Privacy Notice
THIS NOTICE DESCRIBES HOW MEDICINE INFORMATION ABOUT YOU MAY BE DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFOMATION. PLEASE REVIEW IT CAREFULLY.
We respect our legal obligation to keep health infomation that identafies you private. We are obligated by law to give you notice of our practices. This Notice describes how we protect you health information and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use our disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for tratment purposes are: setting uo an appointment for you terting of examining your eyes prescribing glasses, contanct lenses, or eye medacations and faxing them to be filled showing you low vision aids referring you to anthor doctor or clinic for eye care or low vision aids or services or getting copies of your health infomation from another proffesional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking about your health or vision care plans, or other sources of payment prepating adn sending bills or claims and collenting unpaid amounts (eihter ourselves or through a collention agency or attorney). "Health care operations" means those administrative and managerial functions tha we have to do in order to run our office. Examples of how we use or disclose you health infomation for health care operations are: financial or billing audits internal quality assurance personnel dicisions participating in managed care plans defense of legal matters business palnning and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permession. If we neeed to disclose your health infomation outside of our office for these reasons [we usually will not] ask you for special written permission.
USES AND DISCLOSED FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us some may never come up at our officeat all. Such uses or disclose are:
when a state or federal law mandates that certain didease reported for a specific purpose for public health purposes, such as contagious disease reporting, inverigation or surveillance and notices to and from the federal Food and Drug Administration regarding drugs or medical devices diclosures to governmetal authorities about victims of suspected abuse, neglect or demestic violance uses and diclouser for healtho oversight activities, such as for the licensing of doctors for audits by Medicare or Medicaid or for investigation of possible violatios of health care laws diclosure fo judicial an administrive proceedings, such as in response to subpoenas or orders of courts or administrative agencies discloures for law eforcment puposes, such as to provide information about someonewho is or is suspected to be a victim of a crime to provide infomrmation about a crimeat our office or to repert a crime that happennes 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 diclosures for health related research uses or diclosures for specialized government functions, such as for the protection of the protection of the president or high renking government officials for lawful national intelligence activities for military purposes for the evaluation and health of members of the foreing service disclosures of de-identified information disclosures relating to worker's compensation programs disclosures of a "limited data set" for research, public health, or health care operations incidental disclosures that are an unavoidable by-product of permitted uses or diclousures diclosures to "buisiness associates" who perform heath care operations for us and who commit to respect the privacy of your health information.
Unless you object, we will also share relavent information about your care with your family or friends who are helping you with your eye care.
APPINTMENTS REMINDERS
We may call or write to remind you of scheduled appoinments, or that it is time to make a routine appoinment. 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 mail you an appoinment reminder card, and/or leave you a reminder massage on you machine or with someone who answers your phone if you are not home.
OTHER USES AND DISCLOSURES
We will not make any other uses of your health information unless you sign a written "authorise form" is determined by federal law. Sometimes, we may initiate the authorized process if the uses or disclosure is our idea. Sometimes, you may initiate the process if it's your idea for us to send your information ro 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 form 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 writting. Send them to the office contact person named at the begginig of this notice.
YOU RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you rights regarding you health infomation. You can: ask us to restrict our uses and disclosures for purposes of treatment(except emergencys treatment), payment or health care operations. We do not have to do this, but if we agree, we must honot the restricitions that you want. To ask for restrictions, send a written request to the office contact person at the address, fax or E Mail shown at the beginning ag this Notice.
Ask us to communicate with you in a cofidential way, such as by phoning you at work rather than at home, by mailing health infomation to a different address, or by using E mail to your personal E mail address. We will accommodate these request if they are reasonable, and if you pay us for the extra cost. If you want to ask for confidental communications, send a written reequest to the office contact person at the address, fax or E mai shown at the beginnig of this Noice. Ask to see or to get photocopies of your health infomation. By law, there are a few limited situations in which we can refuse to permit access of copying. For the most part, however, you will be able to review or have a copy of your health infomation within 30 days of aking us (or sixty days if the information is stored off-site). You may have to pay for photo copies in advance. If we deny your request, we will send you a written esplanation, and instructions about how to get an impatial review of our denial if one is legally available. By law, we can hane one 30 day extension of the time for us to give you access of photo copies of we send youa written notice of the extension. If you want to review or ger a photo copies of you health infomation, send a written request to the office person at the address, fax or E mail shown at the beginning of this Notice.
Ask us to amend you health infomation if you think that it is incorrect or incomlete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to the persons whoe we know got the wrong information, and others thar you specify. If we do not agree,you can write a statement of your position, and we will include it with your health iformation along with any rebuttal statemnent that we may write. Once your statement of position and/or our rebuttal is included in your health informatin, we will send it along whenever we make a permitted disclosureof your health information. By law, we can have amend your health information, send a written request, including your reasons fot the amendment, to the office contact person at the address, fax or E mail shown at the begenning of this Notice.
Get a list of the disclosures that we have make 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 perposues of treatment,paymet or health care operations disclosures with your authorization incidential disclosures diclosures required by law and some other limited disclosures. You are entitled to one such list per year without charge. If you want mote frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receveing it, but by law we can have a 30 day extension of time if we notify you of the extension in writting. If you want a list, send a wriiten request to the office contanct person at the address, fax or E mail shown in the beginnig of this Notice.
Get additional 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 additional 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 ifomation 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, we have copies available in our office, and post it on our Web site.
