Geneva Eye Care Optometry

Notice of Privacy
 

GENEVA EYE CARE OPTOMETRY
NOTICE OF PRIVACY PRACTICES

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. THE PRIVACY OF YOUR
MEDICAL INFORMATION IS IMPORTANT TO US.

Overview

The law requires us to keep your protected health information (?PHI?) private in accordance with
this Notice of Privacy Practices (?Notice?), as long as thi5 Notice remains in effect. We are also
required to provide you with a paper copy of this Notice, Which contains our privacy practices,
our legal duties, and your rights concerning your PHI.

From time to time, we may revise our privacy practices and the terms of our Notice at any time,
as permitted or required by applicable law. Such revisions to our privacy practices and our
Notice may be retroactive. Our Notice will be updated and made available to our patients prior to
any significant revisions of our privacy practices and policies,

Our Privacy Practices

Use and Disclosure. We may use or disclose your PHI for treatment, payment, or health care
operations. For your convenience, we have provided the following examples of such potential
uses or disclosures:

Treatment. Your PHI may be used by or disclosed to any physicians or other health care
providers involved with the medical services provided to you.

Payment. Your PHI may be used or disclosed in order to collect payment for the
medical services provided to you.

Health Care Operations. Your PHI may be used or disclosed as part of our internal
health care operations. Such health care operations may include, among other things,
quality of care audits of our staff and affiliates, conducting training programs,
accreditation, certification, licensing, or credentialing activities.

Appointment Reminders. We may call to remind you of scheduled appointments. We
may also notify, you of other treatments or services available at our office that might help
you.

Authorizations. We will not use or disclose your medical information for any reason except
those described in this Notice, unless you provide us with a written authorization to do so. We
may request such an authorization to use or disclose your PHI for any purpose, but you are not
required to give us such authorization as a condition of your treatment. Any written
authorization from you may be revoked by you in writing at any time, but such revocation will
not affect any prior authorized uses or disclosures.

Patient Access. We will provide you with access to your PHI, as described below in the
Individual Rights section of this Notice. With your permission, or in some emergencies, we may
disclose your PHI to your family members, friends, or other people to aid in your treatment or
the collection of payment. A disclosure of your PHI may also be made if we determine it is
reasonably necessary or in your best interests for such purposes as allowing a person acting on
your behalf to receive filled prescriptions, medical supplies, X rays, etc..

Locating Responsible Parties. Your PHI may be disclosed in order to locate, identify or notify a

family member, your personal representative, or other person responsible for your care. If we
determine in our reasonable professional judgment that you are capable of doing so, you will be
given the opportunity to consent to or to prohibit or restrict the extent or recipients of such
disclosure. If we determine that you are unable to provide such consent, we will limit the PHI
disclosed to the minimum necessary.

Disasters. We may use or disclose your PHI to any public or private entity authorized by law or
by its charter to assist in disaster relief efforts.

Required by Law. We may use or disclose your medical information when we are required to do
so by law. For example, your PHI may be released when required by privacy laws, workers
compensation or similar laws, public health laws, court or administrative orders, subpoenas,
certain discovery requests, or other laws, regulations or legal processes. Under certain
circumstances, we may make limited disclosures of PHI directly to law enforcement officials or
correctional institutions regarding an inmate, lawful detainee, suspect, fugitive, material witness,
missing person, or a victim or suspected victim of abuse, neglect, domestic violence or other
crimes. We may disclose your PHI to the extent reasonably necessary to avert a serious threat to
your health or safety or the health or safety of others. We may disclose your PHI when necessary
to assist law enforcement officials to capture a third party who has admitted to a crime against
you or who has escaped from lawful custody.

Deceased Persons. After your death, we may disclose your PHI to a coroner, medical examiner,
funeral director, or organ procurement organization in limited circumstances.

Research. Your PHI may also be used or disclosed for research purposes only in those limited
circumstances not requiring your written authorization, such as those which have been approved
by an institutional review board that has established procedures for ensuring the privacy of your
PHI.

Military and National Security. We may disclose to military authorities the medical information
of Armed Forces personnel under certain circumstances. When required by law, we may disclose
your PHI for intelligence, counterintelligence, and other national security activities.

Your Individual Rights

Access and Copies. In most cases, you have the right to review or to purchase copies of your
PHI by requesting access or copies in writing to our Privacy Officer. Please contact our Privacy
Officer regarding our copying fees.

Disclosure Accounting. You have the right to receive an accounting of the instances, if any, in
which your PHI was disclosed for purposes other than those described in the following sections
above: Use and Disclosures, Facility Directories, Patient Access, and Locating Responsible
Parties. For each 12-month period, you have the right to receive one free copy of an accounting
certain details surrounding such disclosures that occurred after April 13, 2003. If you request a
disclosure accounting more than once in a 12-month period, we will charge you a reasonable,
cost-based fee for each additional request. Please contact our Privacy Officer regarding these
fees.

Additional Restrictions. You have the right to request that we place additional restrictions
on our use or disclosure of your PHI, but we are not required to honor such a request. We
will be bound by such restrictions only if we agree to do so in writing signed by our Privacy
Officer.

Alternate Communications. You have the right to request that we communicate with you
about your PHI by alternative means or in alternative locations. We will accommodate any
reasonable request if it specifies in writing the alternative means or location, and provides a
 

 

 

satisfactory explanation of how future payments will be handled.

Amendments to PHI. You have the right to request that we amend your PHI. Any such
request must be in writing and contain a detailed explanation for the requested amendment.
Under certain circumstances, we may deny your request but will provide you a written
explanation of the denial. You have the right to send us a statement of disagreement to which
we may prepare a rebuttal, a copy of which will be provided to you at no cost. Please
contact our Privacy Officer with any further questions about amending your medical record.


Complaints

If you believe we have violated your privacy rights, you may complain to us or to the
Secretary of the U.S. Department of Health and Human Services. You may file a complaint
with us by notifying our Privacy Officer.

We support your right to protect the privacy of your medical information. 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.



Contact Us

LYLY UNG, O.D.
940 GENEVA AVENUE
415 585-6588
415 585-6403
LUNGOD@PACBELL.NET