Notice of Privacy Practices
Effective date of notice: April 14, 2003
Drs. Hong and Stasko
(650) 593-1661
(Fax) (650) 595-5203
(e-mail) postmaster@myfamilyeyedoc.com
This notice describes how medical information about you may be used and disclosed, and how you can obtain access to this information. Please review it carefully.
General Rule
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 such written authorization.
Uses or Disclosures of Health Information
Examples of how we use information for treatment purposes:
- When our technician or doctor tests your eyes and prescribes glasses, contact lenses or medication.
- When our staff helps you select and order glasses or contact lenses or treats with vision therapy.
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 services.
- If we send a prescription for glasses, contacts or medication to another professional to be filled.
- When we phone to let you know that your glasses or contact lenses are ready to be picked up.
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 insurance coverage, or about other sources of payment.
- When we prepare bills to send to you or your health or vision care plan (sent by mail, fax or computer).
- When we process payment by credit card and when we try to collect unpaid amounts due.
- When we have to ask a collection agency or attorney to help us with unpaid amounts due.
We use and disclose your health information for healthcare operations (those administrative and managerial functions that we have to do in order to run our office) in a number of ways. For example, for financial or billing audits, to enable our doctors to participate in managed care plans, for the defense of legal matters, to develop business plans, and for outside storage of our records.
Appointment Reminders
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.
Uses & 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:
- A state or federal law that mandates certain health information be reported for a specific purpose.
- 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 on victims 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.
- To comply with legal proceedings, such as a court or administrative order or subpoena.
- To law enforcement officials for limited law enforcement purposes.
- 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 disclosures to prevent a serious threat to health or safety.
- To federal officials for lawful intelligence, counterintelligence and other national security purposes.
- Disclosures relating to workers' compensation programs.
- Disclosures to business associates who perform healthcare operations for us and who agree to keep your health information private.
Other Disclosures
We will not otherwise use or disclosure your health information unless you sign a written authorization form. You may revoke authorization at any time unless we have already acted in reliance upon it.
Your Rights Regarding Your Health Information
You may make a written request to us to any of the following concerning your medical information.
- To put additional restrictions on our use and disclosure of your medical information. We do not have to agree to your request, but if we agree, we must honor the restrictions that you want.
- To communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing health information to a different address, or by using e-mail to your personal email address. We will accommodate these requests if they are reasonable, and if you reimburse us for any extra cost.
- To see or to get copies of your health information. By law, there are a few limited cases in which we can refuse to permit access or copying. We will respond to your request within 30 days. You will have to reimburse us for photocopies in advance.
- To amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. In some cases, we do not have to agree to your request.
- To receive a list of the disclosures of your health information within the past six years (but not disclosures before April 14, 2003), except disclosures for purposes of treatment, payment or health care operations, disclosures made in accordance with an authorization signed by you, and some other limited disclosures. We will usually respond to your request within 60 days of receiving it.
Our Notice of Privacy Practices
We must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time in compliance with the law. If we change this Notice, we will post the new notice in our office, have copies available in our office and post it on our website.
Complaints
If you think that we have not properly respected your privacy rights, you are free to complain to us or to the U.S. Department of Health and Human Services. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to Drs. Hong and Stasko at the address, fax or e-mail shown at the beginning of this notice. If you prefer, you can discuss your complaint in person or by phone.
For More Information
If you want more information about our privacy practices, call or visit Drs. Hong and Stasko at the address or phone number shown at the beginning of this notice.
