NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH AND OTHER INFORMATION COLLECTED FROM AND ABOUT YOU AS A PATIENT AND SITE USER MAY BE USED AND DISCLOSED BY US AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. WE RESPECT THE RIGHT TO PRIVACY AND YOU SHOULD KNOW HOW WE USE THE PRIVATE INFORMATION YOU SHARE WITH US. THIS POLICY IS INCLUSIVE OF ALL BUSINESS AND HEALTH CARE ACTIVITIES AND APPLIES TO OUR OPERATIONS REGARDLESS OF OUR EXPRESSION TO DISTINQUISH BUSINESS OR HEALTH CARE ACTIVITIES AND PRACTICES WITHIN THE TEXT OF THIS POLICY STATEMENT.
SUMMARY OF GUIDING PRIVACY PRINCIPLE
The information you share with us in used to provide quality, professional service to you. We collect only what we need to know to make sound professional and business judgments in the course of providing product, services, care, and collecting payment. When we share information it is shared to help you obtain the product, services and care you request. If compelled to provide your private or medical information to others, we do so only consistent with law or as required by law.
OUR LEGAL DUTY
Certain Federal and state laws require us to maintain the privacy of your health information. In some instances these law also requires us to give you this notice about our privacy practices with regard to any information considered medical in nature and otherwise, and they outline our legal duties, and your rights concerning your health and private information. This notice takes effect 11/1/2013, and will remain in effect until we replace it or revise it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided that any applicable law permits the changes. We reserve the right to make the changes in our privacy practices and the content of our notice effective for all health and/or private information that we maintain, including health information we created or received prior to any changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available on our website.
For more information about our privacy practices, or to obtain a written copy of this notice, please contact us using the information listed at the end of this notice. If you request a written copy of this notice, a small administrative fee will be assessed.
OUR USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
We use and disclose health and private information about you to fulfill eyeglass and contact lens orders, provide treatment, request and receive payment, and other related operations. For example:
Treatment: We may use your health information for treatment or disclose it to an optometrist, physician or other health care provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we provide to you. We may also disclose your health information to another health care provider or business entity in an attempt to collect fees and costs owed to us. These entities may or may not be obligated to follow our privacy practices but may be subject to other obligations under law.
Health Care Operations: We may use and disclose your health information for our eye care operations. Eye care operations include quality assessment and improvement activities, reviewing the competence or qualifications of eye care professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities. We may disclose your health information to another health care provider or organization that is subject to the federal privacy rules and that has a relationship with you to support some of their eye and health care operations. We may disclose your information to help these organizations conduct quality assessment and improvement activities, review the competence or qualifications of health care professionals, or detect or prevent health care fraud and abuse.
Your Authorization: You may also give us written authorization to use your health or private information or to disclose it to anyone for any purpose under certain circumstances. If you give us such an authorization, you may revoke it in writing at any time. Your revocation will not affect any uses or disclosures permitted by your authorization while it was in effect. Unless you give us such a written authorization, we cannot use or disclose your health or private information for any reason except those described or inferred as reasonable from this notice.
To Your Family and Friends: We may disclose your private, eye and health care information to a family member, friend or other person to the extent necessary to help with your eye and health care or obtain payment for your eye and health care. Before we disclose your health information to these people, we will provide you with an opportunity to object to our use or disclosure. If you are not present, or in the event of your incapacity or an emergency, we will disclose your medical and private information based on our professional judgment of whether the disclosure would be in your best interest. We may use our professional judgment and our experience with common practice to make reasonable inferences of what is in your best interest related to your eye care and medical records with us. We may use or disclose information about you to notify or assist in notifying a person involved in your care, of your location and general condition.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).
Disaster Relief: We may use or disclose your health information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.
Public Benefit: While many of the following will not apply to our relationship, we may use or disclose your medical information as authorized by law for the following purposes deemed to be in the public interest or benefit:
as required by law;
for public health activities, including disease and vital statistic reporting, child abuse reporting, FDA oversight, and to employers regarding work-related illness or injury;
to report adult abuse, neglect, or domestic violence;
to health oversight agencies;
in response to court and administrative orders and other lawful processes;
to law enforcement officials pursuant to subpoenas and other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person;
to coroners, medical examiners, and funeral directors;
to organ procurement organizations;
to avert a serious threat to health or safety;
in connection with certain research activities;
to the military and to federal officials for lawful intelligence, counterintelligence, and national security activities;
to correctional institutions regarding inmates; and
As authorized by state worker’s compensation laws.
PATIENT RIGHTS
Access: You have the right to look at or get copies of your eye care and health information, with some exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may request access by sending us a letter to the address at the end of this notice. If you request your patient records, we will charge you a reasonable cost-based fee that may include labor, copying costs, and postage. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we may - but are not required to - prepare a summary or an explanation of your eye care and health information for a fee. Contact us using the information listed at the end of this notice for more information about fees.
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information over the last 6 years (but not before 11/1/2013. We may charge you a reasonable, cost-based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for more information about fees.
Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your private, eye care and health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement we may make to a request for additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. Your request is not binding unless our agreement is in writing.
Alternative Communication: You have the right to request that we communicate with you about your eye care and health information by alternative means or to alternative locations. You must make your request in writing to our office. You must specify in your request the alternative means or location, and provide satisfactory explanation how you will handle payment under the alternative means or location you request.
Amendment: You have the right to request that we amend your private, eye care and health information. Your request must be in writing, and it must explain why we should amend the information. We may deny your request as determined in our sole and absolute judgment by noting your request in our records with an explanation for our decision.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have other questions or concerns, please contact EyeglassUniverse.com using the information listed at the end of this notice or if you believe that:
we may have violated your privacy rights,
we made a decision about access to your health information incorrectly,
our response to a request you made to amend or restrict the use or disclosure of your health information was incorrect, or
we should communicate with you by alternative means or at alternative locations;
You may contact us using the information listed below. We support your right to the privacy of your private and health care information
CONTACT THE EYEGLASSUNIVERSE.COM OFFICE AT:
EyeglassUniverse.com
c/o Midwest Optical Associates Inc.
7723 Tylers Place Blvd #269
West Chester, OH 45069
513-338-4895 Office
513-779-4100 Fax
privacy@eyeglassuniverse.com
