Eye-Q Vision Care, PLLC


NOTICE OF PRIVACY PRACTICES


THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice. This Notice takes effect July 1, 2006, and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, as permitted by applicable law. Any such changes would be effective for all health information that we maintain, including health information we created or received prior to the changes. In the event we make a material change in our privacy practices, we will change this Notice and provide it to you.

For more information about our privacy practices, or for additional copies of this Notice, please let us know.


USES AND DISCLOSURES OF HEALTH INFORMATION

We may use and disclose information about you for treatment, payment, and healthcare operations.

Treatment: Your health information may be disclosed to an optician, ophthalmologist, or other healthcare provider for the purposes of: (a) the provision, coordination, or management of health care and related services by health care providers;  (b) consultation between health care providers relating to a patient;  (c) the referral of a patient for health care from one health care provider to another; or (d) recall information.  

Payment: We may use and disclose your health information to obtain payment for services we provide you.  This may include: (a) billing and collection activities and related data processing; (b) actions by a health plan or insurer to obtain premiums or to determine or fulfill its responsibilities for coverage and provision of benefits under its health plan or insurance agreement, determinations of eligibility or coverage, adjudication or subrogation of health benefit claims; (c) medical necessity and appropriateness of care reviews, utilization review activities; and (d) disclosure to consumer reporting agencies of information relating to collection of premiums or reimbursement.

Healthcare Operations:  Your health information may be used and disclosed in connection with our healthcare operations.  Healthcare operations include such things as quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.

Your Authorization:  In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose.  If you give us an authorization, you may later revoke it in writing at any time.  Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.  Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those previously described in this Notice.

Marketing Health Products or Services:  We will never sell or use your health information for marketing communications without your prior written authorization.  We may provide you with information regarding products or services that we offer related to your health needs

To You, Your Family and Friends:  We must disclose your health information to you, as described in the Patient Rights section of this Notice.  We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment of health services, but only if you agree that we may do so or, if you are not able to agree, if it is necessary in our professional judgment.

Persons Involved in Care:  We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death.  If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures.  In the event of your incapacity or emergency circumstances, we will disclose health information that is directly relevant to the person's involvement in your healthcare.  We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up eyeglass, contact lens, or therapeutic prescriptions; contact lenses and ocular or lens solutions; and other similar forms of health information.

Required by Law:  We may use or disclose your health information when we are required to do so by law, including judicial and administrative proceedings.

Abuse or Neglect:  We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.  We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

National Security:  We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.  We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities.  We may disclose to correctional institutions or law enforcement officials having lawful custody of protected health information of inmate or patient under certain circumstances.

Appointment Reminders and Treatment Alternatives:  We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters) or information about treatment alternatives or other health-related benefits and services that may be of interest to you.


PATIENT RIGHTS

Access:  You have the right to review or get copies of your health information (with limited exceptions) with a written request or by filling out an information access request form from our office.  Information may be released in the form of photocopies, a written summary and explanation of your health information, or in any other format that you request unless we cannot practicably do so.  We will charge you a reasonable cost-based fee for expenses such as copies and staff time.  Your request may be sent to us at the address listed at the end of the Notice.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations, where you have provided an authorization and certain other activities, for the last 6 years, but not prior to July 1, 2006.  If you request this accounting more than once in a 12 month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.

Restriction:  You have the right to request that we place additional restrictions on our use or disclosure of your health information.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).

Alternative Communication:  You have the right to request in writing that we communicate with you about your health information by alternative means or to alternative locations.  Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.

Amendment:  You have the right to request that we amend your health information.  Your request must be in writing, and it must explain why the information should be amended.  We may deny your request under certain circumstances.


QUESTIONS AND COMPLAINTS

If you want more information about our privacy practices or have questions or concerns, please contact us.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to you health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or locations, you may complain to us using the information listed at the end of this Notice.  You may also submit a written complaint to the U.S. Department of Health and Human Services.  We will provide you with the address to file your complaint upon request.

We support your right to the privacy of your health information.  We will not retaliate in any way if you choose to file a complaint with the U.S. Department of Health and Human Services.

Contact Person

Roman Hamasaki O.D.
18009 Highway 99, Suite C-1
Lynnwood, WA 98037
425-776-5209