Appointments: (830) 379-6300
520 East Donegan Street, Seguin,TX 78155
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Practice Privacy Statement



This is formal notification, as required by the government, concerning the privacy policy of this practice. This practice has an obligation to maintain all medical information in the strictest of confidence. Our practice cannot release information about you, including conversations, reminder calls, test results and other confidential issues, without your written consent. Patient information about health care is identified as “PHI” or protected health information. This policy requires that you, the patient, identify at the time of registration specific information about release of information. You can change this information at any time with written notification. Changes can only impact the care of information from that point in time forward.

Your protected health information “PHI” is a part of your medical care, and can be used or disclosed as follows:

  • For your treatment in this practice and other locations under our immediate care for medical care needs. This may include any referral for services, diagnostic tests or treatment related to your medical care needs.

  • For obtaining payment for treatment with your identified health care program. This would include any documentation related to this care, including history forms and progress notes. This would include eligibility, verification, prior authorization and claim submission.

  • For operations of this practice, such as enrolling with insurance programs, hospital privileges, accounting, and compliance with federal and state laws and regulations.

  • Appointment reminders and health related benefit services only with your consent identified on the registration form.

  • Disclosure to your family concerning any related health care information with your consent on the registration form which can be modified at any time in writing.

Consent is not required for emergency care and treatment. An emergency is identified as a medical condition that in the judgment of the physician requires information for care on your behalf.

Certain disclosures can be made without your consent, and they are as follows:

  • Disclosure required by the government or law enforcement agencies. An example of this would be victims of abuse.

  • Information used for public health purposes, medical examiners or related to a persons death or for the health department for disease tracking.

  • Information used for health care oversight, such as site review by an insurance program.


Your rights for your health information include: The right to request limits on the uses and disclosure at registration or any time during your care. The right to choose how we send this information to you, including use of an alternate address. The right to see and obtain copies of your “PHI”, but there may be copy and postage fees. The right to get a listing of who we have made disclosures to about your “PHI”. The right to correct your file through an amendment process if appropriate.

This practice reserves the right to modify or change this Privacy Statement and process at any time. Revision to the Notice will be available upon request by contacting the office. The changes will be effective retroactively to the initial date of the Privacy Notice. An updated Privacy Notice will be posted in the office within 60 days of the revision.

If you have a concern or a complaint about how your “PHI” is being used, from this time forward you should first contact our Office Manager or you may contact the Office of Civil Rights.

Office of Civil Rights – Regional Manager
Department of Health & Human Services

233 N. Michigan Ave. Ste. 240 Chicago Illinois 60601