Notice of Privacy Practices


Davidson Eye Associates, P.A.
2 Hospital Dr.
Lexington, N.C.  27292 

Tel.  336.243.2436


If you have any questions regarding this Notice of Privacy, please contact our Privacy Officer or Office Manager 

This notice is effective on March 28, 2012.

Revised June 15, 2013 

This Privacy Policy describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare operations for our business.  This policy also describes your rights regarding your protected health information.  "Protected health information" includes demographical information, and is information about you that may identify you and relates to your past, present, or future physical or mental health condition and related health care services. 

I.  Uses and Disclosures

Your confidential healthcare information may be used or disclosed to assist us with treatment, payment, or healthcare operations of our office:

  • Treatment-Information will be shared with healthcare professionals, within our office, to provide you with quality healthcare. Information may be shared with healthcare providers outside our office (e.g. specialists, laboratories, home health agencies) when another provider or care giver is needed to assist your physician with diagnosis or treatment of a condition.
  • Payment-Information will be released to your insurance company to assist in the payment for services provided. Information may also be shared to verify eligibility, obtain authorizations, or prove medical necessity for services provided.
  • Healthcare Operations-Information may be shared with contracted business associates that provide additional support to our office. Examples include but are not limited to auditors, consultants, collection agencies, accountants, and accreditation services. We may use your information to periodically send you appointment reminders, our newsletter, or to notify you by email or mail about services or treatments that we think may be beneficial to you. Please contact our privacy officer if you do not wish to receive these materials.

Your confidential healthcare information may be used or disclosed for other reasons without your authorization as follows:

  • Required Uses and Disclosures-Under law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate our compliance with the requirements of Section 164.500 et. seq. We may use or disclose your protected health information to the extent that it is required by law. The use or disclosure will be in compliance with the law and will be limited to its requirements. You will be notified, as required by law, of any such uses or disclosures.
  • Public Health Activities- As permitted by law, for the purpose of controlling disease, injury, or disability.
  • Health Oversight- As authorized by law, for the purpose of audits, investigations and inspections.
  • Abuse or Neglect- As authorized by law, to a health authority that deals with child abuse or neglect.
  • Food and Drug Administration- As required, to report adverse events, product defects or problems and to enable product recalls.
  • Legal Proceedings – In response to a subpoena or court order
  • Law Enforcement-Legal processes as required by law for law enforcement purposes.
  • Coroners, Funeral Directors, and Organ Donations- As requested, for identification purposes, to assist in determining cause of death, or other duties required by law or authorized by law.
  • Research- When approved by an institutional review board
  • Military Activity/NationalSecurity-Under certain situations, if you are Armed Forces personnel. Examples: To determine eligibility for benefits and to conduct national security and intelligence activities.
  • Workers Compensation-As authorized, to comply with workers’ compensation laws.
  • Inmates-As necessary, if you are an inmate of a correctional facility.
  • Emergency Situations-As needed, when authorization can not be provided.
  • Family Members/Others -Unless you object, we may disclose to a member of your family, a relative, close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to object or agree to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
  • Training students and other health care providers to help them learn or improve their skills.

Your confidential healthcare information may be used or disclosed for other reasons, ONLY after we receive written authorization from you.

An example would be marketing activities for the practice.  You may revoke any such authorization at any time by submitting a written request to our office.  Except to the extent that your doctor or this practice has used or released information based upon your prior authorization, no further use or disclosure will occur. 


II.  Your Rights

The following is a list of your rights with respect to your protected health information. All requests must be in writing to our privacy officer.

  • You have the right to inspect and copy your protected health information.You may review and request copies of your protected health information held by our office. This includes medical and billing information. Your request to review your information may be approved or denied depending on the circumstances. Under Federal Law, you may not inspect records planned for use in legal/criminal proceedings, or where law prohibits access. In some cases, you may have the right to have a denial reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.
  • You have the right to request a restriction of your protected health information. You may ask us not to use or disclose any part of your protected health information for treatment, payment, or healthcare operations. You may request that parts of your information not be released to family members or others involved in your care. Any request not to send information to your medical insurance provider will be honored, if allowed by law, and if you pay in full for the service at the time the service is rendered. Any such written restriction request must state the specific restriction requested and to whom you want the restriction to apply. Other than for restrictions related to payment discussed above, your doctor is not required to agree to a restriction, particularly if he believes it is not in your best interest.

You have the right to receive confidential communications from us by alternative  means or at alternative locations.  You may request to be contacted at a different phone number or different address.  You will not be required to explain your reasoning for the request.  We will attempt to comply with your request when the alternative means of communication is reasonable and our resources permit the type of communication.

You have the right to request an amendment to your protected health information.  Your request must be in writing with an explanation as to why the information should be amended.  In certain cases, we may deny your request for an amendment.  In such a case, you have the right to file a statement of disagreement with us.  We may prepare a rebuttal to your statement and will provide you a copy of any such rebuttal.

  • You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures made by our Business Associates or us for reasons other than for treatment, payment, or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members, or friends involved in your care as a result of an authorization signed by you. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003 for up to the previous 6 years. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions, and limitations. If you request an accounting more than once in a 12 month period, we will charge you a reasonable cost-based fee for responding to the additional request.
  • You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

III.  Complaints

If you believe that your privacy rights have been violated, you may contact our Privacy Officer directly at the address or phone number on the front of this notice, or you may contact the Secretary of Health and Human Services.  We will then notify you, in writing, regarding our decision and/or actions taken with regard to your complaint.  We will not retaliate against you for filing a complaint.  Notification of any potential violations will assist us in achieving maximum privacy standards. We are required by law to abide by the terms of this Notice.  We may change the terms of our Notice at any time. The new Notice will be effective for all protected health information we maintain at that time. Upon verbal or written request, we will provide you with any revised Notice of Privacy Practices.