Privacy Notice
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Please read it carefully.
This notice is solely for your information. Healthy Eyes Optometry Inc(We or Us) understands that your personal health information (Personal Health Information) is confidential. This notice of our privacy practices describes generally how we may use and disclose this Personal Health Information to provide services to you and other purposes that are permitted or required by law. This Notice also explains your rights regarding Personal Health Information. This Notice becomes effective as of April 14, 2003. Personal Health Information is protected health information that individually identifies you and relates to past, present, and future health care or payment for such health care services. We are required by the federal privacy regulations to keep Personal Health Information about you private give you this Notice of our legal duties and privacy practices with respect to your Personal Health Information and follow the terms of the Notice that are currently in effect.
Our legal duty is to abide by these laws and policies described in this notice. We reserve the right to change our privacy practice and to make new provisions at anytime provided such changes are permitted by applicable law. In the event we make a material change in our privacy practices, we will change this notice and provide it to you.
We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or to disclose your health information after we have received a written revocation of the authorization. You may request a copy of our notice at any time. Please call our office at 916-983-6838.
HOW WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION
In performing our duties, we may use and disclose your Personal Health Information in various ways. We have provided you with examples in certain categories, however, not every use or disclosure in a category will be listed. Such uses and disclosures include:
Treatment
We may use or disclose Personal Health Information to your providers, including, optometrists, optical dispensaries or physicians who participate in the provision of your health care. We may confirm your prescription with the optical lab or contact lens distributor. We may provide you with an appointment reminder, general vision care information, including information regarding alternative treatment, services, products or options (e.g. new types of lenses or frames, or services) through telephone, mail or e-mail.
Payment
When you use your health care or vision benefits, We may use and disclose Personal Health Information about you in several ways, such as, to determine your eligibility in a vision or health care plan, determine your plan benefits, bill and collect payment, coordinate your benefits, or investigate a claim. For example, we may send a claim to your vision plan identifying you and services provided to you so that we may be paid. We may release Personal Health Information about your dependants to you. We may provide you with an explanation of benefits for you or your dependants.
Health Care Operations
We may use and disclose Personal Health Information about you for certain operational, administrative, research and quality assurance activities. For example, we may perform quality of care reviews, investigation of fraud, and review services and products to evaluate our performance in serving you. We may assist your health plan in conducting a review of claims submitted by us to ensure you are charged correctly. We may contact you for customer surveys to monitor quality of services and products.
Persons Involved in Care
We may use our discretion to disclose Personal Health Information to notify a family member, your personal representative or another person involved in your care. For example, we may allow a person to pick up your finished glasses or lenses, medical supplies, or copy of your prescription. We may disclose your Personal Health Information to a family member, friend or other person to the extent necessary to help with your care or with payment for your care.
Additional Uses or Disclosures
We may disclose Personal Health Information about you concerning:
Public Health or Safety to address situations as permitted by law, including reporting problems with products or product recall notices, threats to public health and safety, disaster relief efforts or national security.
Military as required by military command authorities if you are serving in the military.
Organ and Tissue Donation to assist in organ or tissue donation and transplantation.
Law Enforcement to respond to a law enforcement official, court or administrative order or other lawful purposes.
Coroners, Medical Examiners.
Regulatory or Administrative Oversight to state insurance departments, Office of Civil Rights, Department of Health and Human Services and others that regulate us.
Contractors who are our business associates and provide services to us who will be required to protect your Personal Health Information.
Disclosure as You Request
We may only use and disclose Personal Health Information as generally described in this Notice or according to laws that apply to us. Other uses or disclosure of your Personal Health Information will be made only with your written permission, identified as an authorization.
If you revoke your permission, we will no longer use or disclose Personal Health Information about you for the reasons stated in your authorization, except to the extent that we have already taken action in reliance on the authorization.
