Privacy Notice
PLEASE REVIEW THIS CAREFULLY.
We are obligated by law to give you notice of our privacy
prectices. this notice describes how we protect your health
information and what rights you have regarding it.
prectices. this notice describes how we protect your health
information and what rights you have regarding it.
the most common reason why we disclose your health
information is for treatment, payment or health care
operations. We use your health information inside our
offices for these purposes without any special permission.
If we need to disclose your health information outside of
our offices for these reasons, we usually will not ask you
for special written permission. In some situations, the law
allows us to use or disclose your health information
without your permisssion. Unless you oblect, we will also
share relevent information about your care with your family
or friends who are helping you with your eyecare.
information is for treatment, payment or health care
operations. We use your health information inside our
offices for these purposes without any special permission.
If we need to disclose your health information outside of
our offices for these reasons, we usually will not ask you
for special written permission. In some situations, the law
allows us to use or disclose your health information
without your permisssion. Unless you oblect, we will also
share relevent information about your care with your family
or friends who are helping you with your eyecare.
We may call or email to remind you of scheduled
appointments, or that it is time to make a routine
appointment. Unless you tell us otherwise, we will mail you
an appointment reminder on a post card or send an electronic reminder, leave a
message on your home answering machine or with
someone who answers your phone if you are not home.
appointments, or that it is time to make a routine
appointment. Unless you tell us otherwise, we will mail you
an appointment reminder on a post card or send an electronic reminder, leave a
message on your home answering machine or with
someone who answers your phone if you are not home.
We will not make any other uses or disclosures of your
health information unless you sign a written "authorization
form." The content of the "authorization form" is
determined by federal law. 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.
health information unless you sign a written "authorization
form." The content of the "authorization form" is
determined by federal law. 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.
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), payment, or health care
operations. We do not have to agree to do this, but if we
agree, we must honor the restrictions you want. To ask for
a restriction, send a written request to the contact person
of the office.
--ask us to communicate with you in a confidential way,
such as phoning you at work rather than home. We will
accommodate these requests if they are reasonable, and if
you pay us for any extra cost. Requests should be made in
writing.
--ask to see or to get photocopies of you rhealth
information. You will be able to review or have a copy of
your health information within 30 days of asking us. You
may have to pay for the photocopies in advance. By law,
we can have one 30 day extension of the time for us to give
you access or photocpies if we send you a written notice of
the extension. If you wouod like to review or get
photocopies of your health information, send a written
request to the contact person.
--ask us to amend your health information if you think
thaat it is incorrect or incomplete. If we agree we will
amend the information within 60 days from when you ask
us. We will send the corrected information to persons who
we know received the wrong information, and others 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 statemtn you may
write. By law we can have a 30 day extension of time to
consider a request for amendment if we notify you in
writing.
--get a list of the disclosures that we have made of your
health informationwithin the past 6 years. By law, the list
will not include:disclosures for purposes of treatment,
payment or health care operationsdisclosures with your
authorizationincidental disclosuresdisclosures required by
lawand some other limited disclosures. We usually
respond to you r 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 writing.
--get additional paper copies of this Notice of Privacy
Practices upon request. If you want additional paper
copies, send a written request to the contact person.
information. you can:
--ask us to restrict our uses and disclosures for purposes
of treatment(except emergency), payment, or health care
operations. We do not have to agree to do this, but if we
agree, we must honor the restrictions you want. To ask for
a restriction, send a written request to the contact person
of the office.
--ask us to communicate with you in a confidential way,
such as phoning you at work rather than home. We will
accommodate these requests if they are reasonable, and if
you pay us for any extra cost. Requests should be made in
writing.
--ask to see or to get photocopies of you rhealth
information. You will be able to review or have a copy of
your health information within 30 days of asking us. You
may have to pay for the photocopies in advance. By law,
we can have one 30 day extension of the time for us to give
you access or photocpies if we send you a written notice of
the extension. If you wouod like to review or get
photocopies of your health information, send a written
request to the contact person.
--ask us to amend your health information if you think
thaat it is incorrect or incomplete. If we agree we will
amend the information within 60 days from when you ask
us. We will send the corrected information to persons who
we know received the wrong information, and others 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 statemtn you may
write. By law we can have a 30 day extension of time to
consider a request for amendment if we notify you in
writing.
--get a list of the disclosures that we have made of your
health informationwithin the past 6 years. By law, the list
will not include:disclosures for purposes of treatment,
payment or health care operationsdisclosures with your
authorizationincidental disclosuresdisclosures required by
lawand some other limited disclosures. We usually
respond to you r 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 writing.
--get additional paper copies of this Notice of Privacy
Practices upon request. If you want additional paper
copies, send a written request to the contact person.
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 or Notice of Privacy Practices, we will
post the new notice in our office and have copies available.
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 or Notice of Privacy Practices, we will
post the new notice in our office and have copies available.
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.
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 more information about our privacy practices,
call or visit the office and speak to the contact person.
call or visit the office and speak to the contact person.