HIPAA
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL 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 while it is in effect. This Notice takes effect April
14, 2003, and will remain in effect until we replace it.
CHANGES TO THIS
NOTICE
We will abide by
the terms of the Notice currently in effect. We reserve the right to change the terms of
this Notice and to make the new notice provisions effective for all protected health
information that we maintain. An updated version of the Notice may be obtained from the
Privacy Officer, whose address is provided at the end of this Notice. Updated versions are
also available at any of our retail centers.
NOTICE EFFECTIVE
DATE
The effective
date of this Notice is April 14, 2003.
You may request
a copy of our Notice at any time. For more information about our privacy practices, or for
additional copies of this Notice, please contact us using the information listed at the
end of this Notice.
USES AND
DISCLOSURES OF HEALTH INFORMATION
We disclose
health information about you for treatment, payment, and healthcare operations. We also
use this information for these purposes. For example:
Treatment: We
may use your health information to provide optical goods and services to you. For example,
we may disclose your health information to an optometrist or other healthcare provider
providing treatment to you in order to: (a) provide, coordinate, or manage the healthcare
and related services that are provided to you by healthcare practitioners; (b) enable your
healthcare providers to consult among themselves about your vision; (c) refer you to a new
healthcare provider; or (d) to contact you in the event of a product recall. We may also
use your health information for these purposes.
Payment: We may
use and disclose medical information about you in order to be paid for the optical goods
and services rendered to you. This may include contacting your health insurer to determine
the existence of insurance coverage for the optical goods and services you receive,
sending copies or excerpts of your health information to your health insurer to receive
payment, and using your health information for our own internal management of the billing
process. By way of example, a bill sent to your insurance company may include information
that identifies you and the procedures used to provide services to you.
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. We may also use your health information to
provide you with information regarding services that we offer related to your healthcare
needs.
Healthcare
Operations: We may use and disclose your health information in connection with our
healthcare operations. Healthcare operations encompass all those activities that we as an
optical practice must do to run smoothly and efficiently and specifically include
activities such as quality assessment and improvement activities, reviewing the competence
or qualifications of healthcare professionals, evaluating practitioner and provider
performance, and conducting training programs, accreditation, certification, licensing or
credentialing activities. For example, we may periodically review your records, as well as
those of other customers, in connection with these activities. As part of our healthcare
operations, it may also become necessary for us to use and disclose your health
information in connection with the healthcare operations of another company that has a
relationship with you, such as an HMO.
Business
Associates: We may use and disclose certain medical information about you to our business
associates. A business associate is an individual or entity under contract with us to
perform or assist us in performing a function or activity that requires us to disclose
your health information to them. Examples of business associates include, but are not
limited to, consultants, accountants, lawyers and third-party billing companies. We
require the business associate to protect the confidentiality of your health information.
To You, Your
Family and Friends: We must disclose your health information to you, as described in the
Information Rights section of this Notice. We may disclose your health information to a
family member, friend or other person to help with your healthcare or with payment for
your healthcare, but only if you agree or do not object 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 assisting you to obtain healthcare
services. 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 you become incapacitated, or during an emergency, we may disclose your health
information to others, including healthcare providers, on the basis of our professional
judgment. We will also use our professional judgment and our experience with common
practice to make reasonable inferences in your best interest in allowing a person to pick
up eyewear, medical supplies or 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 disclosures for use in judicial and administrative proceedings, or to law
enforcement officials, or to the proper authorities if we reasonably believe that you are
a possible victim of abuse, neglect, or domestic violence or the possible victim of other
crimes.
Public Health:
We may use or disclose your health information in connection with public health
activities, health oversight activities, and with worker's compensation matters. We may
also 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 protected health information to a
correctional institution or law enforcement official having lawful custody of an inmate or
patient.
State Laws: The
laws of the state where you are receiving your optical goods and services from us may
provide greater rights to you. To the extent your state has such laws, they are described
on the attachment to this Notice.
Your
Authorization: In addition to our use and disclosure of your health information for the
purpose described above, 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 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 described in this Notice.
YOUR INFORMATION
RIGHTS
Although all
records concerning your goods and services obtained from us are our property, you have the
following rights concerning your information.
Right to Request
Restrictions: You have the right to request restrictions on certain uses and disclosures
of your information. We are not required to honor your request. We encourage you to make
these requests in writing.
Right to
Confidential Communications: You have the right to receive confidential communications of
your information by alternative means or at alternative locations. For example, you may
request that we contact you only at work or by mail. We require that you make this request
in writing.
Right to Inspect
and Copy: You have the right to inspect and copy your information in most circumstances.
We require that you make this request in writing.
Right to Amend:
You have the right to amend your health information in circumstances where you believe
that information is inaccurate or incomplete. We require that you make this request in
writing, and that you tell us why you believe that we should amend your information.
Right to an
Accounting: You have the right to request and obtain an accounting of certain disclosures
of your information. You must make this request in writing.
Right to Obtain
Copy: You have the right to obtain a paper copy of this Notice upon request. A
request to exercise any of these rights must be submitted to the Privacy Officer. Forms to
help you make your request are available on-line at www.wsifb.com or from the Privacy
Officer. You may also obtain paper copies of these forms from us.
FOR MORE
INFORMATION OR TO REPORT A PROBLEM
If you have
questions and would like additional information, you may contact the Privacy Officer at
336-759-0551. If you believe your privacy rights have been violated, you may file a
complaint with us or with the Secretary of the Department of Health and Human Services,
Office of Civil Rights, HIPAA, 200 Independence Avenue, S.W., Washington, DC 20201. All
complaints must be submitted in writing.
Forms also are
available on-line at www.wsifb.com and can be submitted by E-mail to: privacy@wsifb.com or
by mail to Privacy Officer, WSIFB, 7730 North Point Boulevard, Winston-Salem, NC
27106.
There will be no
retaliation for filing a complaint.
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