Privacy Notice
NOTICE OF PRIVACY PRACTICES
Effective date of notice: April 14, 2003
All About Eyes Optometry
654-A N. Santa Cruz Avenue
Los Gatos, CA 95030
(408)399-3909 or (408)399-2600 Fax
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
OUR LEGAL DUTY
We respect our legal obligation to keep health information, that identifies you, private. The law obligates us to give you notice of our privacy practices. We must
follow the privacy practices that are described in this Notice while it is in effect.
CHANGES TO THIS NOTICE
We will 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 in compliance with and 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 and have copies available in our office.
USES AND DISCLOSURES OF HEALTH INFORMATION
We disclose health information about you for treatment, payment, and healthcare operations. We also use this information for these purposes. For example:
Treatment: We may use your health information to provide optometric services to you. For example, we may disclose your health information to an ophthalmologist or other healthcare provider providing treatment to you in order to: (a) provide, coordinate, or manage the health care and related services that are provided to you by health care practitioners (b) enable your health care providers to consult among themselves about your vision (c) refer you to a new health care provider or (d) to contact you in the event of a product recall. We may also use your health information for these purposes.
Payment: We may use and disclose medical information about you in order to be paid for the optometric services rendered to you. This may include contacting your health insurer to determine the existence of insurance coverage for the optometric services you receive, sending copies or excerpts of your health
information to your health insurer to receive payment, and using your health information for our own internal management of the billing process. By way of example, a bill sent to your insurance company may include information that identifies you and the procedures used to provide services to you.
Appointment Reminders and Treatment Alternatives: We may use or disclose your health information to provide you with appointment reminders (such as
voicemail messages, postcards, letters, or emails) or information about treatment alternatives or other health-related benefits and services that may be of
interest to you. We may also use your health information to provide you with information regarding services that we offer related to your healthcare needs.
Healthcare Operations: We may use and
disclose your health information in
connection with our healthcare operations.
Healthcare operations encompass all
those activities that we as an optometric
practice must do to run smoothly and
efficiently and specifically include activities
such as quality assessment and
improvement activities, reviewing the
competence or qualifications of healthcare
professionals, evaluating practitioner and
provider performance, and conducting
training programs, accreditation,
certification, licensing or credentialing
activities. For example, we may
periodically review your chart, as well as
those of other patients, in connection with
these activities. As part of our health care
operations, it may also become necessary
for us to use and disclose your health
information in connection with the
healthcare operations of another company
that has a relationship with you, such as
an HMO.
Business Associates: We may use and
disclose certain medical information about
you to our business associates. A
business associate is an individual or
entity under contract with us to perform or
assist us in performing a function or
activity that requires us to disclose your
health information to them. Examples of
business associates include, but are not
limited to, consultants, accountants,
lawyers and third-party billing companies.
We require the business associate to
protect the confidentiality of your health
information.
To You, Your Family and Friends: We
must disclose your health information to
you, as described in the Information
Rights section of this Notice. We may
disclose your health information to a family
member, friend or other person to help
with your healthcare or with payment for
your healthcare, but only if you agree or do
not object that we may do so or, if you are
not able to agree, if it is necessary in our
professional judgment.
Persons Involved in Care: We may use or
disclose health information to notify, or
assist in the notification of (including
identifying or locating) a family member,
your personal representative or another
person responsible for assisting you to
obtain health care services. If you are
present, then prior to use or disclosure of
your health information, we will provide you
with an opportunity to object to such uses
or disclosures. In the event you become
incapacitated, or during an emergency, we
may disclose your health information to
others, including health care providers, on
the basis of our professional judgment.
We will also use our professional
judgment and our experience with
common practice to make reasonable
inferences in your best interest in allowing
a person to pick up medical supplies or
forms of health information.
Required by Law: We may use or disclose
your health information when we are
required to do so by law, including
disclosures for use in judicial and
administrative proceedings, or to law
enforcement officials, or to the proper
authorities if we reasonably believe that
you are a possible victim of abuse,
neglect, domestic violence, or other
crimes.
Public Health: We may use or disclose
your health information in connection with
public health activities, health oversight
activities, and with worker?s
compensation matters. We may also
disclose your health information to the
extent necessary to avert a serious threat
to your health or safety or the health or
safety of others.
National Security: We may disclose to
military authorities the health information
of Armed Forces personnel under certain
circumstances. We may disclose to
authorized federal officials health
information required for lawful intelligence,
counterintelligence, and other national
security activities. We may disclose
protected health information to a
correctional institution or law enforcement
official having lawful custody of an inmate
or patient.
