NOTICE OF PRIVACY PRACTICES AND PATIENT BILL OF RIGHTS

Effective Date: August 2, 2019

The Notice of Privacy Practices and Patient Bill of Rights describes how medical information about you may be used and disclosed, and how you can access this information under law and, as a patient of this Center, your other rights and obligations. Please review it carefully.

If you have any questions about this Notice, please contact the Privacy Officer at: 75 Enterprise, Suite 200, Aliso Viejo, CA 92656.

We understand that your medical information is personal and we are committed to protecting your medical information. While you are a patient at this Eye Center (“Center”), we create records of the care provided to you. We need these records to provide you with quality health care and to comply with certain legal requirements.

The Privacy Practices describe how we may use and disclose your medical information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your medical information under law.

The Privacy Practices describe the privacy practices of this Center as well as our affiliated surgeons and optometrists (referred to as “we” throughout this Notice). We will share information with each other as necessary to carry out our respective treatment obligations, payment activities and health care operations.

The Center adopted the Bill of Rights because of our belief that respect for patients’ rights will enhance patients’ experiences and improve the results of the patients’ surgery. The Center used the American hospital Association’s (AHA) Management Advisory, “A Patient’s Bill of Rights” approved by the AHA Board of Trustees on October 21, 1992, as the foundation for our Bill of Rights with the AHA’s support and encouragement.

The Center has a number of functions to perform, including the immediate and ongoing care of patients, the continuing education of health care professionals, patients, and the community, and basic clinical research. All of these activities must be conducted with an overriding concern for the values and dignities of our patients.

Privacy Practices

Your Rights Although the records containing your medical information are the physical property of this Center, the information belongs to you. By law, you have the right to:

Our Responsibilities

We are required to:

Examples of Permitted Disclosure of Medical Information by this Center

The following are examples of the types of uses and disclosures of your medical information that are permitted (these examples are not meant to be exhaustive).

Treatment.    We may use and disclose your medical information to provide, coordinate, or manage your health care and related services. For example, we may disclose your medical information to the doctors and technicians that care for you while you are undergoing surgery or an optometrist that cares for you after surgery to ensure that they have the necessary information to treat you.

Payment.    Your medical information may be disclosed, as needed, to obtain payment from your insurance company or other person responsible for payment for your health care services. For example, we may disclose your medical information to an insurance company so that it can determine your eligibility or coverage for insurance benefits.

Health Care Operations.   We may use or disclose your medical information for our internal operations, which include activities necessary to operate this Center and provide our patients with high quality patient care. For example, we may use your medical information for quality improvement purposes to evaluate the care provided to you. We may also use a sign-in sheet at the reception desk asking for your name or call you by name in the waiting area. We may use your medical information to contact your to remind you of appointments, tell you about or recommend possible treatment options or alternatives that may be of interest to you, or inform you about other health related benefits and services that may be of interest to you.

Other Permitted Uses and Disclosures  

Authorization Required

Authorization.  For services and disclosures of your medical information beyond the uses and disclosures described in the Privacy Practices or as authorized or required by law, we are required to obtain your written authorization. You may revoke an authorization in writing at any time to stop future use or disclosures by us with certain limited exceptions.

Bill of Rights

Your Rights and Our Responsibilities

You have a right to:

Your Responsibilities

The collaborative nature of health care requires that a patient (and their family members/guardian and/or Personal Representative) participate in their care. The effectiveness of care and patient satisfaction depends, in part, on the patient fulfilling certain responsibilities. You are responsible for providing information about past illnesses, hospitalization, medications, and other matters related to your health. To participate effectively in decision-making, you must take responsibility for requesting additional information or clarification about your condition or treatment when you do not fully understand information and/or instructions. You are also responsible for informing your health care professionals if you anticipate problems following the prescribed treatment or post-operative care.

You should be aware of the Center’s obligation to be reasonable, efficient and equitable in proving care to other patients and the community; the Center’s policies and standard operating procedures are designed to fulfill this obligation. You are responsible for making reasonable accommodations for the needs of other patients, the professional staff and employees of the Center. You are responsible for proving necessary information for insurance claims and working with the Center to make payment arrangements, when necessary.

Your vision depends on much more than the health care you receive at the Center. As a result, you are responsible for recognizing the impact of your lifestyle on the health of your eyes and vision.

Changes to this Notice

By law, we must abide by the terms of the Privacy Practices; however, we reserve the right to change our Privacy Practices and/or this Notice. If we revise this Notice, the new Notice will be effective for all the medical information we maintain. Any new Notices will be available by accessing the website, www.nvisioncenters.com, requesting that a copy be sent to you in the mail or asking for a copy at the time of your next appointment or visit.

Personal Representative

Your Personal Representative may exercise your rights on your behalf. A Personal Representative may include your guardian if you are a minor, lack decision-making capacity or are legally incompetent, or a person you have authorized to act on your behalf as specified in a written document (such as a power of attorney).

For More Information or to Report a Complaint

If you have questions or would like more information about this notice, you may contact the Privacy Officer at 75 Enterprise, Suite 200, Aliso Viejo, CA 92656.

If you believe your privacy rights have been violated, you may file a written complaint with the Privacy Officer or the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Effective Date: April 14, 2003.

Date Revised: August 2, 2019