Notice of Privacy Practice

HOW WE USE OR DISCLOSE YOUR HEALTH INFORMATION:

The law allow us to use or disclose your information for the following purposes:

1. Treatment, payment and regular health care operations, dispense and provide prescription
 ophthalmic goods and services to you, bill your insurance carrier, if you have third party coverage, record and monitor the service provided to you.  Information will also be provided upon your request.

2. Disclose information to Public Health Officials, Law Enforcement, health oversight activities (for audits, investigation, etc), Judicial and Administrative, Deceased Person information,
Worker compensations programs, FDA (for reporting adverse drug events and quality issues), if there is any serious threat to your health or safety, in time of national security,
if you are in the military or a veteran of the armed forces when requested, or if you
become an inmate in a correctional facility.

3. Personal communications:  when we may contact you to provide appointment reminders, annual eye exam cards, and other information about treatment alternatives or other health-related benefits and services that may be of interest to you as well as communicate with individuals involved in your care or payment for your care.

4. Our business Associates: there are some services provided by us through contracts with business associates.  When these services are contracted for, we may disclose health information about you to our business associates so that they can perform the job we have asked of them and bill you or your third party payer for services rendered.  We require the business associate to safeguard the health information.

5. Victim of abuse, neglect or domestic violence: we will disclose information to a government authority, such as social service or protective services of abuse, neglect, or domestic violence.

6. Marketing communications: we must obtain your written authorization prior to using your health information to send you any marketing materials.  We may communicate with you about products or services relating to your treatment, care or alternative treatments, or providers without authorization.


Except as described in this 'Notice of Privacy Practices', we shall not use or disclose your health
information without your written authorization.  If you give us permission for any other purpose, you can revoke your authorization in writing at any time.

1. You can request certain uses and disclosures of your health information.  We are not required to agree to the restriction that you requested.

2. You can inspect and copy your health information.  These items will include only your prescription and your billing record.  Your request must be in writing.  We may charge you for the cost of copying, mailing or other supplies necessary to grant your request.  We may deny your request to inspect and copy in certain limited circumstances. If denied, you may request denial be reviewed.

3. You can request to have your information amended if incomplete or incorrect.  We are not required to change your health information and will provide you with information about procedure for addressing any disagreement with the denial.

4. You have the right to receive an accounting of disclosures of your health information we have made after April 14, 2003 for most purposes other than treatment, payment, health care operations, information provided to you, and certain government functions.  You must have the request in writing.  Time period may not be longer that six years.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.

5. You must request that we contact you about medical matters only in writing or at a different residence or post office box.  You must state how or when you would like to be contacted. We will accommodate all reasonable requests.

If you wish to exercise one or more of these rights, contact our office:

Avon family Eyecare, LLC
36941 Detroit RD
Avon, OH  44011
(440) 934-3770

5373 Oberlin Ave
Lorain, OH  44053
(440)282-3670

Changes to this 'Notice of Privacy Practices':

    We reserve the right to amend our practices and this 'Notice of Privacy Practices' at any time in the future and to make the new Notice effective for all medical information we maintain.  Until such amendment is made, we are required by law to comply with this notice.  The revise notice will be posted in our office and a paper copy will be available upon request.

For More information or to Report a Problem:
    
    If you have any questions or would like additional information about our privacy practices, you may contact our office at the above address.  If you believe your privacy rights have been violated, you may file a written complaint, for which there will be no retaliation, to our office, or with the Secretary of Health and Human Services.

    Your signature on the 'Patient Welcome Information' serve as an acknowledgement that you have received our Privacy Notice and that you have understood that the doctors and staffs made good faith effort in providing all material for you to better understand your rights to privacy.