We respect our legal obligation to keep your health & identification information 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 we use or disclose your
health information is for treatment, payment or health care
operations. Examples of how we use or disclose information for
treatment purposes are: setting up and reminding (this may be by
phone or mail at your home, we may speak to you or leave a message
with a person or machine) of appointments for you; testing or
examining your eyes; prescribing glasses, contact lenses, or eye
medications and faxing the prescriptions to be filled; referring you to another doctor or clinic for eye care or
low vision aids or services; or 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 use or disclose your health information for health care
operations are: financial or billing audits; internal quality
assurance; personnel decisions; participation in managed care
plans; defense of legal matters; business planning; and outside
storage of our records.
We routinely use your health information inside
our office for these purposes without any special permission. If
we need to disclose your health information outside of our office
for the above listed reasons, we will not ask you for 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 your health information without
your permission. Not all of these situations will apply to us;
some may never come up at our office at all. Such uses or
disclosures are:
State or federal law mandates, for public health
purposes, such as contagious disease reporting, investigation or
surveillance; and notices to and from the federal Food and Drug
Administration regarding drugs or medical devices; abuse or
neglect, health oversight activities, for audits by Medicare or
Medicaid, or for investigation of possible violations of health
care laws, disclosures for judicial and administrative
proceedings, law enforcement purposes, medical examiner, funeral
directors, to organizations that handle organ or tissue donations,
for health related research, to prevent a serious threat to health
or safety;, specialized government functions, lawful national
intelligence activities, military purposes, evaluation and health
of members of the foreign service, de-identified information,
worker’s compensation programs, "limited data set" for research,
public health, or health care operations, incidental disclosures
that are an unavoidable by-product of permitted uses or
disclosures; disclosures to "business associates" who perform
health care operations for us and who commit to respect the
privacy of your health information.
Unless you object, we will also share relevant
information about your care with your family or friends who are
helping you with your eye care.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of
your health information unless you sign a written "authorization
form." The content of an "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 your 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 end of this 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 restrictions that you want.
·
Ask us to communicate with you in a confidential way. We
will accommodate these requests if they are reasonable.
·
Ask to see or to get photocopies of your health
information. Under federal law however, you may not inspect or
copy the following records; psychotherapy notes; information
compiled in reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding, and protected
health information that is subject to law that prohibits access to
protected health information
·
Request an amendment of your health information 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.
·
Obtain a list of the disclosures 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
purposes of treatment, payment or health care operations;
disclosures with your authorization; incidental disclosures;
disclosures required by law; and some other limited disclosures.
You are entitled to one such list per year without charge.
·
Obtain additional paper copies of this Notice of Privacy
Practices upon request.
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, have copies available in our office, and post it on our
Web site www.looks4you.com
COMPLAINTS
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
via mail or fax or you can E mail the office manager at admin@looks4you.com. If you prefer, you can discuss 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. However, if you
would like to request a restriction you must send a written request.