Notice of Privacy Practices for Protected Health Information

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 required by law to maintain the privacy and security of your protected health information, provide this notice of our legal duties and privacy practices, follow the terms of the notice currently in effect, and notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

Who Will Follow This Notice

This notice applies to Clay Eye Physicians & Surgeons, and the physicians, providers, employees, staff, trainees, volunteers, and business associates who may create, receive, maintain, or transmit protected health information on our behalf. These individuals and locations may share information with one another for treatment, payment, and health care operations as permitted by law.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record. You may ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary, usually within 30 days of your request, and may charge a reasonable, cost-based fee.

Ask us to correct your medical record. You may ask us to correct health information about you that you believe is incorrect or incomplete. We may deny your request, but we will tell you why in writing within 60 days.

Request confidential communications. You may ask us to contact you in a specific way, such as by home, office, or cell phone, or to send mail to a different address. We will agree to reasonable requests.

Ask us to limit what we use or share. You may ask us not to use or share certain health information for treatment, payment, or health care operations. We are not required to agree to most requests, but we will comply if required by law. If you pay for a service or health care item out of pocket in full, you may ask us not to share information about that service or item with your health plan for payment or health care operations, and we will agree unless a law requires us to share it.

Get a list of those with whom we have shared information. You may ask for an accounting of certain disclosures of your health information for up to six years before the date of your request. We will include disclosures except those excluded by law, such as disclosures for treatment, payment, health care operations, and certain other disclosures.

Get a copy of this notice and file a complaint. You may ask for a paper copy of this notice at any time. You may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you may tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, tell us what you want us to do, and we will follow your instructions when we can.

1. You may tell us whether to share information with your family, close friends, or others involved in your care or payment for your care.

2. You may tell us whether to share information in a disaster relief situation.

3. If you are not able to tell us your preference, we may share information if we believe it is in your best interest or needed to lessen a serious and imminent threat to health or safety.

4. We will not use or disclose your information for marketing purposes, sell your information, or use or disclose psychotherapy notes, if any, without your written authorization when authorization is required by law. This practice does not share, sell, rent, or lease its customer list or mobile opt-in data to third parties for marketing purposes.

5. If we use your information for fundraising, we will tell you how to opt out of future fundraising communications.

6. We may disclose health information about you when we are required to do so by federal, state, or local law.
   
7. We may disclose protected health information about you in connection with certain public health reporting activities.
   
8.   We may disclose protected health information 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 included 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.
   
9.   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 information to a person subject to the Food and Drug Administration’s power for biological product deviations; to track products; to enable product recalls, repairs or replacements; or 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.
   
10.   We may disclose a patient’s health information where we reasonable believe a patient is a victim of abuse, neglect or domestic violence and the patient authorized the disclosure or it is required or authorized by law.
    
11.   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 included audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal, or administrative proceedings or actions or any other activity necessary for the oversight of 1) 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.
    
12.   We may disclose your health information as required by law including in response to a warrant, subpoenas, or other order of a court or administrative hearing body or to assist law enforcement identify or locate a suspect, fugitive, material witness or missing person.  Disclosures for law enforcement purposes also permit use to make disclosures about victims of crimes and the death of an individual, among others.
    
13.   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.
    
14.  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.
    
15.  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.
    
16.  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 purposes 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.
    
17.  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.
    
18.  If you are an inmate, we may release protected health information 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.
    
19.  Finally, we may disclose protected health information 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.  Our business associates must promise that they will respect the confidentiality of your personal and identifiable health information.

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, 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 medical information to contact you as a reminder that you have an appointment or that you should schedule an appointment.

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.

Marketing Analysis.  We may use and disclose your personal health information in order to tell or inform you of a new treatment, product and or location available to you

Our Uses and Disclosures

We may use and share your protected health information for treatment, payment, and health care operations, and for other purposes permitted or required by law.

Special Protections for Substance Use Disorder Records

To the extent we create, maintain, or receive substance use disorder patient records protected by 42 CFR Part 2, those records receive additional protections. We will not use or disclose Part 2 records in a civil, criminal, administrative, or legislative proceeding against you unless you provide written consent or a court order and subpoena or other legally sufficient request permits the disclosure.

Treat you. We may use your health information and share it with other professionals who are treating you. For example, we may share information about your eye condition, medications, or medical history with another physician involved in your care.

Run our organization. We may use and share your health information to operate our practice, improve your care, train staff, conduct quality review, and contact you when necessary. For example, we may use health information to review the quality of services provided to you.

Bill for your services. We may use and share your health information to bill and receive payment from health plans or other entities. For example, we may give information about your eye examination or procedure to your health plan so it will pay for the service.

Help with public health and safety issues. We may share health information for public health activities, such as preventing disease, reporting adverse events, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety, or helping with product recalls.

Do research. We may use or share your information for health research when permitted by law, such as when an Institutional Review Board or Privacy Board has approved the research or when your written authorization is obtained if required.

Comply with the law. We will share information about you when federal, state, or local law requires it, including with the U.S. Department of Health and Human Services if it wants to determine whether we are complying with federal privacy law.

Respond to organ and tissue donation requests. We may share health information with organ procurement organizations, transplant centers, and eye or tissue banks as permitted by law.

Work with a medical examiner or funeral director. We may share health information with a coroner, medical examiner, or funeral director when an individual dies.

Other Uses and Disclosures Requiring Written Authorization

We will obtain your written authorization before using or disclosing your protected health information for purposes not described in this notice or otherwise permitted or required by law. If you give us authorization, you may revoke it in writing at any time. We will stop using or disclosing your information for that purpose, except to the extent we have already relied on your authorization.

Address workers’ compensation, law enforcement, and other government requests. We may use or share health information for workers’ compensation claims, law enforcement purposes, health oversight activities, military, national security, protective services, correctional institution purposes, and other special government functions when permitted or required by law.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information; provide you with this notice; follow the duties and privacy practices described in this notice; and let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

Respond to lawsuits and legal actions. We may share health information in response to a court or administrative order, subpoena, discovery request, or other lawful process when the legal requirements for disclosure are met.

We reserve the right to change this notice and make the revised notice effective for health information we already have about you as well as information we receive in the future. When we make a material change, we will make the revised notice available upon request and post it as required by law.

Complaints and Contact Information

If you have questions about this notice, want to exercise your rights, or want to file a complaint with us, please contact: Privacy Officer, Clay Eye Physicians & Surgeons, 2023 Professional Center Drive, Orange Park, Florida 32073.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting the Office for Civil Rights website. We will not retaliate against you for filing a complaint.

Effective date: July 15, 2026. This notice should be reviewed by legal counsel or a qualified HIPAA compliance officer before distribution.