Privacy Practices
Last Updated: February 20, 2024
NOTICE OF
PRIVACY PRACTICES FOR OPTIMIZED EYE CARE, PC
Optimized Eye Care P.C.
207 E. Ohio Street #233
Chicago, IL 60611
Contact Our Privacy
Officer at (773) 309-1281 or [email protected]
YOUR INFORMATION. YOUR
RIGHTS. OUR RESPONSIBILITIES.
This notice describes
how medical information about you may be used and disclosed by Optimized Eye
Care, PC (“we”) and how you can get access to this information. Please review
it carefully.
Your Rights
When it comes to your
health information, you have certain rights. This section explains your rights
and some of our responsibilities to help you.
Get an electronic or
paper copy of your Patient Chart
● You can ask to
see or get an electronic or paper copy of your Patient Chart. Ask us how to do
this at [email protected].
● We reserve the
right to request identification from you to verify your identity before
providing a copy of your Patient Chart to you.
● We will provide
a copy or a summary of your health information, usually within 30 days of your
request. We may charge a reasonable, cost-based fee.
Ask us to correct your
Patient Chart
● You can ask us
to correct information about you that you think is incorrect or incomplete. Ask
us how to do this at [email protected].
● We may say “no”
to your request, but we’ll tell you why in writing within 60 days.
Request confidential
communications
● 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 say “yes” to
all reasonable requests.
Ask us to limit what we
use or share
● 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, but will do our best
to accommodate you. However, we may say “no” 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 say “yes” unless a law requires us to share that
information.
Get a list of those
with whom we’ve shared information
● You can ask for
a list (accounting) of the times we’ve shared your health information for six
years prior to the date you ask, who we shared it with, and why. Request an
accounting from [email protected].
● We will include
all the disclosures except for those about treatment, payment, and health care
operations, and certain other disclosures (such as any you asked us to make).
We’ll provide one accounting a year for free but will charge a reasonable,
cost-based fee if you ask for another one within 12 months.
Get a copy of this
privacy notice
● You can ask for
a paper copy of this notice at any time, even if you have agreed to receive the
notice electronically. We will provide you with a paper copy promptly.
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 make
sure the person has this authority and can act for you before we take any
action on your behalf.
File a complaint if you
feel your rights are violated
● You can
complain if you feel we have violated your rights by contacting us using the
contact information on page 1
● 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 cannot and
will not retaliate against you for filing a complaint.
Your Choices
For certain health
information, you can tell us your choices about what we share. If you have a
clear preference for how we share your information in the situations described
below, talk to us at [email protected]. Tell us what you want us to do, and
we will follow your instructions.
In these cases, you
have both the right and choice to tell us to:
● Share
information with your family, close friends, or others involved in your care
● Share
information in a disaster relief situation
If you are not able to
tell us your preference, for example if you are unconscious, we may go ahead
and share your information if we believe it is in your best interest. We may
also share your information when needed to lessen a serious and imminent threat
to health or safety.
In these cases we never
share your information unless you give us written permission:
● Marketing
purposes
● Sale of your
information
Our Uses and Disclosures
How do we typically use or share your health
information?
● We typically
use or share your health information in the following ways.
○ Treat You
■ We can use your
health information and share it with professionals, including eye care
professionals (ophthalmologist, optometrist, optician, or optical staff) who
are treating you.
■ Example: A
doctor treating you for an injury asks another doctor about your overall health
condition. Send your prescription to eye care product retailers.
■ We can use and
share your health information, including your eyewear prescription information,
with qualified eye care professionals and eye care product retailers so you can
obtain appropriate vision or ocular products for your care.
■ Example: You
would like to make a purchase from a retailer of eyewear. You successfully
complete Visibly’s vision test and, by agreeing to the to the Service
Agreement, you give us permission to send your health information, including
vision test status, prescription, and any other pertinent information, to the
retailer for the dispensing of your corrective eyewear.
● Run our
organization
○ We can use and
share your health information to run our practice, improve your care, and
contact you when necessary.
■ Example: We use
health information about you to manage your treatment and services. Bill for
your health services.
■ We can use and
share your health information to bill and get payment from health plans or
other entities.
■ Example: We
give information about you to your health insurance plan so it will pay for
your services.
How else can we use or
share your health information?
We are allowed or
required to share your information in other ways – usually in ways that
contribute to the public good, such as public health and research. We have to
meet many conditions in the law before we can share your information for these
purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
● Help with
public health and safety issues
○ We can share
health information about you for certain situations such as:
■ Preventing
disease
■ Helping with
product recalls
■ Reporting
adverse reactions to medications
■ Reporting
suspected abuse, neglect, or domestic violence
■ Preventing or
reducing a serious threat to anyone’s health or safety
● Do research
○ We may use or
share your non-personally identifiable information for health research, such as
for academic study, clinical advancements or diagnosis determination research.
This research may be sold or made publicly available, but under no
circumstances will it include any personally identifiable information. In
addition, some research may result in the discoveries or developments of new
technologies, medical devices, therapies, or treatments. In the event of any
new discoveries or developments, you will have no proprietary or other
ownership interest or claim for compensation related to these discoveries or
developments.
● Comply with the
law
○ We will share
information about you if state or federal laws require it, including with the
Department of Health and Human Services if it wants to see that we’re complying
with federal privacy law.
● Respond to
organ and tissue donation requests and work with a medical examiner or funeral
director
○ We can share
health information about you with organ procurement organizations
○ We can share
health information with a coroner, medical examiner, or funeral director when
an individual dies
● Address
workers’ compensation, law enforcement, and other government requests
○ We can use or
share health information about you:
■ For workers’
compensation claims
■ For law
enforcement purposes or with a law enforcement official
■ With health
oversight agencies for activities authorized by law
■ For special
government functions such as military, national security, and presidential
protective services
● Respond to
lawsuits and legal actions
○ We can share
health information about you in response to a court or administrative order, or
in response to a subpoena.
Note: we do not create
or manage a hospital directory, or maintain psychotherapy notes.
Our Responsibilities
● We are required
by law to maintain the privacy and security of your protected health
information.
● We will let you
know promptly if a breach occurs that may have compromised the privacy or
security of your information.
● We must follow
the duties and privacy practices described in this notice and give you a copy
of it.
● We will not use
or share your information other than as described here unless you tell us we
can in writing. If you tell us we can, you may change your mind at any time.
Let us know in writing if you change your mind.
● For more
information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Certain kinds of
medical information may receive enhanced privacy protection under federal or
state law. This includes medical information that is:
● Maintained in
psychotherapy notes
● About alcohol
and drug abuse prevention, treatment and referral
● About HIV/AIDS
testing, diagnosis or treatment
● About venereal
disease and/or communicable disease(s)
● About genetic
testing
We do not expect to maintain
this type of sensitive medical information. If we do, we will disclose this
type of sensitive medical information only with your prior written
authorization or if permitted or authorized by law. The protection given to
this type of sensitive medical information may depend upon the State in which
you receive services or treatment.
Changes to the Terms of this Notice
We can change the terms
of this notice, and the changes will apply to all information we have about
you. The new notice will be available on our web site. You have the right to
receive a paper copy of this Notice at any time. If you wish to do so, please
contact our Privacy Official at [email protected].
