KINGS EYE CENTER
NOTICE OF PRIVACY PRACTICES
TO OUR PATIENTS. This notice describes how health information about you, as a patient of this practice, may be used and disclosed, and how you can get access to your health information. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your health information. We are required by law to maintain the confidentiality of your health information. We realize that these laws are complicated, but we must provide you with the following important information:
REASONS WE MAY SHARE YOUR INFORMATION
1. We may share your health information with other health care providers for treatment purposes.
2. We may send reminder cards to notify you of future or missed appointments
3. We may call and leave a message on your phone if we are unable to reach you. You may request
that we contact you at places other than your home. We may not always be able to honor such
4. We may share medical information about you so that we may bill your insurance company or any
other third party.
USE AND DISCLOSURE OF YOUR HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES
The following circumstances may require us to use or disclose your health information:
1. To public health authorities and health oversight agencies that are authorized by law to
2. Lawsuits and similar proceedings in response to a court or administrative order.
3. If required to do so by a law enforcement official.
4. When necessary to reduce or prevent a serious threat to your health and safety or the
health and safety of another individual or the public. We will only make disclosures to
a person or organization able to help prevent a threat.
5. If you are a member of U.S. or foreign military forces (including veterans) and if
required by the appropriate authorities.
6. To federal officials for intelligence and national security activities authorized by law.
7. To correctional institutions or law enforcement officials if you are an inmate or under
the custody of a law enforcement official.
8. For Workers Compensation and similar programs.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
1. Communications. You can request that our practice communicate with you about
your health and related issues in a particular manner or at a certain location.
For instance, you may ask that we contact you at home, rather than at work.
We will accommodate reasonable requests.
2. You can request a restriction in our use or disclosure of your health information for
treatment,payment or health care operations. Additionally, you have the right to
request that we restrict our disclosure of your health information to only certain
individuals involved in your care or the payment for your care, such as family members
and friends. We are not required to agree to your request; however, if we do agree, we are
bound by our agreement except when otherwise required by law, in emergencies, or when the
information is necessary to treat you.
3. You have the right to inspect and obtain a copy of the health information that may be
used to make decisions about you, including patient medical records and billing
records, but not including psychotherapy notes.
4. You may ask us to amend your health information if you believe it is incorrect or
incomplete, and as long as the information is kept by or for our practice.
You must provide us with a reason that supports your request for an amendment.
5. You are entitled to receive a copy of Kings Eye Center Notice of Privacy Practices.
You may ask us to give you a copy of this Notice at any time. To obtain a copy of this
notice contact our office.
6. Right to file a complaint. If you believe your privacy rights have been violated, you
may file a complaint with our practice or with the Secretary of the Department of
Health and Human Services. All complaints must be submitted in writing. You will not
be penalized for filing a complaint.
7. Right to provide an authorization for other uses and disclosures. Our practice will
obtain your written authorization for uses and disclosures that are not identified by
this notice or permitted by applicable law.
The above requests or complaints must be made in writing and submitted to the Privacy Officer
of Kings Eye Center. Upon receipt of your request or complaint our Privacy Officer will investigate
and respond in the appropriate time and manner.
If you have any questions regarding this notice or our health information privacy policies, please
contact Kings Eye Center's Privacy Officer.
Kings Eye Center Medical Group, Inc.