We respect our legal obligation to keep health information that
identifies you private. This Notice describes how we protect your
health information and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
We will use your Protected Health Information (PHI) for
treatment. This may include setting up an appointment for you,
examining your eyes, prescribing glasses, contact lenses, or
medications. In addition, we may share your PHI with referring
physicians, laboratories, pharmacies, or other health care personnel
providing you treatment.
We will use your PHI to collect payment for treatment you receive
in our office. We may do this with insurance forms filed for you in
the mail or sent electronically. We will be sure to only work with
companies with a similar commitment to the security of your health
information.
We may disclose your PHI for Health Care Operations. This means
our office may use information in your health record to monitor the
performance of the doctors and staff members providing treatment to
you. This information will be used in an effort to continually
improve the quality and effectiveness of the services we provide.
ADDITIONAL USES AND DISCLOSURES FOR OTHER REASONS WITHOUT
PERMISSION
In some situations, the law allows or requires us to use or
disclose your health information without your permission. Some of
these situations may never come up in our office. These disclosures
include:
- State or Federal law that mandates release of certain health
information;
- certain public health purposes, such as contagious disease
reporting,
investigations, and notices to and from the FDA regarding drugs
or medical devices;
- release of information to government authorities about victims
of
suspected abuse, neglect, or domestic violence;
- uses and disclosures for health oversight activities,
such as for the licensing of doctors; for audits by Medicare
or Medicaid; or for investigations of possible violations of
health care laws;
- disclosures for Judicial and administrative
proceedings, such as in response to subpoenas or orders of
courts or administrative agencies;
- disclosures to law enforcement agencies to provide
information about crimes committed in our office or
elsewhere;
- disclosures for health related research;
- disclosures to prevent serious threats to health or safety;
- uses or disclosures for specialized government
functions, such as protection of high ranking government
officials, for lawful national intelligence activities, or
for military purposes;
- disclosures of de-identified information;
- disclosures relating to worker's compensation programs;
- disclosures to "business associates" who perform health
care operations for us and who commit to respect the privacy
of your health information;
- incidental disclosures that are an unavoidable
by-product of permitted uses or disclosures.
Unless you object, we may also share relevant information about
your care with your family or friends who are helping you with your
eye care.
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled appointments. We
may also mail you appointment reminders on post cards, or leave
reminder messages on your answering machine or with someone who
answers your phone if you are not home.
OTHER USES AND DISCLOSURES OF PHI
This office will obtain your written authorization before using
or disclosing PHI about you for the purposes other than those
provided for above (or as otherwise permitted or required by law).
You may revoke this authorization in writing at anytime. Upon
receipt of the written revocation, we will stop using or disclosing
PHI about you, except to the extent that we have already taken
action in reliance on the authorization.
YOUR HEALTH INFORMATION RIGHTS
You may obtain a paper copy of this notice upon request at any
time. To receive a paper copy, please contact our office.
You may request a restriction on certain uses and disclosures of
PHI. You have the right to request additional restrictions on our
use or disclosure of PHI about you by sending a written request to
our office. We do not have to agree to your request, but if we
agree, we must honor your restrictions.
You have the right to access and copy your PHI. For the most part
you will be able to review or have a copy of your health information
within 30 days of asking us. We may charge a small fee for our time
and the photocopying. By law, there are a few limited situations in
which we can refuse to permit access. If you are denied access to
your PHI, you may ask that the denial be reviewed.
If you feel that your PHI is incomplete or incorrect, you may
request that we amend it. You may make this request for as long as
we maintain the PHI. To receive an amendment, you must send a
written request to our office. You must include a reason that
supports your request. In certain cases, we may deny your request
for amendment. If we deny your request for amendment, you have the
right to file a statement of disagreement and we may give you a
rebuttal to your
statement.
You have the right to get a list of the disclosures that we have
made of your PHI within the past six years (or shorter period of
time). By law, the list will not include: disclosures for purposes
of treatment, payment, or health care operations, and some other
limited disclosures. You are entitled to one such list per year
without charge. If you want more frequent lists, we will collect a
small charge in advance.
You may request additional paper copies of this Notice of Privacy
Practice at any time. If you want additional copies, send a written
request to our office contact person.
We are required by law to maintain the privacy of your health
information and to provide you with this Notice of our Privacy
Practices. We are required to practice the policies and procedures
described in this notice but we reserve the right to change the
terms of our Notice. If we change our privacy practices, we will be
sure all our patients receive the revised Notice.
Your have the right to express complaints to us or to the U.S.
Department of Health and Human Services, Office of Civil Rights, if
you believe your privacy rights have been compromised. If you want
to complain to us, send a written complaint to the office contact
person listed at the top of this notice. If you prefer, you can
discuss your complaint in person or by phone.
Crystal Eyes Vision Center
