HIPAA NOTICE OF PRIVACY PRACTICES

Effective Date: 2/10/2025
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or requires by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and relates to your past, present or future physical or mental health or condition and related health care services.

Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your optometrist, our office staff and others outside of our office that are involved in your care and treatment for the purposes of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law.

How We May Use Your Health Information

• Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes coordination or management of your health care with a third party. For example, your protected health information may be provided to another healthcare provider to whom you have been referred to ensure they have the necessary information to diagnose or treat you.
  
• Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, we may disclose relevant information to your health plan to obtain approval for services or to process insurance claims.
  
• Healthcare Operations: We may use or disclose your protected health information, as needed, to support the business activities of our practice. These activities include, but are not limited to, quality assessment, staff training, licensing, and administrative tasks. For example, we may use your information for internal reviews to improve our services or contact you to remind you of appointments. We may also call you by name in the waiting room when your optometrist is ready to see you.

Other Permitted and Required Uses and Disclosures

We may use or disclose your protected health information in the following situations without your authorization:

• As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law.
  
• Public Health Activities: To report health information for public health purposes, such as preventing or controlling disease.  Communicable Diseases: To notify appropriate authorities if you have been exposed to a communicable disease.
  
• Health Oversight: To comply with audits or investigations.
  
• Abuse or Neglect: To report child abuse or neglect, or if we believe you are a victim of abuse, neglect, or domestic violence.
  
• Legal Proceedings: To respond to a court order or subpoena.
  
• Law Enforcement: To provide information to law enforcement officials in specific circumstances.
  
• Coroners, Funeral Directors, and Organ Donation: For identification purposes, determining cause of death, or organ donation.
  
• Research: For research purposes under strict oversight.
  
• Criminal Activity: To prevent or lessen a serious threat to public safety.
  
• Military and National Security: For military or national security activities as authorized by law.
  
• Workers’ Compensation: To comply with workers’ compensation laws.

​​​​​​​Other Permitted and Required Uses and Disclosures With Your Consent

Other uses and disclosures of your PHI will be made only with your consent, authorization, or opportunity to object unless otherwise required by law. You may revoke this authorization, at any time, in writing, except to the extent that we have already taken action in reliance on the authorization.

Your Privacy Rights

• Access to Your Records: You have the right to request access to your medical records and receive a copy.
  
• Amendment Requests: If you believe your medical record contains inaccurate information, you can request an amendment.
  
• Restrictions on Disclosure: You may request limitations on certain disclosures of your PHI, although we are not obligated to agree to all requests.
  
• Confidentiality Requests: You may request that we communicate with you in a specific way or at a certain location to maintain your privacy.
  
• Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI.
  
• Receive a Copy of This Notice: You have the right to obtain a paper copy of this notice at any time, even if you previously agreed to receive it electronically.
  

Changes to This Notice
We reserve the right to change this Notice at any time. The new Notice will apply to all health information we maintain. A copy of the revised Notice will be available in our office.

Filing Complaints
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer named at the beginning of this notice or with the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Acknowledgment of Receipt of Notice of Privacy Practices
By signing below, I acknowledge that I have received and reviewed the Notice of Privacy Practices.