NOTICE OF PRIVACY PRACTICES
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.
OUR
LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy
of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and
your rights concerning your health information. We must follow the privacy practices that are described in this Notice while
it is in effect. This Notice takes effect April 14, 2003, and will remain in effect until we replace it.
CHANGES TO THIS NOTICE
We will abide by the terms of the Notice currently
in effect. We reserve the right to change the terms of this Notice and to make the new notice provisions effective for all
protected health information that we maintain. An updated version of the Notice may be obtained on-line at www.njeyeguy.com
or from the Privacy Officer, whose address is provided at the end of this Notice. Updated versions are also available at any
of our retail vision centers.
NOTICE EFFECTIVE DATE
The
effective date of this Notice is April 14, 2003.
You may request a copy of our Notice at any
time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the
information listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We disclose health information about you for treatment, payment, and healthcare operations. We also
use this information for these purposes. For example:
Treatment: We may use
your health information to provide optometric services to you. For example, we may disclose your health information to an
ophthalmologist or other healthcare provider providing treatment to you in order to: (a) provide, coordinate, or manage the
health care and related services that are provided to you by health care practitioners; (b) enable your health care providers
to consult among themselves about your vision; (c) refer you to a new health care provider; or (d) to contact you in the event
of a product recall. We may also use your health information for these purposes.
Payment:
We may use and disclose medical information about you in order to be paid for the optometric services rendered to you. This
may include contacting your health insurer to determine the existence of insurance coverage for the optometric services you
receive, sending copies or excerpts of your health information to your health insurer to receive payment, and using your health
information for our own internal management of the billing process. By way of example, a bill sent to your insurance company
may include information that identifies you and the procedures used to provide services to you.
Appointment
Reminders and Treatment Alternatives: We may use or disclose your health information to provide you with appointment
reminders (such as voicemail messages, postcards, or letters) or information about treatment alternatives or other health-related
benefits and services that may be of interest to you. We may also use your health information to provide you with information
regarding services that we offer related to your healthcare needs.
Healthcare Operations:
We may use and disclose your health information in connection with our healthcare operations. Healthcare operations encompass
all those activities that we as an optometric practice must do to run smoothly and efficiently and specifically include activities
such as quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals,
evaluating practitioner and provider performance, and conducting training programs, accreditation, certification, licensing
or credentialing activities. For example, we may periodically review your chart, as well as those of other patients, in connection
with these activities. As part of our health care operations, it may also become necessary for us to use and disclose your
health information in connection with the healthcare operations of another company that has a relationship with you, such
as an HMO.
Business Associates: We may use and disclose certain medical information
about you to our business associates. A business associate is an individual or entity under contract with us to perform or
assist us in performing a function or activity that requires us to disclose your health information to them. Examples of business
associates include, but are not limited to, consultants, accountants, lawyers and third-party billing companies. We require
the business associate to protect the confidentiality of your health information.
To
You, Your Family and Friends: We must disclose your health information to you, as described in the Information Rights
section of this Notice. We may disclose your health information to a family member, friend or other person to help with your
healthcare or with payment for your healthcare, but only if you agree or do not object that we may do so or, if you are not
able to agree, if it is necessary in our professional judgment.
Persons Involved in
Care: We may use or disclose health information to notify, or assist in the notification of (including identifying
or locating) a family member, your personal representative or another person responsible for assisting you to obtain health
care services. If you are present, then prior to use or disclosure of your health information, we will provide you with an
opportunity to object to such uses or disclosures. In the event you become incapacitated, or during an emergency, we may disclose
your health information to others, including health care providers, on the basis of our professional judgment. We will also
use our professional judgment and our experience with common practice to make reasonable inferences in your best interest
in allowing a person to pick up medical supplies or forms of health information.
Required
by Law: We may use or disclose your health information when we are required to do so by law, including disclosures
for use in judicial and administrative proceedings, or to law enforcement officials, or to the proper authorities if we reasonably
believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.
Public Health: We may use or disclose your health information in connection with public
health activities, health oversight activities, and with worker's compensation matters. We may also disclose
your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety
of others.
National Security: We may disclose to military authorities the health
information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health
information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose
protected health information to a correctional institution or law enforcement official having lawful custody of an inmate
or patient.
State Laws: The laws of the state where you are receiving your
optometric services from us may provide greater rights to you. To the extent your state has such laws, they are described
on the attachment to this Notice.
Your Authorization: In addition to our use
and disclosure of your health information for the purpose described above, you may give us written authorization to use your
health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing
at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.
Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those
described in this Notice.
YOUR INFORMATION RIGHTS
Although
all records concerning your services obtained from us are our property, you have the following rights concerning your information.
Right to Request Restrictions: You have the right to request restrictions
on certain uses and disclosures of your information. We are not required to honor your request. We encourage you to make these
requests in writing.
Right to Confidential Communications: You have the right
to receive confidential communications of your information by alternative means or at alternative locations. For example,
you may request that we contact you only at work or by mail. We require that you make this request in writing.
Right to Inspect and Copy: You have the right to inspect and copy your information in most
circumstances. We require that you make this request in writing.
Right to Amend:
You have the right to amend your health information in circumstances where you believe that information is inaccurate or incomplete.
We require that you make this request in writing, and that you tell us why you believe that we should amend your information.
Right to an Accounting: You have the right to request and obtain an accounting of
certain disclosures of your information. You must make this request in writing.
Right
to Obtain Copy: You have the right to obtain a paper copy of this Notice upon request.
A
request to exercise any of these rights must be submitted to the Privacy Officer. Forms to help you make your request are
available from the Privacy Officer. You may also obtain paper copies of these forms from us.
FOR
MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information,
you may contact the Privacy Officer at (973) 827-4120. If you believe your privacy rights have been violated, you may file
a complaint with us or with the Secretary of the Department of Health and Human Services, Office of Civil Rights, HIPAA, 200
Independence Avenue, S.W., Washington, DC 20201. To file a complaint with us, please contact: Privacy Officer, 418 Route 23,
Franklin, NJ 07416. All complaints must be submitted in writing. There will be no retaliation for filing a complaint.