Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duty and your rights concerning your health information. This Notice takes effect April 13, 2003 and will remain in force until we replace it.

We reserve the right to change our privacy practice 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 health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our private practices, we will change this Notice and make the new Notice available upon request.

You may request a copy of our Notice at any time. For more information about our private practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

USES AND DISCLOSURES OF HEALTH INFORMATION

We disclose health information about you for treatment, payment and healthcare operations. For example:
    Treatment: We use or disclose health information to a physician or other healthcare provider providing treatment to you. For example, a doctor treating you for diabetes would need to know if diabetic changes are present in your eyes.
    Payment: We may use and disclose your health information to obtain payment for services we provided to you. For example, we may need to give information about the service rendered to your insurance company so they will pay for the service.
    Healthcare Operations: We may use and disclose your healthcare information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualification of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditations, certification, licensing or credentialing activities.
    Your Authorization: In addition to our use of your healthcare information for treatment, payment or healthcare operations, you may give us written authorization to use your healthcare 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 disclosures permitted by your authorization while it was in effect. Unless you give us written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.
    To Your Family and Friends: We must disclose your health information to you, as described in the Patients Rights section of this Notice. We may disclose your health information to a family member, friend, or other person to the extent to help with your healthcare or with payment of your healthcare, but only if you agree we may do so.
    Persons Involved in Healthcare: We may use or disclose health information to assist in the notification of a family member or another person responsible for your care of your general condition. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based upon a determination using our professional judgment only health information that is directly relevant to the person’s involvement in your healthcare. We will also use or professional judgment and our experience with common practices to make reasonable inferences of your best interest allowing a person to pick up prescriptions, medical supplies or other similar forms of health information.
    Marketing Healthcare-related Services: We will not use your healthcare information for marketing communications without your written authorization.
    Workman’s Compensation: We may disclose health information to the extent necessary to comply with laws related to Workman’s Compensation.
    Required by Law: We may use or disclose your healthcare information when we are required to do so by law.
    Abuse or Neglect: We may disclose your healthcare information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health, safety or the health or safety of others.
    Appointment Reminders: We may use or disclose your health information for the use of communicating with you. Some of the examples of this include, but are not limited to postcards, email or automated telephone systems. We may use your name, address and phone number, the name of your scheduled treating physician, and the time and place of your scheduled appointment for the limited purpose contacting you to notify you of a pending appointment or other related healthcare communication.

PATIENT RIGHTS

    Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use that format you request unless we cannot practically do so. You must make a request in writing to obtain your health information. You may obtain a format to request access at the front desk of our office.
    Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclose your health information for purposes other than treatment, payment of healthcare operations and certain other activities since April 14, 2003 but not before April 14, 2003.
    Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by your agreement (except in an emergency).
    Amendment: You have the right to request that we amend your health information. Your request must be in writing and it must explain why your health information must be amended. We may deny your request under certain circumstances.
    Electronic Notice: If you receive this Notice on our website or by electronic mail (email) you are entitled to receive this Notice in written form.

QUESTIONS AND COMPLAINTS

If you desire more information about our privacy practices or have questions or concerns, please contact us. If you believe your privacy rights have been violated, you may file a complaint with us or with the Office of Civil Rights.

Silver Lake Eye Clinic Office Manager, HIPAA Privacy Contact (425-316-9400)
Dr. Roger W. Hall, HIPAA Privacy Officer (425-316-9400)