Effective: November 3, 2025
NOTICE OF PRIVACY PRACTICES
THIS NOTICE OF PRIVACY PRACTICES (“NOTICE”) DESCRIBES HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AND HOW YOU CAN GET ACCESS TO SUCH INFORMATION. PLEASE READ IT CAREFULLY.
Your “health information,” for purposes of the Notice, is generally any information that identifies you and is created, received, maintained or transmitted by us in the course of providing health care items or services to you (referred to as “health information” in this Notice).
We are required by the Health Insurance Portability and Accountability Act of 1966 (“HIPAA”) and other applicable laws to maintain the privacy of your health information, to provide individuals with this Notice of our legal duties and privacy practices with respect to such information, and to abide by the terms of this Notice. We are also required by law to notify affected individuals following a breach of their unsecured health information.
USES AND DISCLOSURES OF INFORMATION WITHOUT YOUR AUTHORIZATION
The most common reasons why we use or disclose your health information are for treatment, payment, or health care operations. Examples of how we use or disclose your health information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses, or eye medications and faxing them to be filled; showing you low vision aids, referring you to another doctor or clinic for eye care or low vision aids or services; or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or vision care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “Health care operations” means those administrative and managerial functions that we must carry out in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.
OTHER DISCLOSURES AND USES WE MAY MAKE WITHOUT YOUR AUTHORIZATION OR CONSENT
In some limited situations, the law allows or requires us to use or disclose your health information without your consent or authorization. Not all of these situations will apply to us; some may never come up at our office at all. Such uses or disclosures are:
- When a state or federal law mandates that certain health information be reported for a specific purpose;
- For public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices;
- Disclosures to governmental authorities about victims of suspected abuse, neglect, or domestic violence;
- Uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
- Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;
- Disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that has happened somewhere else;
- Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
- Uses or disclosures for health-related research;
Uses and disclosures to prevent a serious threat to health or safety; - Uses and disclosures to contact you as a reminder that you have an appointment with our practice;
- If you are an inmate of a correctional facility or under the custody of a law enforcement official, we may disclose your health information to the correctional institution or law enforcement official in order to provide you with medical services, protect you or others, or to ensure the safety of the correctional facility;
- Disclosures to organizations that handle organ procurement to facilitate organ or tissue donation and transplantation;
- Uses or disclosures for specialized government functions, such as for the protection of the president or high-ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service;
- Disclosures relating to worker’s compensation programs;
Unless you object, we will also share relevant information about your care with your family and friends who are helping you with your eye care. Upon your death, we may disclose your family members or to other persons who were involved in your care or payment for health care prior to your death health information relevant to their involvement in your care unless doing so is inconsistent with your preferences as expressed to us prior to your death.
USES AND DISCLOSURES OF REPRODUCTIVE HEALTH CARE INFORMATION
We will not use or disclose your health information for the purpose of: (1) conducting a criminal, civil, or administrative investigation into any person for seeking, obtaining, providing, or facilitating lawful reproductive health care; (2) imposing criminal, civil, or administrative liability on any person for seeking, obtaining, providing or facilitation lawful reproductive health care; or (3) identifying a person for the purpose of investigating or imposing liability on a person for seeking, obtaining, providing, or facilitating lawful reproductive health care.
We must receive a valid attestation before using or disclosing your health information potentially related to reproductive health care: (1) for health oversight activities; (2) for judicial or administrative proceedings; (3) for law enforcement purposes; or (4) to coroners and medical examiners.
SPECIFIC USES AND DISCLOSURES OF INFORMATION REQUIRING YOUR AUTHORIZATION
The following are some specific uses and disclosures we may not make of your health information without your authorization:
Marketing activities. We must obtain your authorization prior to using or disclosing any of your health information for marketing purposes unless such marketing communications take the form of face-to-face communications we may make with individuals or promotional gifts of nominal value that we may provide. If such marketing involves financial payment to us from a third party your authorization must also include consent to such payment. We may contact you to raise funds for the practice and you have a right to opt out of receiving such communications.
Sale of health information. We do not currently sell or plan to sell your health information and we must seek your authorization prior to during so.
Psychotherapy notes. Although we do not create or maintain psychotherapy notes on our patients, we are required to notify you that we generally must obtain your authorization prior to using or disclosing any such notes.
YOUR RIGHTS TO PROVIDE AN AUTHORIZATION FOR OTHER USERS AND DISCLOSURES
- Other uses and disclosures of your health information that are not described in this Notice will be made only with your written authorization.
- You may give us written authorization permitting us to use your health information or to disclose it to anyone for any purpose.
- We will obtain your written authorization for uses and disclosures of your health information that are not identified in this Notice or are not otherwise permitted by applicable law.
- We must agree to your request to restrict disclosure of your health information to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law and such information pertains solely to a health care item or service for which you have paid in full (or for which another person other than the health plan has paid in full on your behalf).
Any authorization you provide to us regarding the use and disclosure of your health information may be revoked by you in writing at any time. After you revoke your authorization, we will no longer use or disclose your health information for the reasons described in the authorization. However, we are generally unable to retract any disclosures that we may have already made with your authorization. Information disclosed to a third party pursuant to the HIPAA Privacy Rule, including in compliance with an authorization, may be subject to redisclosure and no longer protected by the HIPAA Privacy Rule.
YOUR INDIVIDUAL RIGHTS
You have many rights concerning the confidentiality of your health information. You have the right:
- To request restrictions on the health information we may use and disclose for treatment, payment and health care operations. We are not required to agree to these requests. To request restrictions, please send a written request to us at the address below.
To tell us how you would like us to communicate with you. For example, you may ask that we call you at a certain phone number, or you may tell us whether we may leave a message for you. To request confidential communications, you must make your request in writing to the individual and address listed below. Your request must specify how or where you wish to be contacted. We will follow all reasonable requests for confidential communications.
- To inspect or copy your health information. You must make such requests in writing to the address below. If you request a copy of your health information we may charge you a fee for the cost of copying, mailing or other supplies. In certain circumstances we may deny your request to inspect or copy your health information, subject to applicable law.
- To amend health information. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the To request an amendment, you must write to us at the address below. You must also give us a reason to support your request. We may deny your request to amend your health information if it is not in writing or does not provide a reason to support your request. We may also deny your request if the health information:
- Was not created by us, unless the person that created the information is no longer available to make the amendment,
- Is not part of the health information kept by or for us,
- Is not part of the information you would be permitted to inspect or copy, or
- Is accurate and
- To receive an accounting of disclosures of your health information. You must make such requests in writing to the address Not all health information is subject to this request. Your request must state a time period for the information you would like to receive, no longer than 6 years prior to the date of your request and may not include dates before April 14, 2003. Your request must state how you would like to receive the report (paper, electronically).
- To receive a paper copy of this Notice. If you are receiving this notice electronically, you have the right to request a paper copy of this notice by making a request to the individual identified below. If you are receiving this notice electronically, you have the right to request a paper copy of this notice by making a request to the Privacy Officer identified below.
Contact Person
Our contact person for all questions, requests, or further information related to the privacy of your health information is:
Hayleigh Saenz at 4441 N 75th St, , Scottsdale, AZ, 85251
Complaints
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact person at the address, fax, or email shown. If you prefer, you can discuss your complaint in person or by phone.
Changes to This Notice
We reserve the right to change our privacy practices and to apply the revised practices to health information about you that we already have. Any revision to our privacy practices will be described in a revised Notice that will be posted prominently in our office. Copies of this Notice are also available upon request at our reception area.
By signing the last page of this document, I am acknowledging that I received a copy of Eyecare Plus Scottsdale’s Notice of Privacy Practices.