Privacy Policy

The following describes how health information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.

Our practice is dedicated to protecting your health information. We are required by law to maintain the privacy of Protected Health Information (PHI) and to provide you with this Notice of our legal duties and privacy practices with respect to PHI. Our practice is required by law to abide by the terms of this Notice.

This Notice of Privacy Practices (NPP) describes how we may use and disclose your PHI to carry out treatment, payment or healthcare operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition, and is created, received, maintained or transmitted by us in the course of providing healthcare items or services to you.

We may change the terms of our Notice at any time. The new Notice will be effective for all PHI that we maintain at that time, and will be prominently displayed in our facility and on our website. Upon your request, we will provide you with any revised NPP. To request a revised Notice, you may call the office and request that a revised copy be sent to you in the mail, or ask for one at the time of your next appointment.

How We May Use and Disclose Your Health Information

We will use your health information as part of rendering patient care. For example, your health information may be used or disclosed by the doctor or technician treating you, by the business office to process your payment for activities of the practice, including, but not limited to, use by administrative personnel reviewing the quality of the care you receive, employee review activities, training of medical students, licensing, contacting or arranging for other business activities.

We may also use and/or disclose your information in accordance with federal and state laws for the following purposes:

Communication and Marketing

We may, if necessary, contact you by phone or mail. With your permission, we may contact you by email or text.

We will not sell PHI, or use, or disclose, any PHI for the purpose of paid marketing without your written authorization. Exceptions to this rule would be using PHI for public health activities, research purposes (as long as the price charged for the information reflects the cost of gathering and transmitting the information), treatment and payment purposes, sale of the practice and relaying PHI to the individual.


We will use or disclose your health information for treatment purposes by making appointments; testing and examining your eyes; recording in your chart information obtained to determine your course of treatment; prescribing glasses, contact lenses or eye medications and e-prescribing or faxing them to be filled; showing you low vision aids; referring you to another doctor or clinic for eye care, low vision aids or services; or obtaining copies of your health information from another professional that you may have seen previously.


Your health information may be used or disclosed by the business office to process your payment for activities of the practice, including: asking 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).

Healthcare Operations

We may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting area when your doctor is ready to see you. We may list your surname on a dispensing tray, which may be exposed to public view. At times, other patients may inadvertently overhear conversations between you and your healthcare professional due to the design of the facility and need for ease of access. These occurrences are referred to as “incidental disclosures.” We make every effort to keep incidental disclosures to a minimum. Please let us know if you are uneasy in any treatment area. In all instances, we will use the minimum amount of information necessary.


You have the right to opt out of receiving fundraising communications.

Family and Friends

Unless you object, we may disclose your health information to family members, other relatives or close personal friends when the health information is directly relevant to that person’s involvement with your eye care. Upon your death, we may disclose to your family members or other persons who were involved in your care or payment for healthcare prior to your death (such as your personal representative) 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. The HIPAA Privacy Rule protects information about a decedent for a period of 50 years.

Disaster Relief

We may disclose your health information to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts.

Health Oversight Activities

We may use or disclose your health information for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention. We may disclose your health information to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.

Abuse or Neglect

We may disclose your health information when it concerns abuse, neglect or violence to you in accordance with federal and state law.

Legal Proceedings and Law Enforcement

We may disclose your health information for certain judicial or administrative proceedings in response to a court order or a subpoena.

We may disclose your health information for law enforcement purposes or other specialized governmental functions such as military, national security and presidential protective services.

Correctional Institution

Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof, health information necessary for your health and the health and safety of other individuals.

Coroners, Medical Examiners and Funeral Directors

We may disclose your health information to a coroner, medical examiner or a funeral director when an individual dies.

Organ Donation

If you are an organ donor, we may disclose your health information to an organ donation and procurement organization.

Disclosure to Department of Health and Human Services

We may disclose health information when required by the United States Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws.

Food and Drug Administration (FDA)

We may disclose information to the FDA relevant to adverse reactions in regards to supplements, product and product defects to allow for recalls or replacement. Research

We may use and share your information for health research.

Public Safety

We may use or disclose your health information to prevent or lessen a serious threat to the health or safety of another person or to the public.

Workers’ Compensation

We may disclose your health information as authorized by laws relating to workers’ compensation or similar programs.

Business Associates

We may disclose your health information to a business associate with whom we contract to provide services on our behalf. To protect your health information, we require our business associates to appropriately safeguard the health information of our patients.


We will not use or disclose your health information for any other purpose not described in this NPP, without your written authorization. Once given, you may revoke your authorization in writing at any time.

Your Rights Regarding Your Health Information

You have the following rights, with respect to your health information:

  • You have the right to receive communications from us in a confidential manner.
  • You have the right to receive notification should a breach of your PHI occur.
  • You have the right to see or receive a copy of your health record and other health information from us in an electronic or paper format. We will provide a copy usually within 30 days of your request. We may charge a reasonable, cost-based fee.
  • You may request a correction to your health record if you believe it to be incorrect or incomplete. The request must be in writing and will be reviewed bya provider. We do not have to agree to your request, but we’ll tell you why, in writing, within 60 days.
  • You may ask us to restrict certain uses and disclosures of your health information for purposes of treatment, payment and healthcare operations. We are not required to agree to your request, but if we do agree, we will honor the request.
  • You may restrict disclosures to your health plan for services paid for in full directly “out-of-pocket.”
  • You have the right to receive an accounting of the disclosures of your health information made by our practice during the last six years, except for those about treatment, payment and healthcare operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
  • You may request a paper copy of this NPP.
  • If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure that person has this authority and can act for you before we take any action.
  • You have the right to complain to us and/or to the United States Department of Health and Human Services if you believe that we have violated your privacy rights. If you choose to file a complaint, you will not be retaliated against in any way. To complain to us, please contact our Privacy Officer at the address and phone number on the front of this brochure.

If you would like further information regarding your rights, or regarding the uses and disclosures of your health information, you may contact our Privacy Officer at the address and phone number below.

Eye Express and Phillips, Salomon & Parrish
215 First Street North
Winter Haven, FL 33881

Fax 863-595-2840

Policy Effective: April 14, 2003
Revised: March 26, 2013