YOUR RIGHTS REGUARDING PERSONAL HEALTH INFORMATION
You have the following rights regarding your Personal Health Information:
Right to Inspect and Copy. You have the right to inspect and copy Personal Health Information that we maintain. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
Right to Amend. If you feel that Personal Health Information we have about you is incorrect or incomplete, you may ask us to amend your Personal Health Information. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request, the current information is accurate and complete or if we did not create information. If we deny your request, you may send us a written notice of disagreement with our denial.
Right to an Accounting of Disclosures. You have the right to request a list of our disclosures for purposes other that treatment, payment or health care operations or disclosures made to you or your representative, authorized by you, or made to law enforcement personnel. Your request must state a time period and may not include dates before April 14 2003. If you request more than one list in a year, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may change your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request that we restrict the way we use or disclose Personal Health Information regarding treatment, payment or health care operations. You also have the right to request that we restrict the Personal Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request.
Right to Request Confidential communications. You have the right to make a reasonable request that we communicate Personal Health Information to you in a certain way or at a certain address. Your request must specify how or where you wish to be contacted. We will comply with reasonable requests.
Right to a Paper Copy. If you receive this Notice from our Web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form, and you may request from us a paper copy of this Notice at any time.
You may request any of the above described by submitting a written request via e-mail to [email protected] or written correspondence to Healthy Eyes Optometry, 2690 E. Bidwell St, Suite 500, Folsom, CA 95630 Attention: Dr. Han.
Please include your name, address, and telephone number.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the owner. Submit all complaints in writing to Healthy Eyes Optometry Inc, 2690 E. Bidwell St, Suite 500, Folsom, CA 95630 Attention: Dr. Han or e-mail the complaint to [email protected]
You must include your name, address, telephone number, the location and a description of the complaint and we will respond. You may also contact the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
CHANGES TO THIS NOTICE
We may change the terms of this Notice and our privacy policies. If we make such changes, the new terms and policies will apply to all Personal Health Information that we currently have or receive in the future. The effective date of this notice and any revised notice may be found on the first page of the notice. We will post the current notice on Healthy Eyes Optometry web site.
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Please read it carefully.
This notice is solely for your information. Healthy Eyes Optometry Inc(We or Us) understands that your personal health information (Personal Health Information) is confidential. This notice of our privacy practices describes generally how we may use and disclose this Personal Health Information to provide services to you and other purposes that are permitted or required by law. This Notice also explains your rights regarding Personal Health Information. This Notice becomes effective as of April 14, 2003. Personal Health Information is protected health information that individually identifies you and relates to past, present, and future health care or payment for such health care services. We are required by the federal privacy regulations to keep Personal Health Information about you private give you this Notice of our legal duties and privacy practices with respect to your Personal Health Information and follow the terms of the Notice that are currently in effect.
Our legal duty is to abide by these laws and policies described in this notice. We reserve the right to change our privacy practice and to make new provisions at anytime provided such changes are permitted by applicable law. In the event we make a material change in our privacy practices, we will change this notice and provide it to you.
We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or to disclose your health information after we have received a written revocation of the authorization. You may request a copy of our notice at any time. Please call our office at 916-983-6838.
HOW WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION
In performing our duties, we may use and disclose your Personal Health Information in various ways. We have provided you with examples in certain categories, however, not every use or disclosure in a category will be listed. Such uses and disclosures include:
Treatment
We may use or disclose Personal Health Information to your providers, including, optometrists, optical dispensaries or physicians who participate in the provision of your health care. We may confirm your prescription with the optical lab or contact lens distributor. We may provide you with an appointment reminder, general vision care information, including information regarding alternative treatment, services, products or options (e.g. new types of lenses or frames, or services) through telephone, mail or e-mail.
Payment
When you use your health care or vision benefits, We may use and disclose Personal Health Information about you in several ways, such as, to determine your eligibility in a vision or health care plan, determine your plan benefits, bill and collect payment, coordinate your benefits, or investigate a claim. For example, we may send a claim to your vision plan identifying you and services provided to you so that we may be paid. We may release Personal Health Information about your dependants to you. We may provide you with an explanation of benefits for you or your dependants.
