Privacy Notice
Please add your Notice of Privacy Practices here to comply with HIPAA.HOME PAGE - EXAMPLES
WELCOME
We are pleased to welcome you to our practice. Our commitment is not just in meeting your expectations, but in exceeding them! Because we know how much your eye health and appearance can mean to the quality of your life, we are committed to excellence in servicing your complete eye care needs.
WELCOME TO OUR PRACTICE
We are pleased to welcome you to our office. If you're looking for quality care with a personal touch, we hope you'll give us a call. We look forward to the opportunity of serving your family's optometric needs. We are conveniently located nearby and would be delighted to have you as a patient.
WELCOME
We would like to welcome you to our practice. The professionals at our practice provide each patient with quality vision solutions and exceptional customer service. Our staff is experienced in all areas of vision care. Maintaining healthy eyes requires regular vision and eye exams. We look forward to serving you.
NOTICE OF PRIVACY PRACTICE - EXAMPLES
Note: This Notice of Privacy Practices is provided for educational and informational purposes only. This Notice is not intended as legal advice, and is not provided for adoption or publication by any party. The publication of any such notice may create legal obligations or liabilities which may vary depending upon the legal status and business operations of different organizations. The form and content of any Notice of Privacy Practices should be determined only upon informed consultation with qualified legal counsel.
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.
THIS NOTICE IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.
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), [Practice Name here] 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 our healthcare 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 an 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 use your health information for marketing communications without your written authorization.
Required by Law
We may 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 health information to the extent necessary to avert a serious threat to your or 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.
Appointment Reminders
We may use or disclose your health information to provide you with appointment reminders via phone, e-mail or letter.
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 health care 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 amend your protected health information.
-You have the right to receive an account of disclosures of your protected health information.
-You have the right to a paper copy of this notice of privacy practices.
Legal Requirements
[Practice Name here] 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.
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 [Practice Name here]'s privacy policies, please contact [Doctor's name here] at the following address or phone number:
[Practice Name]
[Street Address]
[City, State, Zip Code]
[Phone Number]
OUR LOCATIONS - EXAMPLES
Office #1
ADDRESS: 5150 Chamber Lane, Roseville, CA 95862
PHONE NUMBER: (916)785-1611
FAX NUMBER: (916)785-1616
PAGER NUMBER: (916)785-1620
OFFICE E-MAIL: [email protected]
HOURS OF OPERATION: Mon.-Fri. 8:30-5:30 Sat. 8-1
ADDITIONAL:
Saturday-by appointment only
Closed for lunch from 12:00 to 1:00
OUR PRACTICE - EXAMPLES
NAME AND TITLE: Dr. Thomas Jones
BIOGRAPHY: Dr. Jones is a graduate of Berkeley and has been in private practice for over 10 years. He is a member of The American Optometric Association, The Lions Club of Sacramento and involved in Sight for Students, VSP.
NAME AND TITLE: Caring Staff
BIOGRAPHY: Our staff is thoroughly trained and knowledgeable in all aspects of the optical field.
OUR SERVICES - EXAMPLES
LIST OF SERVICES: Computer assisted eye exams, diagnosis and treatment of ocular disease and injury, complete contact lens services including all specialty lens products, co-management for laser and cataract surgeries, and frame styling to complement your lifestyle. Outside prescriptions welcome.
LIST OF PAYMENT: Cash, checks, Visa, Mastercard, American Express and Discover.
LIST OF ACCEPTED INSURANCE: Most insurance accepted, including VSP, MES, AVP, MEDICARE, MEDI-CAL and more.
FACILITIES AND EQUIPMENT: In-Office laboratory. Digital Retinal Photography. Large selection of frames - we carry over 1000 designer frames including Calvin Klein, Polo, Silhouette, Kenneth Cole, Fendi, Giorgio Armani, Christian Dior, Oakley, Ray Ban, Maui Jim, Marchon, Tura and many more.
LANGUAGES SPOKEN: English/Spanish
SPECIAL EVENTS - EXAMPLES
EVENT #1
EVENT NAME: Open House
DATE: April 2, 2003
TIME: 1:00 PM
LOCATION: 5700 Walker Ave.
Sacramento, CA 95816
DESCRIPTION:
You're invited! We would like to invite you to our upcoming open house. It's the perfect opportunity to meet our staff and get to know the healthcare professionals at your service. We look forward to seeing you.
EVENT #2
EVENT NAME: Sunglass Extravaganza
DATE: May 5, 2003
TIME: 1:00 PM
LOCATION: 22 W. El Camino Ave.
Sacramento, CA 95810
DESCRIPTION:
We would like to invite you to our sunglass extravaganza. Summer is just around the corner and what better way to bring in the sun than wearing a new pair of stylish sunglasses. We have many styles to choose from. We look forward to seeing you.
PROMOTIONS - EXAMPLES
PROMOTION #1
DESCRIPTION:
Sunglasses on sale through the summer! We have a great selection. Ask us about our specials.
PROMOTION #2
DESCRIPTION:
Did you know that your insurance may cover prescription sunglasses? We have a great selection that will help you look cool and protect your eyes!
PROMOTION #3
DESCRIPTION:
The sun?s so bright you've gotta' wear shades... We have sunglasses with polarized lenses. Come in and see the difference and we'll offer you 15% off the first pair!
PROMOTION #4
DESCRIPTION:
New Bifocal Contact Lenses Available
CIBA has come out with a new bifocal contact lens that will enhance your vision both near and far. Privacy Policy | Customer Care | System Requirements | Terms and Conditions | HIPAA Agreement | 2006 Eyefinity, Inc. All rights reserved.
