137 East Avenue Suite 100 Tallmadge, OH 44278
Notice of Privacy Practices
Tallmadge Family Eye Care, LLC
Protected health information includes demographic data, medical histories, test results, insurance information, as well as any other information used to identify you or provide health care services or health care coverage. This information relates to your past, present, or future physical or mental health or condition and is maintained by our practice as an electronic/written record of your contacts and visits to our practice for health care services.
Our practice is required by law to maintain the privacy and security of your protected health information. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. We must follow the duties and privacy practices described in this notice and will promptly notify you if a breach occurs that may have comprised the privacy or security of your information. We will not use or share your information other than described here unless we receive written consent from you. Please review this notice of privacy practices carefully.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
RIGHT TO INSPECT AND COPY: You can ask to see or request an electronic or paper copy of your medical record or other health information we have about you. We will provide a copy or a summary of your health information within 30 days of your request. We may charge you a reasonable fee for electronic or paper copies and any applicable postage/delivery.
RIGHT TO AMEND: You can ask us to correct health information about you that you think is incorrect or incomplete. We may deny your request as we are not required to agree to the amendment, however, you will be notified with the reason for our denial within a reasonable time frame.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATION: You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will accept only reasonable requests.
RIGHT TO REQUEST RESTRICTIONS: You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request and may deny your request if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will comply with your request unless a law requires us to share that information.
RIGHT TO ACCOUNTING OF DISCLOSURES: You can ask for a list (accounting) of the times we have shared your information. We will include all the disclosures except for those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make). We may charge you a reasonable fee if you ask for more than one list within 12 months.
RIGHT TO A PAPER COPY: You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
RIGHT TO CHOOSE SOMEONE TO ACT FOR YOU: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will ensure the person has this authority and can act for you before we take any action.
RIGHT TO FILE A COMPLAINT: You can file a complaint if you feel we have violated your rights by contacting our Privacy Officer at (330) 630-2580, email to email@example.com, or mail a complaint to Attn: Privacy Officer, Tallmadge Family Eye Care, LLC, 137 East Avenue Suite 100, Tallmadge, OH 44287. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint. Our Privacy Officer will respond to your concerns if you provide contact information with your complaint.
HOW WE MAY USE OR SHARE YOUR HEALTH INFORMATION?
Following are ways we may use, share or disclose your health information:
TREATMENT: We may use your health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party involved in your care for treatment, such as a pharmacy, or another health care provider who may be treating you. For example, a doctor performing cataract surgery for you would need information about your overall eye health.
HEALTH CARE OPERATIONS: We may use and share your health information, as needed, to support our business activities, improve your care, and contact you when necessary. This includes, but is not limited to, medical review, legal services, auditing functions, and patient safety activities.
PAYMENT: We may use and share your health information to verify eligibility, investigate claims, bill and receive payment from health plans or other entities. For example, we give information about you to your health insurance plan so it will pay for your services.
SPECIAL NOTICES: We may use or share your health information, as necessary, to contact you to remind you of your appointment,
notify you of optical orders available for pick up, provide results from exams or tests, other information relating to your health and the services we provide you, or general information about our practice. We may contact you by phone, email, text, or other means. You have the right to opt out of certain special communications.
OTHERS INVOLVED IN YOUR HEALTH CARE: Unless you object, we may share your health information to a member of your family, a relative, a close friend, or other person that you identify that relates to their involvement in your health care. If you are unable to agree or if you object to a disclosure of this nature, we may share such information as necessary if we determine that it is in your best interest based on our professional judgement. We may also use our professional judgement in allowing a person to act on your behalf to pick up medications, medical or optical supplies and any other situation as deemed necessary.
OTHER PERMITTED, REQUIRED USES AND DISCLOSURES: We are also allowed to use or share your health information for the following purposes: for help with public health and safety issues; for health research; as required by law; in response to organ and tissue donation requests; when working with a medical examiner or funeral director; to address workers’ compensation claims; law enforcement; for health oversight agencies for activities authorized by law; for special government functions such as military, national security, and presidential protective services; in response to lawsuits and other legal actions; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.