Eclectic Eye - Eyewear Boutique

Privacy Practices

Notice of Privacy Practices for Protected Health

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully!

Effective April 14, 2003

What are Privacy Practices?

Our office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care options. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services. Examples of uses of your health information for treatment purposes: An optical technician obtains health information about you and records it in a medical record. During the course of your treatment, the optometrist determines he/she will need to consult with another specialist in the area. He/she will share the information with such specialist and obtain his/her input.

Example of use of your health information for payment purposes:

We submit requests for payment to your health insurance company. The health insurance company requests information from us regarding your medical care given.

Example of use of your health information for Health Care Operations:

We may obtain services from business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such business associates as necessary to obtain these services. At The Eclectic Eye, we are committed to treating and using protected health information about you responsibly.

Your Health Information Rights

Although your health record is the property of The Eclectic Eye, the information belongs to you. You have the right to: Request a restriction on certain uses and disclosures of your health information by delivering the written request to our office. Although we are not required to grant the request, we will comply with any request granted; Obtain a paper copy of the Notice of Privacy Practices for Protected Information ("Notice") by making a request at our office;

Inspect and copy your health and billing records-you may exercise this right by delivering the request in writing to our office; appeal a denial of access to your protected health information except in certain circumstances; Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office. The physician or other provider is not required to make such amendments; you may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;

Receive an accounting of disclosures to your health information, as required by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;

Confidential communication by requesting that communication of your health information be made by alternative means or at an alternative location by delivering the written request to our office.

Our Responsibilities

The office is required to:

Maintain the privacy of your health information, as required by law; Provide you with notice as to our duties and privacy practices as to the information we collect and maintain about you;

Abide by the terms of this Notice;

Notify you if we cannot accommodate a requested restriction or request; Accommodate your reasonable requests regarding methods to communicate health information with you; and Accommodate your request for an accounting of disclosures. We reserve the right to change or enact new provisions in our privacy practices regarding the protected health information we maintain. If our information practices change, we will amend our Notice, which you are entitled to receive by calling or requesting a copy or by visiting our office and picking up a copy.

Public Health Activities

As Required by Law- We may disclose health information as required by law. This may include reporting a crime, responding to a court order, grand jury subpoena , warrant, discovery request, or other legal process, or complying with health oversight activities, such as audits, investigations, and inspections, necessary to ensure compliance with government regulations and civil rights laws.Controlling Disease- As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. Child Abuse & Neglect- We may disclose protected health information to public authorities as allowed by law to report child abuse or neglect.

Food & Drug Administration (FDA)- We may disclose to the FDA your protected health information relating to the adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recall, repairs, or replacements. Practice Marketing- We may contact you to provide information about treatment alternatives or other health related benefits and services that may be of interest to you (for example, to notify you of any new tests or services we may be offering).

Personal Representative- We may use or disclose information to your personal representative (person legally responsible for your care and authorized to act on your behalf in making decisions related to your health care). Appointment Reminders- We may disclose medical information to provide appointment reminders (for example, contacting you at the phone number you have provided to us and leaving a message as an appointment reminder). Decedents- Consistent with applicable law, we may disclose health information to the coroner, medical examiner, or funeral director.

Communication with Family- Unless you object, health professionals, using their best judgment, may disclose to a family member or close personal friend health information relevant to that person's involvement in your care or payment to your care. We may notify these individuals of your location and general condition.

Workers Compensation- We may disclose health information to the extent authorized by and necessary to comply with the laws relating to workers compensation or other similar programs established by law. Disaster Relief-Unless you object, we may disclose your protected health information to an organization assisting in disaster relief effort.

Other uses and disclosers besides those identified in this Notice will be made only as otherwise authorized by the law or with your written authorization, which you may revoke, except to the extent information or action has already been taken.

For More Information or to File a Complaint

If you have any questions, would like any information, or want to report a problem regarding handling of your information, you may contact our Privacy Officer:

Jessica Benitone, Administrator at (901) 276-3937

Additionally, if you believe your privacy rights have been violated, you can file a written complaint with the Secretary of Health and Human Services whose address is:

200 Independence Avenue SW
Washington, DC 20201

There will not be retaliation for filing a complaint with either the practice or the Secretary of Health and Human Services.