In Focus Eyecare | Notice of Privacy Practices  Effective 11/28/2018 

Your Information. Your Rights. Our Responsibilities. This notice describes how medical information about you may be used and disclosed 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. You can get an  electronic or paper copy of your medical record: 

● You can ask to see or get an electronic or paper copy  of your medical record and other health information  we have about you. Ask us how to do this.  

● We will provide a copy or a summary of your health  information. We may charge a reasonable, cost based fee. 

ASK US TO CORRECT YOUR MEDICAL RECORD ● You can ask us to correct health information about  you that you think is incorrect or incomplete. Ask us  how to do this.  

● 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 will 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, and 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. 

● 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  

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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. 

FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS ARE  VIOLATED 

● You can complain if you feel we have violated your  rights by contacting us at 210-520-6548. 

● You can 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. 

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. 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 ● Include your information in a hospital directory 

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 

● Most sharing of psychotherapy notes 


In the case of fundraising: 

● We may contact you for fundraising efforts, but you  can tell us not to contact you again. 

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  other professionals who are treating you. 

Example: A doctor treating you for an injury asks another  doctor about your overall health condition. 

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 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/consum ers/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 can use or share your information for health research. 

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. 

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RESPOND TO ORGAN AND TISSUE DONATION  REQUESTS 

We can share health information about you with organ  procurement organizations. 

WORK WITH A MEDICAL EXAMINER OR FUNERAL  DIRECTOR 

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. 

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/consum ers/noticepp.html 

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 upon request, in our office, and on  our website. 

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