THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This notice describes how we protect your health information and what rights you have regarding it.
TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your health information is for treatments, payment, or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you, testing or examining your eyes; prescribing glasses, contact lenses, or eye medication and faxing/electronically submitting 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; 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” mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we used or disclose your health information for health care operations are: financial or billing audits; internal quality assistance; personnel decisions; participation in managed care plans, defense of legal matter; business planning; and outside storage of our records.
We routinely use your health information inside our office for those purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask for your special written permission.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose our health information, without your permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.
- Disclosures for health oversight activities
- Disclosures for organ donation or transplantation
- Disclosures for specialized government functions
- Disclosures for Worker’s Compensation
- Disclosures made for judicial and administrative proceedings
- Disclosures made to avert imminent threat to health or safety of a person or public
- Disclosures made to law enforcement
- Disclosures related to public health
- Disclosures that are required by law
- Disclosures to coroners and medical examiners
- Reports to government agencies of abuse, neglect or domestic violence
Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your eyecare.
We may call, text, and/or email you to remind you of a scheduled appointment, or that it is time to make a routine appointment, we may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise we will: send text message reminders, send e-mails, leave messages on your home answering machine or with whoever answers the phone in your absence, we may also call or leave a message at the work number you have provided.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosure of your health information unless you sign a written “authorization form.” The consent of and “authorization form” is determined by federal law. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it’s your idea for us to send you information to someone else. Typically, in this situation you will give us a properly completed authorization form, or you can use one of ours.
If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of the Notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding your health information. You can:
- Ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restriction that you want. To ask for a restriction, send a written request to the office contact person at the address or fax show at the beginning of this Notice.
- Ask us to communicate with you in a confidential way, such as by phoning you at work rather than home, by mailing health information to a different address, or by us using e-mail to your personal e-mail address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the office contact person at the address or fax shown at the defining of this Notice.
- Ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. For the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us (or sixty days if the information is stored off-site). You may have to pay for photocopies in advance. If we deny your request we will send you a written explanation and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30 day extension of the time for us to give you access or photocopies if we send you a written notice of the extension. If you want to review or get photocopies of your health information, send a written request to the office contact person at the address, fax or e-mail shown at the beginning of this Notice.
- Ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. We will send you the corrected information to persons who we know for the wrong information, and others that you specify. If we do not agree, you can write a statement of your position, and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law we can have one 30 day extension of time to consider a request for amendment if we notify you in writing of the extension. If you want to ask us to amend your health information, send a written request, including your reasons for the amendment, to the office contact person at the address, fax or e-mail shown at the beginning of the Notice.
- Get a list of the disclosure that we have made of your health information within the past six years (or a shorter period if you want). By law, the list will not include: disclosures for the purpose of treatment, payment or health care operations, disclosures with you authorization, incidental disclosures; disclosure required by law and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30 day extension of time if we notify you of the extension in wiring. If you want a list, send a written request to the office contact person at the address, fax, or e-mail at the beginning of this Notice.
- Get addition paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already. If you want addition paper copies, send a written request to the office contact person at the address, fax or e-mail shown at the beginning of this Notice.
OUR NOTICE OF PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new Notice in our office and have addition copies available in our office.
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or 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 e-mail shown at the beginning of this Notice. If you prefer you can discussion your complaint in person or by phone.
FOR MORE INFORMATION
If you want more information about our privacy practices, call or visit the office contact person at the address or phone number shown at the beginning of this Notice.