Notice of Privacy Practices for Vision First Eye Care, Inc.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
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 required by law. It also describes your rights to access and control of your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that 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
We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care and service that you receive, and any other use required by law.
Treatment: We may use and disclose your protected health information to an optometrist, ophthalmologist, optician or other healthcare provider providing treatment to you for: the provision, coordination, or management of health care and related services by health care providers; consultation between health care providers relating to a patient; the referral of a patient for health care from one health care provider to another; or for appointment reminders and recall information.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. We may use your health information to determine eligibility or obtain authorization for your vision plan benefits, to bill and collect payment, coordinate your benefits, or investigate a claim. For example, we may send a claim to your vision plan identifying you and services provided to you so that we may be paid. We may also disclose health information to consumer reporting agencies of information relating to collection of payments.
Healthcare Operations: We may use or disclose, as-needed, your protected health information for operational purposes. These activities include, but are not limited to, quality of care assessment activities, utilization review activities, employee review activities, provider audit activities, and conducting for other business activities. We may use or disclose your protected health information, as necessary, to contact you for appointment or recall notices, by phone, voicemeail, postcards and letters, or to provide you with information about treatment alternatives, products or services that may be of interest to you.
Persons Involved in Care: We may use or disclose health information to notify a family member, your personal representative or another person responsible for your care. For example, we may allow a person to pick up your finished glasses or lenses, medical supplies, or copy of your prescription, using our professional judgment and making reasonable inferences of your best interest, and disclosing only health information that is directly relevant to the person's involvement in your healthcare.
Required by Law: We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers' Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization or Opportunity to Object unless required by law.
You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Your Rights regarding Personal Health Information
You have the following rights regarding your Personal Health Information:
You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Your physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically.
You may have the right to have your physician amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
If you believe your privacy rights have been violated, you may file a complaint with us. Submit all complaints in writing to Compliance Officer, Vision First Eye Care, 1937-A Tully Road, San Jose, CA 95122. You may also contact the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to have the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. In the event we make a material change, we will change this Notice and provide it to you at your next visit, or it can be viewed in the store.
This notice was published and became effective on April 14, 2003.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with our Compliance Officer in person or by phone at our Main Phone Number (408-923-0400).