask for restrictions on the ways we use and disclose your health information for treatment, payment and health care operation purposes.  You may also request that we limit our disclosures to persons assisting your care or payment for your care.   We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).

You have a right to designate a personal representative who will have all of the same rights as you regarding your information.

You have the right to request that the practice make reasonable efforts to keep communication of your information confidential.

You have the right to request (specified in writing) that you receive communications containing your protected health information from us by alternative means or at alternative locations.  For example, you may ask that we only contact you at home or by mail.

Except under certain circumstances, you have the right to inspect and copy medical, billing and other records used to make decisions about you.  If you ask for copies of this information, we may charge you a fee for copying and mailing. 

If you believe that information in your records is incorrect or incomplete, you have the right to request that we amend your health information.  Your request must be in writing, and it must explain why the information should be amended.  Under certain circumstances, we may deny your request, such as when the information is accurate and complete.

You have the right to request restrictions and the practice has the right to either agree to or deny such restrictions.  An exception is if you are making payment out of pocket in full and requiring nondisclosure to their insurance company.  In this case, the practice may not deny the request with exception for Medicare and Medicaid.

You have a right to receive a list of certain instances when our business associates or we have used or disclosed your medical information.  Among the uses we are not required to include in the list are uses and disclosures for your treatment, payment for services furnished to you, our health care operations, disclosures to you, disclosures you give us authorization to make and uses and disclosures before April 14, 2003.  If you ask for this information from us more than once every twelve months, we may charge you a fee.

You have a right to be notified following a breach of unsecured PHI.

To exercise any of your rights, please contact us in writing.


If you have any complaints concerning our privacy practices, you may contact the Secretary of the Department of Health and Human Services, at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C.  20201 (e-mail: 

You also may contact us at: 

Gold Eye Clinic/Palestine Laser & Surgery Center, PLLC
Linney Patton, COE, Privacy Officer
501 E. Kolstad Street
Palestine, TX 75801
web site:

We support your 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.

This notice is effective as of  October 1, 2014.