This notice of the privacy practices of our office is being given to you in compliance with the federal Health Insurance Portability & Accountability Act of 1996 (HIPAA) and is effective as of April 14, 2003. This law defines our medical practice as a Covered Entity and all of your individually identifiable health information as Protected Health Information. This information may be in any form (oral, written or electronic). We are required by law to maintain the privacy of your Protected Health Information and to provide you with notice of our legal duties and privacy practices with respect to this information. Any significant change in our privacy practices will be posted in our office and made available to you at your next office visit. Our office manager is the designated Privacy Officer and can be reached at the above phone number.

Physicians Eye Clinic will take all reasonable precautions to protect the confidentiality of your Protected Health Information. We may use and disclose your medical information for the following purposes: treatment, payment and health care operations.

  • TREATMENT means providing, coordinating and managing your health care and related services by one or more health care providers. This includes creating and maintaining a written medical record, sending a letter to a referring physician, relaying your prescription to a local optical shop or pharmacy, and giving information to a hospital where you receive care. We may contact you to provide appointment reminders, treatment schedules, or information about health related services that might be of interest to you. This contact may be by phone, Email, letter, or postcard.
  • PAYMENT OPERATIONS are those activities necessary for obtaining reimbursement for our services from you or a third party, such as Medicare/Medicaid or your insurance company. Confirming insurance coverage, obtaining authorizations, sending bills or statements, and utilization review are examples of such activities. Our bills and statements contain information about the care we have rendered and your diagnosis.
  • HEALTH CARE OPERATIONS include the business aspects of running a medical practice, such as conducting quality assessment and improvement activities, cost-management analysis, and auditing functions.

Except for medical emergencies or when required by law, your Protected Health Information will not be disclosed to other people, including health care workers not concurrently involved with your care, nor your family (other than legal guardians), relatives, or friends without authorization from you. Allowing others to accompany you into an exam room or to a hospital room is assumed to be tacit authorization to discuss your medical information in their presence unless you inform us otherwise. Unintentional disclosure of protected health information is possible within our office during some of our procedures and communications during treatment.

You have the following rights with regard to your Protected Health Information:

  • The right to receive a paper copy of this Notice of Privacy Practices.
  • The right to review your Protected Health Information. The physical medical record is the property of Physicians Eye Clinic. The information in the medical record will be given to you upon request.
  • The right to amend your Protected Health Information and have such amendment become a part of your permanent record.
  • The right to request that some or all of your Protected Health Information be forwarded to another person or organization. This requires written, signed authorization. You have the right to obtain an accounting of disclosures of your Protected Health Information. Handling and photocopy charges may apply.
  • You may revoke authorization to release your Protected Health Information by presenting a written signed restriction to our Privacy Officer. We will honor and abide by this request, except to the extent that such disclosures have already occurred pursuant to your previous authorization.

If you feel your privacy protections have been violated you may contact our Privacy Officer or file a complaint without penalty to U.S. Department of Health & Human Services, Office of Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201.

Rev. 5-14-14