State Laws: The laws of the state where
you are receiving your optometric services
from us may provide greater rights to you.
To the extent your state has such laws,
they are described on the attachment to
this Notice.
Your Authorization: In addition to our use
and disclosure of your health information
for the purpose described above, you may
give us written authorization to use your
health information or to disclose it to
anyone for any purpose. If you give us an
authorization, you may revoke it in writing
at any time. Your revocation will not affect
any use or disclosures permitted by your
authorization while it was in effect. Unless
you give us a written authorization, we
cannot use or disclose your health
information for any reason except those
described in this Notice.
YOUR INFORMATION RIGHTS
Although all records concerning your
services obtained from us are our
property, you have the following rights
concerning your information.
Right to Request Restrictions: You have
the right to request restrictions on certain
uses and disclosures of your information.
We are not required to honor your request.
We encourage you to make these
requests in writing.
Right to Confidential Communications:
You have the right to receive confidential
communications of your information by
alternative means or at alternative
locations. For example, you may request
that we contact you only at work or by mail.
We require that you make this request in
writing.
Right to Inspect and Copy: You have the
right to inspect and copy your information
in most circumstances. We require that
you make this request in writing.
Right to Amend: You have the right to
amend your health information in
circumstances where you believe that
information is inaccurate or incomplete.
We require that you make this request in
writing, and that you tell us why you believe
that we should amend your information.
Right to an Accounting: You have the right
to request and obtain an accounting of
certain disclosures of your information.
You must make this request in writing.
Right to Obtain Copy: You have the right to
obtain a paper copy of this Notice upon
request. A request to exercise any of these
rights must be submitted to the Privacy
Officer. Forms to help you make your
request are available from the Privacy
Officer. You may also obtain paper copies
of these forms from us.
FOR MORE INFORMATION OR TO
REPORT A PROBLEM
If you have questions and would like
additional information, you may contact the
Privacy Officer at the address or phone
number at the beginning of this notice. If
you believe your privacy rights have been
violated, you may file a complaint with us
or with the Secretary of the Department of
Health and Human Services, Office of Civil
Rights, HIPAA, 200 Independence Avenue,
S.W., Washington, DC 20201. To file a
complaint with us, please contact the
Privacy Officer at the address or phone
number shown at the beginning of this
notice. All complaints must be submitted
in writing. There will be no retaliation for
filing a complaint.
Effective date of notice: April 14, 2003
All About Eyes Optometry
654-A N. Santa Cruz Avenue
Los Gatos, CA 95030
(408)399-3909 or (408)399-2600 Fax
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
OUR LEGAL DUTY
We respect our legal obligation to keep health information, that identifies you, private. The law obligates us to give you notice of our privacy practices. We must
follow the privacy practices that are described in this Notice while it is in effect.
CHANGES TO THIS NOTICE
We will 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 in compliance with and 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 and have copies available in our office.
USES AND DISCLOSURES OF HEALTH INFORMATION
We disclose health information about you for treatment, payment, and healthcare operations. We also use this information for these purposes. For example:
Treatment: We may use your health information to provide optometric services to you. For example, we may disclose your health information to an ophthalmologist or other healthcare provider providing treatment to you in order to: (a) provide, coordinate, or manage the health care and related services that are provided to you by health care practitioners (b) enable your health care providers to consult among themselves about your vision (c) refer you to a new health care provider or (d) to contact you in the event of a product recall. We may also use your health information for these purposes.
Payment: We may use and disclose medical information about you in order to be paid for the optometric services rendered to you. This may include contacting your health insurer to determine the existence of insurance coverage for the optometric services you receive, sending copies or excerpts of your health
information to your health insurer to receive payment, and using your health information for our own internal management of the billing process. By way of example, a bill sent to your insurance company may include information that identifies you and the procedures used to provide services to you.
Appointment Reminders and Treatment Alternatives: We may use or disclose your health information to provide you with appointment reminders (such as
voicemail messages, postcards, letters, or emails) or information about treatment alternatives or other health-related benefits and services that may be of
interest to you. We may also use your health information to provide you with information regarding services that we offer related to your healthcare needs.
Healthcare Operations: We may use and
disclose your health information in
connection with our healthcare operations.
Healthcare operations encompass all
those activities that we as an optometric
practice must do to run smoothly and
efficiently and specifically include activities
such as quality assessment and
improvement activities, reviewing the
competence or qualifications of healthcare
professionals, evaluating practitioner and
provider performance, and conducting
training programs, accreditation,
certification, licensing or credentialing
activities. For example, we may
periodically review your chart, as well as
those of other patients, in connection with
these activities. As part of our health care
operations, it may also become necessary
for us to use and disclose your health
information in connection with the
healthcare operations of another company
that has a relationship with you, such as
an HMO.
