(effective 09/23/2013)

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND YOUR RIGHTS REGARDING THAT INFORMATION.

The most common reason we use or disclose your health information is for treatment, payment, and health care operations.

DISCLOSURE FOR TREATMENT 

Disclosure for these purposes does not require any special consent. Use or disclosure for treatment purposes may include but is not limited to obtaining or sharing your health information with other health care professionals involved in the past, current, or future treatment of your healthcare.

DISCLOSURE FOR PAYMENT

For payment purposes we may utilize the health, personal, or billing information to facilitate the payment of services from your health or vision care plans. This information may be disclosed in submitting and sending bills or claims, and collecting unpaid amounts (either ourselves or through a collection agency or attorney).

DISCLOSURE for HEALTH CARE OPERATIONS

Health care operations mean those administrative and managerial functions that are required in the day to day operation of our office. We may utilize your information in quality assurance, staff training, deciding what new services to offer. We may disclose information to doctors, technicians, staff, optometry or optical students for learning purposes. Information may also be disclosed to business associates for the purpose of complying with legal requirements and for internal auditing. We will advise these associates of their obligation to maintain your privacy and enter into business associate agreements to ensure that protection. De-identified or limited data set of information may be utilized in health related research.

OTHER DISCLOSURES

In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Such uses or disclosures include:

  • health oversight activities, which may include audits by state regulatory board and audits by Medicare, Medicaid, or third party payers
  • disclosures for judicial and administrative proceedings
  • disclosures for law enforcement purposes
  • uses and disclosures to prevent a serious threat to health or safety such as disease control or prevention, child abuse or neglect, report adverse medical reactions, and/or product recalls.
  • emergency situations such as natural disaster
  • uses or disclosures for specialized government functions including national security
  • disclosures relating to worker’s compensation programs
  • incidental disclosures that are an unavoidable by-product of permitted uses or disclosures
  • other uses and disclosures as required by state or federal law.
  • disclosures of relevant information about your care with your power of attorney or your guardian

PATIENT COMMUNICATION

We may call, write, fax, email, or text you appointment reminders, notify you that your materials are ready, yearly appointment notices, and/or newsletters. We may also call, write, or email you to notify you of other treatments or services available at our office that might help you. Email and texts are not considered secure methods of communication, however, they may be the most convenient method of communication for you. You may request that we communicate with you via a secure method.

OTHER USES AND DISCLOSURES

We will not make any other uses or disclosures of your health information without your written consent. The authorization may be revoked at any time unless we have already acted upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of this Notice.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

  • You may ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. To ask for a restriction, send a written request to this office.
  • You may ask us to restrict our uses and disclosures to your insurance carrier, if you opt to pay for your services and materials out of pocket. To ask for a restriction, send a written request to this office.
  • You may ask us to communicate with you in a confidential way.  We will accommodate these requests if they are reasonable.  If you want to ask for confidential communications, send a written request to this office.
  • You may request to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. In most cases you will be able to review or have a copy of your health information within 30 days of your written request (or sixty days if the information is stored off-site). You will have to pay for photocopies in advance. If we deny your request,  we will send you a written explanation. By law, we are allowed one 30 day extension prior to granting you access to your file or photocopies if we send you a written notice of the extension. If you want to review or get photocopies of your health information, send a written request to this office.
  • You may ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from your request. We will send the corrected information to persons who we know got the wrong information, and others that 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 on our behalf. Once your statement of position is included in your health information, we will send it along whenever we make a permitted disclosure of your health information.  By law, 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 this office.
  • You may get a list of the disclosures that we have made of your health information within the past six years. By law, the list will not include: disclosures for purposes of treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You will have to pay for the list in advance. We will usually respond to your request within 60 days of receiving it, but by 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 this office.
  • You may get additional paper copies of this Notice of Privacy Practices upon request. This notice is published on

our web site and is prominently displayed in our office. If you want additional paper copies, send a written request to the office contact person at the address or email shown at the bottom of this Notice.

OUR NOTICE OF PRIVACY PRACTICES

This privacy practice notice may be modified at any time at our discretion. 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 post it on our Web site.

COMPLAINTS

If you believe that we have not properly respected the privacy of your health information, you may file a complaint with our privacy practice coordinator, Darrick Bub, O.D. or the U.S. Department of Health and Human Services, Office for Civil Rights.

Direct all correspondence to:

Sharp Eyes Vision Center

Attn: Privacy Practice Coordinator

10411 W Fairmont Pkwy

La Porte, TX 77571

mail@sharpeyesvisioncenter.com