Optik Icare Iwear
FORM OF NOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES
This Notice of Privacy Practices ("Notice") describes how we may use or disclose your health information and how you can get access to such information. Please read it carefully.
Your "health information," for purposes of this Notice, is generally any information that identifies you and is created, received, maintained or transmitted by us in the course of providing health care items or services to you (referred to as "health information" in this Notice).
We are required by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and other applicable laws to maintain the privacy of your health information, to provide individuals with this Notice of our legal duties and privacy practices with respect to such information, and to abide by the terms of this Notice.
We are also required by law, to notify affected individuals following a breach of their unsecured health information.
THIS NOTICE IS EFFECTIVE 10/25/2017 UNTIL FURTHER NOTICE.
Please review this entire notice explaining the uses and disclosures Optik icare iwear may make, with respect to your medical information. Outlined are your rights, how to exercise them when advancing complaints and additional information about our privacy practices.
OUR LEGAL DUTY
We use many methods to protect your oral, written and electronic medical information from illegal use or disclosure. We are required by law to:
(a) keep your medical information private;
b) provide you with this notice and follow the policies listed here;
(c) inform you if we cannot agree to limit how we share your medical information;
(d) agree to reasonable requests to contact you by alternative means or at alternative locations;
(e) get your written approval to share your medical information for reasons other than those listed above;
(f) get your written approval to share your medical information for reasons other than permitted by law; and
(f) notify you of any breaches of your unsecured health information.
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. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all medical information that we maintain, including medical information we created or received before we made the changes. If we make a significant change in our privacy practices, we will change this notice and make available a copy of the notice at our office.
You may request a paper copy of our notice at any time, by contacting us using the information found at the end of this notice.
USES AND DISCLOSURES OF MEDICAL INFORMATION
We will use and disclose medical information about you for treatment, payment and health care operations. For example:
Treatment: We may disclose your medical information, without your permission, to a physician or other health care provider to treat you, or to coordinate or manage your health care and any related services. For example, we may share information about your eye condition to another health care professional to assist in their treatment of you.
Payment: We may use and disclose your medical information, without your permission, to determine eligibility, process claims or make payment for covered services you receive under your benefit plan. We may also disclose your medical information to a health care provider or another health plan for that provider or plan to obtain payment or engage in other payment activities. For example, we may need to give information about your treatment to your health plan so they will pay us or reimburse you for the treatment.
Health Care Operations: We may use and disclose your medical information, without your permission, for health care operations. Health care operations include, for example, health care quality assessment and improvement activities and general administrative activities.
Persons Involved in Your Care: Unless you object, we may disclose your medical information to a family member, friend or any other person you involve in your health care or payment for your health care. We will disclose only the medical information that is relevant to the person’s involvement, and at all times, we will only disclose the minimum necessary information. In addition, we may disclose your medical information to your personal representative (generally, a person who has authority to act on your behalf to make decisions related to your care).
Medical Emergency & Disaster Relief: We may use or disclose your name, location and general condition to notify, or to assist an appropriate public or private agency to locate and notify, a person responsible for your health care in appropriate situations, such as a medical emergency or during disaster relief efforts.
Appointment Reminders & Health-Related Benefits and Services: We may contact you to remind you of appointments. We may use your medical information to communicate with you about health-related products, benefits and services, payment for those products, benefits and services, and treatment alternatives that may be of interest to you.
Additional Uses and Disclosures Without Your Authorization: We may use and disclose your medical information, without your permission, when required by law, and when authorized by law for the following kinds of public health and interest activities;
judicial and administrative proceedings, law enforcement, research and other public benefit functions: for public health, including to report disease and vital statistics, child and adult abuse, neglect or domestic violence; to avert a serious and imminent threat to health or safety; to a health oversight agency for health care oversight, such as activities of state insurance commissioners, licensing and peer review authorities and fraud prevention enforcement agencies; to the Secretary of the Department of Health and Human Services (“HHS”) for the purpose of investigating or determining our compliance with HIPAA; for research; in response to court and administrative orders and other lawful process; to law enforcement officials with regard to crime victims, crimes on our premises, crime reporting in emergencies and identifying or locating suspects or other persons; to coroners and medical examiners to identify a deceased person, determine cause of death, or other lawful duties; to funeral directors as needed to carry out their duties; to organ procurement, banking, or transplantation organizations to assist with organ, eye, or tissue donation and transplantation; to the military regarding individuals who are Armed Forces personnel or foreign military personnel, for activities considered necessary by appropriate military command authorities; to federal officials for lawful intelligence, counterintelligence and national security activities, and correctional institutions and law enforcement regarding persons in lawful custody; and as authorized by state worker’s compensation laws.
Uses and Disclosures With Your Authorization: You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you give us a written authorization, we will not use or disclose your medical information for any purpose other than those described in this notice. An authorization is required for the following: most uses and disclosures of psychotherapy notes; most uses and disclosures for marketing purposes; and the sale of your medical information.
You have the right to examine and receive, a copy of your medical information with limited exceptions. You must make a written request to the contact at the end of this notice to obtain access to your medical information.
You have the right to a list of instances after April 13, 2003, in which we disclosed your medical information for purposes other than treatment, payment and health care operations, as authorized by you, and for certain other activities. You must make your request to the contact at the end of this notice. We will provide you with information about each accountable disclosure, made during the period for which you request the accounting with the exception; we are not obligated to account for a disclosure that occurred more than six years before the date of your request and never for a disclosure that occurred before April 14, 2003.
You have the right to request that we amend your medical information. You must make a written request to the contact at the end of this notice. The written request must explain why the information should be amended.
We may deny your request:
- if it is not in writing or does not provide a reason to support your request.
- was not created by us, unless the person that created the information is no longer available to make the amendment,
- is not part of the health information kept by or for us,
- is not part of the information you would be permitted to inspect or copy, or
- is accurate and complete.
Restriction: You have the right to request that we restrict our use or disclosure of your medical information for treatment, payment or health care operations, or with family, friends or others you identify. We are not required to agree to your request, except if you (or someone on your behalf) pay for a health care item or service in full and you request that we not disclose information about the health care to your health plan. If we agree to a restriction request, we will abide by our agreement, except in a medical emergency or as required or authorized by law. You must make a written request to the contact at the end of this notice.
Confidential Communication: You have the right to request that we communicate with you about your medical information in confidence by alternative means or to alternative locations that you specify. You must make a written request to the contact at the end of this notice and your request must represent that the information could endanger you if it is not communicated in confidence as you request. We will accommodate your request if it is reasonable and specifies the alternative means or location for confidential communication.
Right to Obtain a Paper Copy: You are entitled to receive this notice in written form, even if you receive this notice on our web site or by e-mail. Please contact us using the information at the end of this notice to obtain this notice in written form.
QUESTIONS AND COMPLAINTS
If you would like further information with respect to our privacy practices, or have questions or concerns, please contact us using the information at the end of this notice.
If you think we may not have respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint.
Should you wish to address a complaint to us, Optik icare iware, please forward a written complaint to our office contact person, Stephanie Kirste at the address, fax or E mail shown below. If you prefer, you can discuss your complaint in person or by phone.
Attention: Stephanie Kirste
Optik icare iwear
121 S. Main Ave, Aztec NM 87410
The Office for Civil Rights of the United States
Department of Health and Human Services
200 Independence Avenue, SW, Room 509F,
Washington, D.C. 20201
You may contact the Office of Civil Rights’ Hotline at 1-800-368-1019. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.