Golden Eye Optometry, Inc.
17497 Main Street Hesperia, CA 92345
Phone (760) 948-3345
Fax (760) 948-3346

This notice is effective April 14, 2003

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.  Please review it carefully.


Right to Notice

          As a patient, you have the right to adequate notice of the uses and disclosures of your protected health information.  Under the Health Insurance Portability and Accessibility Act (HIPAA), Golden Eye Optometry, Inc. can use your protected health information for treatment, payment and health care operations.

a)Treatment

          We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.

b) Payment

          We may use and disclose your health information to obtain payment for services we provide you.

c) Health care operations

          We may use and disclose your health information in connection with you health care operations. Healthcare operations include quality assessment and improvement activities, reviewing the competency or qualifications of healthcare professionals, evaluating provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.

Your Authorization

          Most uses and disclosures that do not fall under treatment, payment, health care operations will require your written authorization.  Upon signing, you may revoke your authorization (in writing) through our practice at any time.

Emergency Situations

          In the event of your incapacity or emergency situation, we will disclose health information to a family member, or another person responsible for your care, using our professional judgment.  We will only disclose health information that is directly relevant to the person’s involvement in your healthcare.

Marketing

          We will not give, sell, or trade your health or personal information to any other party except those listed below tha are protected by law.  We may use your personal informatio for internal marketing purposes (i.e. Practice newsletters, promotion events like Open Houses or trunk shows, reminders for appointments, or special occasions such as holiday greetings) without your written permission but will not release any health information under such circumstance

Required by Law

          We many also use or disclose your health information when we are required to do so by law.

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 victim of other crimes.  We may disclose your healthy information to the extent necessary to avert a serious threat to your other people’s health or safety.

National Security

          We may disclose the health information of Armed Forces personnel to military authorities under certain circumstances.  We may disclose health information to authorized federal officials required for lawful intelligence, counterintelligence and other national security activities. We may disclose health information of inmates or patients to the appropriate authorities under certain circumstances.

Complaints

          If you have complaints regarding the way your protected health information was handled, you may submit a complaint in writing to our office.  You will not be retaliated against in any manner for a complaint.

Contact Information

          For further information about our privacy policies, please contact Dr.  Nicole Sava at the following address or phone number:

Golden Eye Optometry, Inc.
17497 Main Street Hesperia, CA 92345
Phone (760) 948-3345
Fax (760) 948-3346

Or, you may contact:  

The U.S. Department of Health and Human Services,
Office of the Secretary 200
Independence Avenue S.W.,  Washington, D.C 20201
Toll Free (877) 696-6775

Appointment Reminders

          We may use or disclose your health information to provide you with appointment reminders via mail, phone, or e-mail.
Your Rights as a Patient

  • You have the right to restrict the disclosure of your protected health information (in writing). The request for restriction may be denied if the information is required for treatment, payment or healthcare operations.
  • You have the right to receive confidential communications regarding your protected health information.
  • You have the right to inspect and copy your protected health information.
  • You have the right to inspect and copy your protected health information.
  • You have the right to request that we amend your protected health information if you believe it is incomplete or inaccurate.
  • You have the right to a paper copy of this notice of privacy practices.

Legal requirements

          Golden Eye Optometry, Inc, is required by law to maintain the privacy of your protected health information.  We are required to abide by the terms of this notice as it is currently stated, and reserve the right to change this notice.  The policies in any new notice will not be in effect until they are posted to this site, or are available within our office.

Golden Eye Optometry, Inc.
HIPPAA Notice of Privacy Policies
www.goldeneyeoptometry.com