WELCOME
We are pleased to welcome you to our practice. Our commitment is not just in meeting your expectations, but in exceeding them! Because we know how much your eye health and appearance can mean to the quality of your life, we are committed to excellence in servicing your complete eye care needs.
WELCOME TO OUR PRACTICE
We are pleased to welcome you to our office. If you're looking for quality care with a personal touch, we hope you'll give us a call. We look forward to the opportunity of serving your family's optometric needs. We are conveniently located nearby and would be delighted to have you as a patient.
WELCOME
We would like to welcome you to our practice. The professionals at our practice provide each patient with quality vision solutions and exceptional customer service. Our staff is experienced in all areas of vision care. Maintaining healthy eyes requires regular vision and eye exams. We look forward to serving you.
NOTICE OF PRIVACY PRACTICE - EXAMPLES
Note: This Notice of Privacy Practices is provided for educational and informational purposes only. This Notice is not intended as legal advice, and is not provided for adoption or publication by any party. The publication of any such notice may create legal obligations or liabilities which may vary depending upon the legal status and business operations of different organizations. The form and content of any Notice of Privacy Practices should be determined only upon informed consultation with qualified legal counsel.
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.
THIS NOTICE IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.
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), [Practice Name here] 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 our healthcare 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 an 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 use your health information for marketing communications without your written authorization.
Required by Law
We may 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 health information to the extent necessary to avert a serious threat to your or 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.
Appointment Reminders
We may use or disclose your health information to provide you with appointment reminders via phone, e-mail or letter.
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 health care 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 amend your protected health information.
-You have the right to receive an account of disclosures of your protected health information.
-You have the right to a paper copy of this notice of privacy practices.
Legal Requirements
[Practice Name here] 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.
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 [Practice Name here]'s privacy policies, please contact [Doctor's name here] at the following address or phone number:
[Practice Name]
[Street Address]
[City, State, Zip Code]
[Phone Number]
OUR LOCATIONS - EXAMPLES
Office #1
ADDRESS: 5150 Chamber Lane, Roseville, CA 95862
PHONE NUMBER: (916)785-1611
FAX NUMBER: (916)785-1616
PAGER NUMBER: (916)785-1620
OFFICE E-MAIL: [email protected]
HOURS OF OPERATION: Mon.-Fri. 8:30-5:30 Sat. 8-1
ADDITIONAL:
Saturday-by appointment only
Closed for lunch from 12:00 to 1:00
OUR PRACTICE - EXAMPLES
NAME AND TITLE: Dr. Thomas Jones
BIOGRAPHY: Dr. Jones is a graduate of Berkeley and has been in private practice for over 10 years. He is a member of The American Optometric Association, The Lions Club of Sacramento and involved in Sight for Students, VSP.
NAME AND TITLE: Caring Staff
BIOGRAPHY: Our staff is thoroughly trained and knowledgeable in all aspects of the optical field.
OUR SERVICES - EXAMPLES
LIST OF SERVICES: Computer assisted eye exams, diagnosis and treatment of ocular disease and injury, complete contact lens services including all specialty lens products, co-management for laser and cataract surgeries, and frame styling to complement your lifestyle. Outside prescriptions welcome.
LIST OF PAYMENT: Cash, checks, Visa, Mastercard, American Express and Discover.
LIST OF ACCEPTED INSURANCE: Most insurance accepted, including VSP, MES, AVP, MEDICARE, MEDI-CAL and more.
FACILITIES AND EQUIPMENT: In-Office laboratory. Digital Retinal Photography. Large selection of frames - we carry over 1000 designer frames including Calvin Klein, Polo, Silhouette, Kenneth Cole, Fendi, Giorgio Armani, Christian Dior, Oakley, Ray Ban, Maui Jim, Marchon, Tura and many more.
LANGUAGES SPOKEN: English/Spanish
SPECIAL EVENTS - EXAMPLES
EVENT #1
EVENT NAME: Open House
DATE: April 2, 2003
TIME: 1:00 PM
LOCATION: 5700 Walker Ave.
Sacramento, CA 95816
DESCRIPTION:
You're invited! We would like to invite you to our upcoming open house. It's the perfect opportunity to meet our staff and get to know the healthcare professionals at your service. We look forward to seeing you.
EVENT #2
EVENT NAME: Sunglass Extravaganza
DATE: May 5, 2003
TIME: 1:00 PM
LOCATION: 22 W. El Camino Ave.
Sacramento, CA 95810
DESCRIPTION:
We would like to invite you to our sunglass extravaganza. Summer is just around the corner and what better way to bring in the sun than wearing a new pair of stylish sunglasses. We have many styles to choose from. We look forward to seeing you.
PROMOTIONS - EXAMPLES
PROMOTION #1
DESCRIPTION:
Sunglasses on sale through the summer! We have a great selection. Ask us about our specials.
PROMOTION #2
DESCRIPTION:
Did you know that your insurance may cover prescription sunglasses? We have a great selection that will help you look cool and protect your eyes!
PROMOTION #3
DESCRIPTION:
The sun?s so bright you've gotta' wear shades... We have sunglasses with polarized lenses. Come in and see the difference and we'll offer you 15% off the first pair!
PROMOTION #4
DESCRIPTION:
New Bifocal Contact Lenses Available
CIBA has come out with a new bifocal contact lens that will enhance your vision both near and far. Privacy Policy | Customer Care | System Requirements | Terms and Conditions | HIPAA Agreement | 2006 Eyefinity, Inc. All rights reserved.