Capitol Optometry
Notice of Privacy Practices and Patient Rights

Protecting Your Confidential Health Information Is Important To Us

Dear Patient:
In order to maintain compliance with the new HIPAA privacy regulations, we wish to inform you of our ongoing efforts to do so. Included in these regulations are assurances regarding billing; especially electronic, and third party providers. In addition, we protect all patient information stored electronically, i.e. our databases, as well as all physical written records. We do not want to delay necessary treatment because of a possible concern you may have making your personal health history available to others outside our office.

Due to rapid changes in computer technology and other influences, out Federal Government has been motivated to legally enforce privacy protection regarding patient healthcare information. Because of these new regulations, we want to communicate to you, our valued patient, in writing, our policies and procedures, regarding the protection of your health information everywhere it is used whether it is by internet, phone, FAX, or letter.

We will use and communicate your HEALTH INFORMATION for the sole purpose of providing treatment, obtaining payment from third party purveyors and conducting health care operations as detailed below.

How your HEALTH INFORMATION may be used

To Provide Treatment: We will use your HEALTH INFORMATION within our office to provide you with the highest level of optometric care possible. This may include administrative and clinical office procedures designed to optimize scheduling and coordination of care between office staff, optometric assistants, opticians, and optometrists. In addition, we may share your health information with other optometrists, ophthalmologists, physicians, e.g. your primary care physician, pharmacies, or other health care personnel engaged in providing your care.

To Obtain Payment: We may include your HEALTH INFORMATION with a fee slip, or laboratory slip to collect payment for services or materials you may receive in our office. We may do this electronically or with physical forms sent to insurance companies or others that provide reimbursement.

To Conduct Health Care Operations: Your HEALTH INFORMATION may be used in evaluating staff performances. In addition, your health information may be used in a professional setting with other professionals, interns, or students. Also, our office has routine audits conducted by insurance and other regulatory agencies, during which time your health information may be shared. Finally, your health information may be reviewed during routine processes of certification, licensing, or credentialing activites.

In Patient Reminders: Since we believe that your vision is one of your most precious gifts, we highly recommend routine eye examinations. In order to provide life long eye care on a continuing basis, it is necessary for us to remind you of an impending or missed appointment. We generally provide recalls and reminders by telephone, post card or if instructed, by email. Sometimes it may be necessary to leave messages if personal contact was not made.

Abuse or Neglect: We will notify government authorities if we believe a patient is a victim of abuse, neglect, or domestic violence. We will make this disclosure only when we are compelled by our ethical judgment, when we believe we are specifically required or authorized by law or with the patient’s agreement.

Public Health and National Security: We may be compelled to disclose your HEALTH INFORMATION to Federal officials or military authorities to investigate public health or national security issues. The same holds for federal law enforcement purposes, including, under certain limited circumstances, if you are a victim of a crime or in order to report a crime.

Family, Friends, and Caregivers: Sometimes it may be necessary to share your HEALTH INFORMATION with those you tell us will be helping with your treatment, medications, or payment. We will do this only with your prior permission. In the event of an emergency, and only when you are unable to convey your wishes directly to us, we will use our best judgment when providing necessary information based on your circumstances and only with your best interests in mind.

Final Notes of Disclosure: Other than stated above or where Federal, State, or Local law requires us, we will not disclose your health information other than with your written authorization in writing at any time.

Your Rights as a Patient:
These new laws carefully describe your rights as a patient and are as follows:

Restrictions: You have the right to request to restrict certain uses and disclosures of your health information and we will do our best to honor those requests.

Confidential Communication: You have the right to ask that we communicate with you in a certain manner. You may ask that we only allow you health information to be shared privately with no other family members present or through sealed mail.

Inspect and Copy Your Health Information: You have the right to review, and copy your health information such as you complete chart, x-rays, and billing records. If you would like a copy of your health information feel free to ask.

Amend Your Health Information: You have the right to ask us to update and modify your records if you believe the records we have are incorrect or incomplete. We do ask that this request be done in writing with a description of your reason for the change(s).

Documentation of Health Information: You have the right to ask how and where your health information has been used by our office for any reason other than for treatment, payment or health operations. Our documentation allows us to provide information on health information usage from December 1, 2009 and forward. We ask that you place the time you are requesting in writing and that the time period is no more that six years at a time.

Request a Paper Copy of This Notice: You may obtain a copy of this Notice of Our Privacy Practices from our office. Stop in or give us a call to mail or e-mail you a copy.

We are required by law to maintain the privacy of your health information and to provide this Notice of Privacy Practices to you and your representative. We are required to practice the procedures described in this notice but we do reserve the right to change the terms of our notice. If we change our private practices we will be sure all of our patients receive a copy of the revised notice.

You may express complaints to us or to the Secretary of Health and Human Services if you believe your rights have been compromised. We encourage that you express any concerns regarding the privacy of your health information. Please let us know in writing if you have any concerns or complaints.