1053 River oaks drive
flowood, MS 39232

ESCM Privacy Policy



This Notice describes how we will use and disclose your health information in the Center. The policies outlined in this Notice apply to all of your health information generated by us in the Center, whether recorded in your medical record, invoices, payment forms or other ways.

Our Responsibilities

This organization is required by law to:

  • maintain the privacy of your health information
  • provide you with this notice as to our legal duties and privacy practices with respect to the information we collect and maintain about you
    abide by the terms of this notice
  • notify you if we are unable to agree to a requested restriction
  • accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Any changes to this Notice will be posted on our website and at the Center and will be available from us upon request. We will not use or disclose your health information without your written authorization, except as described in this Notice.

Your Health Information Rights

Although your health record is the physical property of the facility that compiled it, the information belongs to you. You have the right to:

  • request that we not use or disclose your health information for a particular reason related to treatment, payment or our general health care operations and/or to a particular family member, other relative or close personal friend. We are not required to agree to your request. If we do agree to a restriction, we will abide by that restriction unless you are in need of emergency treatment and the restricted information is needed to provide that emergency treatment. To request a restriction, submit a written request to the Privacy Officer listed on the final page of this Notice.
  • to obtain a paper copy of the “Privacy Notice” upon request.
    to inspect and obtain a copy of your health record. To arrange for access to your records, or to receive a copy of your records, you should submit a written request to the Privacy Officer listed on the last page of this Notice. (If you request copies, we will charge you a reasonable fee for copying and mailing the requested information.)
    to amend your health record if you believe that any health information in your record is incorrect or if you believe that important information is missing. Please use the form provided by our Privacy Officer to make such requests. For a request form, please contact the Privacy Officer.
  • to obtain an accounting of disclosures of your health information made by “the Center” during the time period for which you request (not to exceed 6 years). To request an accounting of disclosures, submit a written request to the Privacy Officer listed on the final page of this Notice, using the form provided by us to make such requests. The following disclosures will not be accounted for: (i) disclosures made for the purpose of carrying out treatment, payment or health care operations, (ii) disclosures made to you, (iii) disclosures of information maintained in our patient directory, or disclosures made to persons involved in your care, or for the purpose of notifying your family or friends about your whereabouts, (iv) disclosures for national security or intelligence purposes, (v) disclosures to correctional institutions or law enforcement officials who had you in custody at the time of disclosure, (vi) disclosures that occurred prior to April 14, 2003, (vii) disclosures made pursuant to an authorization signed by you, (viii) disclosures that are part of a limited data set, (ix) disclosures that are incidental to another permissible use or disclosure, or (x) disclosures made to a health oversight agency or law enforcement official, but only if the agency or official asks us not to account to you for such disclosures and only for the limited period of time covered by that request. The accounting will include the date of each disclosure, the name of the entity or person who received the information and that person’s address (if known), and a brief description of the information disclosed and the purpose of the disclosure.
  • receive confidential communications of your health information by alternative means or at alternative locations upon request. This means that you may, for example, designate that we contact you at work rather than home. To request communications via alternative means or at alternative locations, you must submit a written request to the Privacy Officer listed on the final page of this Notice. All reasonable requests will be granted.
  • revoke your authorization to use or disclose health information except to the extent that action has already been taken in reliance on your prior authorization (such a request must be made in writing to the Privacy Officer).

Examples of How We May Use or Disclose Your Health Information

In some circumstances we are permitted or required to use or disclose your health information without obtaining your prior authorization and, except as noted below, without offering you the opportunity to object. These circumstances include:

  • Treatment: We will use your health information for the purpose of providing, or allowing others to provide, treatment to you or any other individual. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician who assumes the provision of your care has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician. We may also contact you to provide appointment reminders.
  • Payment: We will use your health information for the purpose of allowing us, as well as other entities, to secure payment for the health care services provided to you. For example, a bill may be sent to you or a third-party payer, including Medicare or Medicaid. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
  • Regular health care operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing and conducting or arranging for other business activities. For example, we may use a sign-in sheet at the registration desk. We may also call you by name in the waiting room when your physician is ready to see you.
  • Notifications, communications with family: Unless you notify us that you object, we may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, general condition or health information that is directly related to that person’s involvement in your care or payment related to your care. In emergencies, we may disclose this information without giving you an opportunity to object.
    Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
  • Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
  • Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
  • Workers’ compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
  • Public health risks and purposes: As required by law, we may disclose your health information to public health or legal authorities for purposes related to: prevention or controlling disease, injury or disability; reporting of births, deaths, child abuse, neglect, exploitation of vulnerable adults, domestic violence, disease or infection exposure, and we may disclose your health information to a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
  • Required by law and law enforcement: We may disclose health information to a law enforcement official for purposes such as complying with a court order or a valid subpoena or in the course of any judicial or administrative proceeding.
  • Reporting: Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
  • Health oversight activities: We may disclose medical information to health agencies for activities authorized by law, including audits, inspections, licensure or civil, administrative or criminal investigations.
  • Public safety: We may disclose medical information about you to appropriate persons when necessary to prevent or lessen a serious threat to your health or safety or the health and safety of the general public or another person.
  • Specialized governmental functions: When appropriate conditions apply, we may release medical information for military, national security, intelligence activities, criminal corrections, or public benefit purposes.

For More Information or to Report a Problem

To obtain a paper copy of this notice or if you have questions and would like additional information about our privacy policies, you may contact:

Eye Surgical Center of Mississippi
Privacy Officer
1421 N. State Street, Suite 501
Jackson, MS 39202
(601) 969-1430

If you believe your privacy rights have been violated, you can file a written complaint with the Privacy Officer or by mail, fax, or e-mail with the Office for Civil Rights (OCR), Region IV, United States Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street, SW., Atlanta, GA 30303-8909. Voice Phone (404) 562-7886. FAX (404) 562-7881. TDD (404) 331-2867. For all complaints filed by e-mail send to: OCRComplaint@hhs.gov.

Individuals may, but are not required to, use OCR’s Health Information Privacy Complaint Form. To obtain a copy of this form, or for more information about the Privacy Rule or how to file a complaint with OCR, contact any OCR office or go to www.hhs.gov/ocr/hipaa/.

You will not be penalized for filing a complaint.

Effective Date: 4-14-03

1053 River Oaks Drive
Flowood, Mississippi 39232

Phone: 601.969.1430

Monday - Friday 8am-5pm

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