Tarr Eye & Vision Center - Dedicated to Excellence in Family Eyecare

Notice of Privacy Practices

Effective Date of Notice: April 14, 2003

Privacy Officer

Privacy Officer

THIS NOTICE DESCRIBES HOW OPTOMETRIC & MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW CAREFULLY.

At Tarr Eye & Vision Center, we respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our Privacy Practices. This Notice describes how we protect your health information and what rights you have regarding this information.

Treatment, Payment & Health Care Operations

The most common reasons we use or disclose your health information is for treatment, payment or internal health care operations.

By law, we are not required to receive your permission for these purposes. Examples of how we use /disclose information for treatment purposes are: setting up an appointment for you, testing & examining your eyes and vision; diagnosing the status of your vision and ocular health; prescribing medications or other treatment such as lasers, surgery or rehabilitation; faxing information to fill prescriptions; showing you low vision aids; referring you to another health care provider or clinic; or getting copies of your health information from another professional that you may have seen before us.

Examples of how we use/disclose your health information for payment purposes are: asking you about your health and vision plans; asking about other sources of payment; verifying benefit enrollment and/or eligibility; preparing and sending bills or claims (either on paper or electronically); and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “Health care operations” mean those administrative functions that we perform in order to run our offices. Examples of how we use/disclose your health information for health care operations are: financial or billing audits; internal quality assurance; participation in insurance and managed care plans; defense of legal matters; business planning and outside storage of our records.

We routinely use your health information inside our offices for these purposes without any specific permission - it is not required by law. If we need to disclose your health information outside our offices for these reasons, we usually will not ask for your specific permission. We will ask for specific written permission in the following situations: 1) marketing of products/services for which we may receive payment, 2) inclusion in medical studies or scientific research.

Uses & Disclosures for Other Reasons Without Permission

In some situations, the law requires us to use or disclose your information without your specific permission. Not all of these situations will apply to our offices or to you; some may never come up in our offices. Such uses or disclosures are:

Unless you object, we will also share relevant information about your care with your immediate family or other caregivers (i.e. friends, legal representatives) who are helping you with your eye health care.

Appointment Reminders

We may call/write to remind you of scheduled appointments or to notify you when you have missed an appointment, or that it is time to make an appointment for continuing care. If you refuse to allow us to contact you in such a manner, it may become necessary for us to recommend you seek care from another provider/s/, especially if we feel your refusal jeopardizes your eye health and/or vision. While we respect your right to privacy, we insist that you become actively involved in your eye health care and cooperate with us in providing such care. We may also call/write to notify you of new/different treatments or services available for your vision and eye health condition.

Other Uses and Disclosures

We will not make any other uses or disclosures of your health information unless you sign a written Authorization Form. Federal law determines the content of an Authorization Form. We may, from time to time, initiate the “authorization process” if use or disclosure is our idea. Sometimes, you may initiate the process if it is your idea for us to send your information to someone else. In this situation, you will give us written instructions and authorization or you can use one of our standard forms.

If we initiate the process and ask you to complete an Authorization Form, you do not have to sign the authorization, we cannot make the use or disclosure. If you do sign an Authorization Form, you may revoke it at any time (in writing) unless we have already acted in reliance upon the original authorization. Send revocations to the attention of the individual named as Privacy Officer at the end of this Notice.

Your Rights Regarding Your Health Information

The law gives you many rights regarding your personally identifiable health information. You can:

Our Notice of Privacy Practices

We must abide by the terms of this Notice until we choose to make changes. We reserve the right to change this Notice at any time, as allowed by law. If we change the Notice, the new privacy policies will apply to your health information that we already have on file as well as to such information as we may create in the future. If we change our Notice or Privacy Practices, we will post the new Notice in our offices, have copies available in our offices. We are committed to the privacy of your health information and have established corporate policies (in addition to those outlined in this Notice) that guide the training of our providers and staff members in our Privacy Practices. Further, we make every endeavor to assure that our business associates are aware of our Privacy Practices and agree (whenever possible or required by law) to abide by these practices.

Complaints

If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact person at the address, fax or E mail shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.

For More Information

If you want more information about our privacy practices, call or visit the office.