TRACY THAO LE, O. D.
NOTICE OF PRIVACY
PRACTICES
TRACY T. LE, O.D.
301
408-259-1818
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
We respect our legal obligation to maintain the privacy of
your healthcare information. We are also
required to give you notice of our privacy practices. This Notice is effective November 8, 2004 and generally describes how we protect your
healthcare information in addition to your rights regarding this information
USES AND DISCLOSURE OF HEALTH
INFORMATION: TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
In performing our duties, we may use and disclose your
healthcare information or Treatment, Payment and Health Care Operations. Some
examples of this use or disclosure include:
Treatment: booking an appointment for you;
testing or examining your eyes, prescribing eyewear or eye medication and
transmitting prescriptions to be filled; referring you to another eye care
professional, healthcare provider, clinic or optical dispensary for necessary
services, evaluation, consultation, or products; or obtaining copies of your
healthcare information from another professional whom you may have seen before
us.
Payment: Asking you about your medical and;
or vision care plans or other sources of payment for services; billing an collection
related activities (including the use of a collection agency or attorney when
necessary and permitted); actions by a health plan or insurer to determine or
fulfill its responsibilities regarding patient eligibility, coverage and claims
adjudication
Health care Operations: These are administrative and
managerial functions necessary for running our office. Example quality assessment and financial
audits; personnel and training decisions; participation in managed care plans;
defense of legal matters; business planning; outside storage of our records.
We routinely use your health information inside our office
for these purposes without any special permission. If we need to disclose your health
information outside of our office for other reasons, we generally will ask you
for written permission
USES AND DISCLOSURES FOR OTHER
REASONS WITHOUT PERMISSION
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 arise at our office at all. Examples of such disclosures
When
a State of Federal law mandates that certain health information be reported for
a specific purpose;
Public
health or Safety purposes to address situations as permitted by law, including:
problems with optical products or product recall Notices, threats to public
health and safety, crime reporting, disaster relief efforts or national
security;
To
Military command authorities as required concerning your service;
To
governmental authorities about victims of suspected abuse, neglect or domestic
violence;
For
regulatory administrative oversight, such as to professional licensing boards,
state Insurance departments public Health department, and inquiries by medical
benefits administrators such as Medicare;
Law
enforcement in response to a law enforcement official, court or administrative
agency subpoena or order or other lawful purposes including for Workers’
compensation programs;
To
a coroner or Medical Examiner for the performance of their duties
To
parties handling organ and tissue donations and transplantation
Necessary
date for governmental agency research programs, public health or health care
operations.
Disclosures
to contactor who are our business associates who perform health care operations
for us and who commit to respect the privacy of your healthcare information.
Unless you
object, we may also share relevant information about your care with your family
member(s) or personal representative(s) who are directly involved in or are
helping you with you eye care.
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled
appointment, or that it is time to make a routine appointment. We may also call or write to notify you of
other treatments or services available oat our office that might help you. Unless you tell us otherwise, we may mail
you an appointment reminder on a postcard, and/or leave you a reminder message
at your designated primary telephone number or with someone who answers our
phone if you are not available.
OTHER USES AND DISCLOSURES
Any other uses of disclosure of your health information
shall be made only with your signed written permission identified as an
“authorization form.” We or you may initiate the authorization process by using
a properly complete authorization form. This form is available through our office, or you may provide us similar
form if you choose.If you provide us
with an authorization, you may revoke that permission at any time by sending us
a written request.If you revoke your
permission, we will no longer use or disclose your healthcare information for
the reasons stated in your authorization, except to the extent that we have
already acted in reliance upon the authorization.
PATIENT RIGHTS
The law gives you many rights regarding your healthcare
information. You may exercise these
rights by sending a written request addressed to the office contact person
named at the end of this notice.
Right to Request restrictions You may ask us to restrict our uses
and disclosures for purposes of treatment (except emergency treatment), payment
or health care operations. We are not
required to agree to your request, but if we do agree, we must honor the
restrictions that you want.
Right to Request confidential
Communications: you
may make a reasonable request that we communicate your healthcare information
to you in a certain way or at a certain address. Your request must specify you
or where you wish to contacted We will comply with reasonable requests.
Right to Inspect and Copy. You generally have the right to view and copy personal healthcare
information that we maintain. If you
request a copy of the information, we may charge for the costs of copying,
mailing, or other supplies associated with your request. We will notify you of such costs so you may
change your request if desired.
Right to amend. If you feel that personal
healthcare information we have about you is incorrect or incomplete, you may
ask us to amend the information. We will send the corrected information to
parties whom we know received the incorrect or incomplete information, and
others that you specify. We may deny your request for an amendment if it is not
in writing or does not include a reason to support the request, the current
information is accurate and complete, or if we did not create the
information. If we deny your request,
you may send us a written notice of disagreement with our denial.
Right
to an accounting of disclosure(s). you have the right to request one free list
per calendar year of our disclosures for purposes other treatment, payment, or
health Care Operation that were made to you or you representative authorized by
you, or were required by law.Your
request must state a time period within the past six years but cannot include
dates before 14 April 2003.
Right
to a paper Copy: if you received this Notice via email, you may request a paper
copy of this Notice any time.
CHANGES TO 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 as allowed by law, If we change this Notice, the new privacy
practices will apply to your health information that we already have or may
generate in the future. If we change our
Notice of Privacy Practice, we will post the revised Notice in our office and
make copies available.
COMPLAINTS
If you
believe that we have not properly respected the privacy of your health
information, you may file a written complaint with us or with the Secretary of
the U.S. Department of Health and Human Services, Attn: Office for Civil
Rights. You will no be penalized for
making a complaint. If you prefer, you
can discuss your complaint in person or by phone
OFFICE
CONTACT INFORMATION;
TRACY T.
LE, optometrist.
301
Tel:
408-259-1818
