This notice describes how your medical information may be used and disclosed. It also describes how you can access this information. Please review this notice carefully.

Right to Notice

The Health Insurance Portability and Accountability Act (HIPAA) regulations were created to set a national standard for the confidentially of patient records. HIPAA requires that patients be notified of certain uses and disclosures of any Protected Health Information or PHI. We have always protected the privacy of patient files. As a part of our service, we make a record of patient visits to our offices. This record typically contains the result of eye examinations and a record of any glasses or contacts provided by us. By law this information constitutes PHI. We may use your PHI in the course of providing treatment, obtaining payment, and health care operations. Examples of these uses follow:

  • Treatment – We may use or disclose your PHI to another healthcare provider rendering treatment to you.
  • Payment – We may use and disclose your health information to obtain payment for services we provide you.
  • Health Care Operations – We may use and disclose your health information in connection with our health care operations including reminding you to schedule an exam or of a scheduled exam, quality assessment and improvement activities, evaluating provider performance, conducting training programs, accreditation, licensing or credentialing activities.

Your Authorization

Most uses and disclosures for reasons other than treatment, payment, or health care operations will require your separate written authorization. We are not asking for such authorization at this time. However, disclosure of PHI may also be made without your authorization in the event of an emergency or when the law requires disclosure.

Disclosure in Emergency Situations
In the event of your incapacity or an emergency situation, we may disclose your PHI to a family member, or another person responsible for your care, using our professional judgment. We will only disclose information that is directly relevant to the person’s involvement in your healthcare.

Required by Law
We may also disclose your health information when we are required to do so by law. For example, we may disclose your information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or of other crimes. We may disclose your PHI to the extent necessary to avert a serious threat to you or the health or safety of others.

Your Rights as a Patient

Even after giving your authorization, you may revoke your authorization (in writing) through our practice at any time for any future disclosures. You have the right to restrict the disclosure of your PHI (in writing). The request for restriction may be denied to the extent the information is required for treatment, payment, health care operations or is required by law. You have the right to receive confidential communications regarding your PHI. You have the right to inspect and copy your PHI. You have the right to request amendments to your PHI. You have the right to receive an accounting of disclosures of your PHI for reasons other than providing treatment, obtaining payment, and health care operations. You have the right to a copy of this notice.

Legal Requirements

We are required by law to maintain the privacy of your protected health information. We are required to follow the practices described in this notice and our privacy policy. We reserve the right to update our privacy notice and policies. The policies in any new notice will not be in effect until they are available within our offices or posted to our web site.

Complaints and Contact Information

If you have complaints regarding the way your protected health information was handled, you may submit a complaint in writing to our office. You will not be retaliated against in any manner for a complaint. You may also send a written complaint to the U.S. Department of Health and Human Services. Our corporate Privacy Officer can provide you with the appropriate address.

For further information about our privacy policies, please contact our Privacy Officer at: 1825 South Park St., Kalamazoo MI, 49001. Phone (269) 342-0003 or (800) 792-2737.