Business Associates: We may use and
disclose certain medical information about
you to our business associates. A
business associate is an individual or
entity under contract with us to perform or
assist us in performing a function or
activity that requires us to disclose your
health information to them. Examples of
business associates include, but are not
limited to, consultants, accountants,
lawyers and third-party billing companies.
We require the business associate to
protect the confidentiality of your health
information.
To You, Your Family and Friends: We
must disclose your health information to
you, as described in the Information
Rights section of this Notice. We may
disclose your health information to a family
member, friend or other person to help
with your healthcare or with payment for
your healthcare, but only if you agree or do
not object that we may do so or, if you are
not able to agree, if it is necessary in our
professional judgment.
Persons Involved in Care: We may use or
disclose health information to notify, or
assist in the notification of (including
identifying or locating) a family member,
your personal representative or another
person responsible for assisting you to
obtain health care services. If you are
present, then prior to use or disclosure of
your health information, we will provide you
with an opportunity to object to such uses
or disclosures. In the event you become
incapacitated, or during an emergency, we
may disclose your health information to
others, including health care providers, on
the basis of our professional judgment.
We will also use our professional
judgment and our experience with
common practice to make reasonable
inferences in your best interest in allowing
a person to pick up medical supplies or
forms of health information.
Required by Law: We may use or disclose
your health information when we are
required to do so by law, including
disclosures for use in judicial and
administrative proceedings, or to law
enforcement officials, or to the proper
authorities if we reasonably believe that
you are a possible victim of abuse,
neglect, domestic violence, or other
crimes.
Public Health: We may use or disclose
your health information in connection with
public health activities, health oversight
activities, and with worker?s
compensation matters. We may also
disclose your health information to the
extent necessary to avert a serious threat
to your health or safety or the health or
safety of others.
National Security: We may disclose to
military authorities the health information
of Armed Forces personnel under certain
circumstances. We may disclose to
authorized federal officials health
information required for lawful intelligence,
counterintelligence, and other national
security activities. We may disclose
protected health information to a
correctional institution or law enforcement
official having lawful custody of an inmate
or patient.
State Laws: The laws of the state where
you are receiving your optometric services
from us may provide greater rights to you.
To the extent your state has such laws,
they are described on the attachment to
this Notice.
Your Authorization: In addition to our use
and disclosure of your health information
for the purpose described above, you may
give us written authorization to use your
health information or to disclose it to
anyone for any purpose. If you give us an
authorization, you may revoke it in writing
at any time. Your revocation will not affect
any use or disclosures permitted by your
authorization while it was in effect. Unless
you give us a written authorization, we
cannot use or disclose your health
information for any reason except those
described in this Notice.
YOUR INFORMATION RIGHTS
Although all records concerning your
services obtained from us are our
property, you have the following rights
concerning your information.
Right to Request Restrictions: You have
the right to request restrictions on certain
uses and disclosures of your information.
We are not required to honor your request.
We encourage you to make these
requests in writing.
Right to Confidential Communications:
You have the right to receive confidential
communications of your information by
alternative means or at alternative
locations. For example, you may request
that we contact you only at work or by mail.
We require that you make this request in
writing.
Right to Inspect and Copy: You have the
right to inspect and copy your information
in most circumstances. We require that
you make this request in writing.
Right to Amend: You have the right to
amend your health information in
circumstances where you believe that
information is inaccurate or incomplete.
We require that you make this request in
writing, and that you tell us why you believe
that we should amend your information.
Right to an Accounting: You have the right
to request and obtain an accounting of
certain disclosures of your information.
You must make this request in writing.
Right to Obtain Copy: You have the right to
obtain a paper copy of this Notice upon
request. A request to exercise any of these
rights must be submitted to the Privacy
Officer. Forms to help you make your
request are available from the Privacy
Officer. You may also obtain paper copies
of these forms from us.
FOR MORE INFORMATION OR TO
REPORT A PROBLEM
If you have questions and would like
additional information, you may contact the
Privacy Officer at the address or phone
number at the beginning of this notice. If
you believe your privacy rights have been
violated, you may file a complaint with us
or with the Secretary of the Department of
Health and Human Services, Office of Civil
Rights, HIPAA, 200 Independence Avenue,
S.W., Washington, DC 20201. To file a
complaint with us, please contact the
Privacy Officer at the address or phone
number shown at the beginning of this
notice. All complaints must be submitted
in writing. There will be no retaliation for
filing a complaint.