This notice describes how medical information about you may be used and disclosed, and how you can obtain access to this information. Please review it carefully. 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. Generally, we can only use your health information in our office or disclose it outside of our office, without your written permission, for purposes of treatment, payment, or health care operations. In most situations, we will not use or disclose your health information unless you sign a written authorization form. In some limited situations, the law allows or requires us to disclose your health information without written authorization to government agencies.
Uses or Disclosures of Health Information
Examples of how we use information for treatment purposes:
When we set up an appointment for you.
When our technician or doctor tests your eyes.
When the doctor prescribes glasses or contact
When the doctor prescribes medication.
When our staff helps you select and order glasses
or contact lenses.
If we refer you to another doctor or clinic for
eye care or low vision aids or services.
If we send a prescription for glasses or
contacts to another professional to be filled.
When we provide a prescription for medication to
When we phone to let you know that your glasses
or contact lenses are ready for pick up.
We may use your health information within our office or disclose your health information outside of our office for payment purposes. Some examples are:
When our staff asks you about health or vision
care plans that you may belong to, or about
other sources of payment for our services.
When we prepare bills to send to your
health or vision care plan.
When we process payment by credit card and when
we try to collect unpaid amounts due.
When bills or claims for payment are mailed,
fixed, or sent by computer to you or your health
or vision plan.
When we occasionally have to ask a collection
agency or attorney to help us with unpaid
We use and disclose your health information for health care operations in a number of ways. Health care operations mean those administrative and managerial functions that we have to do in order to run our office. We may use or disclose your health information, for example, for financial or billing audits, for internal quality assurance, for personal decisions, to enable our doctors to participate in managed care plans, for the defense of legal matters, to develop business plans, and for outside storage of our records.
We may call to remind you of a scheduled appointment. We may also call to notify you of other treatments or services available at our office that might help you.
Uses & Disclosures Without An Authorization
In some limited situations, the law allows or requires us to give or disclose your health information without your permission. Not all of these situations will apply to us ; some may never happen at our office at all. Such uses or disclosures are:
A state or federal law that mandates certain
health information be reported for a specific
Public health purposes, such as contagious
disease reporting, investigation or
surveillance; and notices to and from the Food
and Drug Administration regarding drugs or
Disclosures to governmental authorities about
victims of suspected abuse, neglect or domestic
Uses and disclosures for health oversight
activities, such as for the licensing of
doctors, audits by Medicare or Medicaid, or
investigation of possible violations of health
Disclosures for judicial and administrative
proceedings, such as in response to subpoenas or
orders of courts or administrative agencies.
Disclosures for law enforcement purposes, such
as to provide information about someone who is
or is suspected to be a victim of a crime; to
provide information about a crime at our office;
or to report a crime that happened somewhere
Disclosure to a medical examiner to identify a
dead person or to determine the cause of death;
or funeral directors to aid in burial; or to
organizations that handle organ or tissue
Uses or disclosures for health related research.
Uses and disclosures to prevent a serious
threat to health or safety.
Uses or disclosures for specialized government
functions, such as for the protection of the
president or high ranking government
officials; for lawful national intelligence
activities; for military purposes; or for the
evaluation and health of members of the
Disclosures relating to workers compensation
Disclosures to business associates who perform
healthcare operations for us and who agree to
keep your health information private.
We will not make any other uses or disclosures of your health information unless you sign a written authorization form. You do not have to sign such a form. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it.
Your Rights Regarding Your Health Information
You can ask us to restrict our uses and
disclosures for purposes of treatment,
payment or healthcare operations. We do not
have to agree to do this, but if we agree, we
must honor the restrictions that you want. To
ask for a restriction, send a written request
to Carlene Carvell, Privacy Office, at our
You can ask us to communicate with you in a
confidential way, such as by phoning you at
work rather than at home, by mailing health
information to a different address, or by using
e-mail to your personal e-mail address. We
will accommodate these requests if they are
reasonable, and if you pay us for any extra
cost. If you want to ask for confidential
communications, send a written request to
Carlene Carvell, Privacy Office, at our
You can ask to see or get photocopies of your
health information. By law, there are few
limited situations in which we can refuse to
permit access of copying. Primarily, however,
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 photocopies
in advance. If we deny your request, we will
send you a written explanation, and instructions
about how to get an impartial review of our
denial if one is legally required. By law, we
can have one 30 day extension of the time for
us to give you access or photocopies if we sent
you a written notice of the extension. If you
want to review or get photocopies of your health
information, send a written request to Carlene
Carvell, Privacy Office, at our address.
You can ask us to amend your health information
if you think 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
got 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 statement that we may write. Once your
statement of position and or rebuttal is included
in your health information, we can have one 30
day extension of time to consider a request for
amendment if we notify you in writing of the
extension. If you want to ask us to amend your
health information , send a written request,
including your reasons for the amendment, to
Carlene Carvell, Privacy Office, at our address.
You can get a list of the disclosures that we
have made of your health information within the
past 6 years ( or a shorter period if you want),
except disclosures for purposes of treatment,
payment or healthcare operations, disclosures
made in accordance with an authorization signed
by you, and some other limited disclosures.
You are entitled to one such list per year
without charge. If you want more frequent lists
you will have to pay for them in advance. We
usually respond to your request within 60 days
of receiving it by the law we can have one 30
day extension of time if we notify you of the
extension in writing. If you want a list, send
a written request to Carlene Carvell, Privacy
Office, at our address.
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 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 you think that we have not properly respected the privacy of your health information, you are free to complain to 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 to Carlene Carvell, Privacy Officer, at our address.
For More Information
If you want more information about our privacy practices, call or contact Carlene Carvell, Privacy Officer, at our address or our phone number.