HOW YOUR MEDICAL INFORMATION
MAY BE USED AND DISCLOSED AND WHAT RIGHTS YOU HAVE.
PLEASE REVIEW IT CAREFULLY.

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
By law, we are allowed to use or disclose your protected health
information (PHI) without your written consent for the purpose of
treatment, payment or health care operations. Examples include
scheduling appointments; examinations; prescribing corrective lenses,
vision aids, or medications and providing prescription information to
suppliers; referrals for other medical care; getting copies of past
records; acquiring guarantor/insurance information; processing bills or
claims; financial or billing audits; internal quality assurance; personnel
decisions; credentialing; legal defense; business planning and record
storage.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT
PERMISSION
In some other limited situations, the law allows us to use or disclose
your PHI without your permission. Examples include disclosures
required by law, subpoenas or court orders; reporting threats to health
or safety; suspected abuse or neglect; knowledge relating to a crime;
public health oversight; organ procurement; worker's compensation
disclosures; incidental disclosures; de-identified information; "limited
data sets" for research and disclosures to "e;business associates" who
are under contractual obligation to respect the privacy of your PHI. Any
information that is disclosed will be limited to the minimum information
required and will only be given to parties with the proper authorization
to obtain this information.
Unless you object, we will also share relevant information about your
care with family or friends helping with your care.
APPOINTMENT REMINDERS/ NOTIFICATIONS
We may call, write or email you to notify you of routine examinations
due, appointment confirmation, order status or services available at
our office. Unless you tell us otherwise, we will mail you an
appointment reminder on a post card and/or call you at the number
you have given us. We may leave a message if you are not available.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your PHI unless you
sign a written "authorization form" the content of which is determined
by federal law. The authorization may be revoked at any time by
writing to the contact below.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
All requests must be made in writing and will be responded to within
the time allowed by law (usually 30 days).
· You may ask us to restrict our uses and disclosures for
purposes of treatment (except emergency treatment), payment or
health care operations. We do not have to agree to this, but if we do,
we must honor the restrictions that you want.
· You may ask us to communicate with you in a confidential
way, such as using a specific phone number or address. We will
accommodate reasonable requests. There may be a charge for any
extra cost involved with the request.
· You may ask to see or to get photocopies of your PHI. You
may have to pay for photocopies in advance. By law, there are a few
limited situations in which we can refuse to permit access or copying.
If we deny your request, we will send you a written explanation, and
instructions about how to get an impartial review of our denial if one is
legally available.
· You may ask us to amend PHI that you think is incorrect. If we
do not agree, a statement of your position and any rebuttal statement
that we may write will be included in your PHI and will be included any
time we disclose your PHI.
· You may request a list of our disclosures of your PHI. By law,
the list will not include: disclosures for purposes of treatment, payment
or health care operations; disclosures with your authorization;
incidental disclosures; disclosures required by law; and some other
limited disclosures. You are entitled to one such list per year without
charge.
· You can receive additional paper copies of this Notice of
Privacy Practices upon request.
OUR NOTICE OF PRIVACY PRACTICES (NPP)
We are obligated by law to protect the your PHI and to abide by the
terms of this NPP. We reserve the right to change this notice at any
time as allowed by law. Any changes in our NPP will posted in our
office and on our website and will apply to any PHI that we already
have as well any that we may generate in the future.
COMPLAINTS
If you think we have not properly respected the privacy of your PHI,
you may contact our office or the U.S. Dept. of Health and Human
Services, Office for Civil Rights to discuss your complaint without fear
of retaliation.
CONTACT INFORMATION:
For more information about our privacy practices you may call, write or
visit our office at the address below. All requests concerning your PHI
must be made in writing to:

Park Family Eye Care
9 South Lincolnway
North Aurora, IL 60542
630 844 2500
Email:ParkEyeCare@aol.com