COMPLAINTS
If you think that we have not properly respected yte privacy of you health information, you are free to complian 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 discuss your complaint in person of 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 beginnig of this Notice.
We respect our legal obligation to keep health infomation that identafies you private. We are obligated by law to give you notice of our practices. This Notice describes how we protect you health information and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use our disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for tratment purposes are: setting uo an appointment for you terting of examining your eyes prescribing glasses, contanct lenses, or eye medacations and faxing them to be filled showing you low vision aids referring you to anthor doctor or clinic for eye care or low vision aids or services or getting copies of your health infomation from another proffesional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking about your health or vision care plans, or other sources of payment prepating adn sending bills or claims and collenting unpaid amounts (eihter ourselves or through a collention agency or attorney). "Health care operations" means those administrative and managerial functions tha we have to do in order to run our office. Examples of how we use or disclose you health infomation for health care operations are: financial or billing audits internal quality assurance personnel dicisions participating in managed care plans defense of legal matters business palnning and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permession. If we neeed to disclose your health infomation outside of our office for these reasons [we usually will not] ask you for special written permission.
USES AND DISCLOSED FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us some may never come up at our officeat all. Such uses or disclose are:
when a state or federal law mandates that certain didease reported for a specific purpose for public health purposes, such as contagious disease reporting, inverigation or surveillance and notices to and from the federal Food and Drug Administration regarding drugs or medical devices diclosures to governmetal authorities about victims of suspected abuse, neglect or demestic violance uses and diclouser for healtho oversight activities, such as for the licensing of doctors for audits by Medicare or Medicaid or for investigation of possible violatios of health care laws diclosure fo judicial an administrive proceedings, such as in response to subpoenas or orders of courts or administrative agencies discloures for law eforcment puposes, such as to provide information about someonewho is or is suspected to be a victim of a crime to provide infomrmation about a crimeat our office or to repert a crime that happennes 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 diclosures for health related research uses or diclosures for specialized government functions, such as for the protection of the protection of the president or high renking government officials for lawful national intelligence activities for military purposes for the evaluation and health of members of the foreing service disclosures of de-identified information disclosures relating to worker's compensation programs disclosures of a "limited data set" for research, public health, or health care operations incidental disclosures that are an unavoidable by-product of permitted uses or diclousures diclosures to "buisiness associates" who perform heath care operations for us and who commit to respect the privacy of your health information.
Unless you object, we will also share relavent information about your care with your family or friends who are helping you with your eye care.
APPINTMENTS REMINDERS
We may call or write to remind you of scheduled appoinments, or that it is time to make a routine appoinment. 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 mail you an appoinment reminder card, and/or leave you a reminder massage on you machine or with someone who answers your phone if you are not home.
OTHER USES AND DISCLOSURES
We will not make any other uses of your health information unless you sign a written "authorise form" is determined by federal law. Sometimes, we may initiate the authorized process if the uses or disclosure is our idea. Sometimes, you may initiate the process if it's your idea for us to send your information ro 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 form 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 writting. Send them to the office contact person named at the begginig of this notice.
YOU RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you rights regarding you health infomation. You can: ask us to restrict our uses and disclosures for purposes of treatment(except emergencys treatment), payment or health care operations. We do not have to do this, but if we agree, we must honot the restricitions that you want. To ask for restrictions, send a written request to the office contact person at the address, fax or E Mail shown at the beginning ag this Notice.
Ask us to communicate with you in a cofidential way, such as by phoning you at work rather than at home, by mailing health infomation to a different address, or by using E mail to your personal E mail address. We will accommodate these request if they are reasonable, and if you pay us for the extra cost. If you want to ask for confidental communications, send a written reequest to the office contact person at the address, fax or E mai shown at the beginnig of this Noice. Ask to see or to get photocopies of your health infomation. By law, there are a few limited situations in which we can refuse to permit access of copying. For the most part, however, you will be able to review or have a copy of your health infomation within 30 days of aking us (or sixty days if the information is stored off-site). You may have to pay for photo copies in advance. If we deny your request, we will send you a written esplanation, and instructions about how to get an impatial review of our denial if one is legally available. By law, we can hane one 30 day extension of the time for us to give you access of photo copies of we send youa written notice of the extension. If you want to review or ger a photo copies of you health infomation, send a written request to the office person at the address, fax or E mail shown at the beginning of this Notice.
Ask us to amend you health infomation if you think that it is incorrect or incomlete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to the persons whoe we know got the wrong information, and others thar you specify. If we do not agree,you can write a statement of your position, and we will include it with your health iformation along with any rebuttal statemnent that we may write. Once your statement of position and/or our rebuttal is included in your health informatin, we will send it along whenever we make a permitted disclosureof your health information. By law, we can have amend your health information, send a written request, including your reasons fot the amendment, to the office contact person at the address, fax or E mail shown at the begenning of this Notice.
Get a list of the disclosures that we have make 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 perposues of treatment,paymet or health care operations disclosures with your authorization incidential disclosures diclosures required by law and some other limited disclosures. You are entitled to one such list per year without charge. If you want mote frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receveing it, but by law we can have a 30 day extension of time if we notify you of the extension in writting. If you want a list, send a wriiten request to the office contanct person at the address, fax or E mail shown in the beginnig of this Notice.
Get additional 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 additional 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 ifomation 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, we have copies available in our office, and post it on our Web site.
COMPLAINTS
If you think that we have not properly respected yte privacy of you health information, you are free to complian 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 discuss your complaint in person of 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 beginnig of this Notice.