THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO HIS 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 healthcare operations. In most other 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.
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 lenses.
When the doctor prescribes medication
When our staff helps you select and order glasses or contact lenses
When we show you low vision aids.
We may disclose your health information outside of our office for treatment purposes, for example:
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 a pharmacist.
When we phone to let you know that your glasses or contact lenses are ready to be picked up.
Sometimes we may ask for copies of your health information from another professional that you may have seen before.
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 you or your health 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, faxed, 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 amounts dueA state or federal law that mandates certain health information be reported for specific purposes.
Public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the Food and Drug Administration regarding drugs or medical devices.
Disclosures to governmental authorities about vicitims of suspected abuse, neglect or domestic violence.
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 healthcare laws.
Disclosures for law enforcement puposes, such as to provide information about someone who is or is suspected to be a vicitim of a crime; to provide information about a crime at our office; or to report a crime that happed somewhere else.
Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations.
Uses or disclosures for health related research
Uses and disclosres 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 member of the foreign service.
Disclosures relating to workers' compensation programs.
Disclosrues to business associates who perform healthcare operations for us and who agree to keep your health information private.You can ask us to restrict our uses and disclosures for purposes of treatment (except emergency 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 Dr. Lisa Shiroishi at the address or fax shown at the beginning of this notice.
We use and disclose your health information for healthcare operations in a number of ways. Health care operations means those administrative and managerial functions that we have to do in order to run our office. We may use or disclose your helath information, for example, for financial or billing audits, for internal quality assurance, for personnel 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 or our records.
We may call to remind you of scheduled appointments. We may also call to notify you of other treatments or services available at our office that might help you.
USE & DISCLOSURES WITHOUT AN AUTHORIZATION:
In some limited situations, the law allows or requires us to use 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:
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:
The law gives you many rights regarding your health information.