Health Care Operations
We may use and disclose Personal Health Information about you for certain operational, administrative, research and quality assurance activities. For example, we may perform quality of care reviews, investigation of fraud, and review services and products to evaluate our performance in serving you. We may assist your health plan in conducting a review of claims submitted by us to ensure you are charged correctly. We may contact you for customer surveys to monitor quality of services and products.
Persons Involved in Care
We may use our discretion to disclose Personal Health Information to notify a family member, your personal representative or another person involved in your care. For example, we may allow a person to pick up your finished glasses or lenses, medical supplies, or copy of your prescription. We may disclose your Personal Health Information to a family member, friend or other person to the extent necessary to help with your care or with payment for your care.
Additional Uses or Disclosures
We may disclose Personal Health Information about you concerning:
Public Health or Safety to address situations as permitted by law, including reporting problems with products or product recall notices, threats to public health and safety, disaster relief efforts or national security.
Military as required by military command authorities if you are serving in the military.
Organ and Tissue Donation to assist in organ or tissue donation and transplantation.
Law Enforcement to respond to a law enforcement official, court or administrative order or other lawful purposes.
Coroners, Medical Examiners.
Regulatory or Administrative Oversight to state insurance departments, Office of Civil Rights, Department of Health and Human Services and others that regulate us.
Contractors who are our business associates and provide services to us who will be required to protect your Personal Health Information.
Disclosure as You Request
We may only use and disclose Personal Health Information as generally described in this Notice or according to laws that apply to us. Other uses or disclosure of your Personal Health Information will be made only with your written permission, identified as an authorization.
If you revoke your permission, we will no longer use or disclose Personal Health Information about you for the reasons stated in your authorization, except to the extent that we have already taken action in reliance on the authorization.
YOUR RIGHTS REGUARDING PERSONAL HEALTH INFORMATION
You have the following rights regarding your Personal Health Information:
Right to Inspect and Copy. You have the right to inspect and copy Personal Health Information that we maintain. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
Right to Amend. If you feel that Personal Health Information we have about you is incorrect or incomplete, you may ask us to amend your Personal Health Information. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request, the current information is accurate and complete or if we did not create information. If we deny your request, you may send us a written notice of disagreement with our denial.
Right to an Accounting of Disclosures. You have the right to request a list of our disclosures for purposes other that treatment, payment or health care operations or disclosures made to you or your representative, authorized by you, or made to law enforcement personnel. Your request must state a time period and may not include dates before April 14 2003. If you request more than one list in a year, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may change your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request that we restrict the way we use or disclose Personal Health Information regarding treatment, payment or health care operations. You also have the right to request that we restrict the Personal Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request.
Right to Request Confidential communications. You have the right to make a reasonable request that we communicate Personal Health Information to you in a certain way or at a certain address. Your request must specify how or where you wish to be contacted. We will comply with reasonable requests.
Right to a Paper Copy. If you receive this Notice from our Web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form, and you may request from us a paper copy of this Notice at any time.
You may request any of the above described by submitting a written request via e-mail to [email protected] or written correspondence to Healthy Eyes Optometry, 2690 E. Bidwell St, Suite 500, Folsom, CA 95630 Attention: Dr. Han.
Please include your name, address, and telephone number.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the owner. Submit all complaints in writing to Healthy Eyes Optometry Inc, 2690 E. Bidwell St, Suite 500, Folsom, CA 95630 Attention: Dr. Han or e-mail the complaint to [email protected]
You must include your name, address, telephone number, the location and a description of the complaint and we will respond. You may also contact the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
CHANGES TO THIS NOTICE
We may change the terms of this Notice and our privacy policies. If we make such changes, the new terms and policies will apply to all Personal Health Information that we currently have or receive in the future. The effective date of this notice and any revised notice may be found on the first page of the notice. We will post the current notice on Healthy Eyes Optometry web site.