notice
of privacy practices
effective
date of notice:
eric
w. leser, o.d. & vicki leung, o.d.
a
professional corporation
23161
woodland
hills, ca
(818)
591-8860
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 written authorization.
we
shred paperwork including, but not limited to, memos, invoices, and
prescriptions, that have any personal health or identification information.
uses or disclosures of health information
examples
of how we use information for treatment
purposes:
·
when we set up an
appointment for you.
·
when our technician or
doctor tests your eyes.
·
when the doctor
prescribes glasses or contact lenses.
·
when the doctor
prescribes medication.
·
when our staff helps
you select and order glasses or contact lenses.
·
when we show you low
vision aids.
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 low vision aids or services.
·
if we send a
prescription for glasses or contacts to another professional to be filled.
·
when we provide a
prescription for medication to a pharmacist.
·
when we phone to let
you know that your glasses or contact lenses are ready to be picked up.
sometimes
we may ask for copies of your health information from another professional that
you have seen before.
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 care plans that you may belong to, or about other
sources of payment for our services.
·
when we prepare bills
to send to you or your health or vision care plan.
·
when we process payment
by credit card and when we try to collect unpaid amounts due.
·
when bills or claims
for payment are mailed, faxed, or sent by computer to you or your health or
vision plan.
·
when we occasionally
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 in a number of ways. health care operations
mean those administrative and managerial functions that we have to do in order
to run our office. we may use or disclose your health information, for example,
for financial or billing audits, for internal quality assurance, for personnel
decisions, 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. we may send you postcards to remind
you that you are due for an appointment.
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
specific purposes.
·
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 about 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.
·
disclosures for
judicial and administrative proceedings, such as in response to subpoenas or
orders of courts or administrative agencies.
·
disclosures for law
enforcement purposes, such as to provide information about someone who is or is
suspected to be a victim of a crime; to provide information about a crime at
our office; or to report a crime that happened somewhere else.
·
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.
·
uses or disclosures for
specialized government functions, such as for the protection of the president
or high-ranking government officials; for lawful national intelligence
activities; for military purposes; or for the evaluation and health of members of
the foreign service.
·
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 make any other uses or disclosures of your health information unless
you sign a written authorization
form. you do not have to sign such a form. if you do sign one, you may
revoke it at any time unless we have already acted in reliance upon it.
your rights regarding your health
information
the law gives you many rights
regarding your health information.
·
you can ask us to
restrict our uses and disclosures for purposes of treatment (except emergency
treatment), payment or healthcare operations. we do not have to agree to do
this, but if we agree, we must honor the restrictions that you want. to ask for
a restriction, send a written request to vicki leung, o.d., at the address shown
at the beginning of this notice.
·
you can ask us 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 pay us for any extra cost. if you
want to ask for confidential communications, send a written request to vicki leung, o.d.,
at the address shown at the beginning of this notice.
·
you can ask to see or
to get photocopies of your health information. by law, there are a few limited
situations in which we can refuse to permit access or copying. primarily,
however, you will be able to review or have a copy of your health information
within 30 days of asking us. you may have to pay for photocopies in advance. if
we deny your request, we will send you a written explanation, and instructions
about how to get an impartial review of our denial if one is legally required.
by law, we can have one 30-day extension of the time for us to give you access
or photocopies if we sent you a written notice of the extension. if you want to
review or get photocopies of your health information, send a written request to
vicki leung, o.d., at the address shown at the beginning of this notice.
·
you can ask us 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. we
will send the corrected information to persons who we know got the wrong
information, and others that you specify. if we do not agree, you can write a
statement of your position, and we will include it with your health information
along with any rebuttal statement that we may write. once your statement of
position and/or rebuttal is included in your health information, we will send
it along whenever we make a permitted disclosure of your health information. by
law, we can have one 30-day extension of time to consider a request for
amendment if we notify you in writing of the extension. if you want to ask us
to amend your health information, send a written request, including your
reasons for the amendment, to vicki leung, o.d., at the address shown
at the beginning of this notice.
·
you can get a list of
the disclosures that we have made of your health information within the past six
years (or a shorter period if you want), 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. you
are entitled to one such list per year without charge. if you want more
frequent lists, you will have to pay for them in advance. we will usually
respond to your request within 60 days of receiving it, but by law we can have
one 30-day extension of time if we notify you of the extension in writing. if
you want a list, send a written request to vicki leung, o.d., at the address shown at the
beginning of this notice.
our notice of privacy practices
by
law, 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 and as allowed by law. if we change this notice, the new
privacy practices will apply to your health information that we already have,
as well as to such information that we may generate in the future. if we change our notice of privacy practices, we will post
the new notice in our office, have copies available in our office.
complaints
if
you think that we have not properly respected the privacy of your health information,
you are free to complain to us or to the
for more information
if
you want more information about our privacy practices, call or visit vicki leung, o.d., at the address or phone number shown at the
beginning of this notice.