Privacy Notice
Notice of Privacy Practices
The intent of this notice is to describe how medical information about you may be used and disclosed and your right to have access to this information. Please read it carefully. If you have any questions, please address them to our Privacy Officer. Our reception desk personnel can assist you in this regard.
Northside Eye Care is a provider of eye care to our patients in a partnership relationship with a number of referring physicians, optometrists and other practitioners. Information about privacy practices addressed in this notice may be accessed by the following:
Any and all health care professionals, i.e. ophthalmologists, optometrists, ophthalmic technicians, optometric technicians, contact lens technicians, opticians, lab technicians, billing and insurance department personnel and
reception personnel in this office as well as any other affiliate office.
Any business associates who are partners of Northside Eye Care with whom we share your eye care and health information.
Our pledge to our patients
Northside Eye Care appreciates that medical information about you is personal and we are committed to protecting this information about you. Your medical information with this office is created from the care provided by our staff as well as services provided to you. This privacy notice applies to all records of your eye care and health care that we maintain, whether these records are created by the staff of this office or your personal or primary care physician. Your personal or primary care Physician may elect to have different policies in place regarding the use and disclosure of your medical information. This office is required under present law to:
Keep any and all medical health information about you private
Make this privacy policy available to you outlining your legal duties and privacy policies with regard to your medical and health data.
Strictly follow and enforce the privacy policy currently in effect.
How Northside Eye Care can use and disclose medical and health information
This office may use and disclose medical and health information for:
Treatment: sending of your medical and health information to another health care provider or to a specialist as part of a referral.
Obtaining payment for treatment: filing of insurance to your insurance company and/or Medicare or Medicaid.
Supporting our current medical operation: comparison of medical data for improving overall patient care and treatment procedures.
This office may use or disclose medical and/or health information without your prior authorization for several reasons. These reasons include public health purposes, abuse/neglect reporting, health care audits, research studies and workers compensation. We will also use or disclose your medical and health information when required by law. This office may also contact you regarding appointment reminders, possible treatment options, alternative health care and/or benefits of services that may be of benefit to you. This office will use or disclose medical and/or health information to a friend or family member who is directly involved in your medical care.
Patient rights regarding medical or health information
In most cases you have the right to request a copy of your medical information or to look at the information maintained by this office as part of your medical care. In order for you to do this, you must submit, in writing, a request to review your information or to receive copies of that information. If copies are requested, this office reserves the right to charge for those copies or for the mailing and/or handling of that information. In the event that this office denies your request to review or receive a copy of your medical or health information, you have a right to submit, in writing, a request for a review of the denial decision. At any time you have the right to correct or amend your information if you feel that the information obtained by this office is incorrect. This office reserves the right to deny your request to amend or correct your information if the amendment or correction was not directly created by this office or its? staff. Again, if your request to amend or correct is denied, you have a right to request, in writing, the decision by this office not to amend or correct your information. You have a right to a list of any or all requests where this office has used or disclosed your medical or health information other than those cases where you have authorized for treatment or insurance payment of services or treatment. The right to such a list is for any or all disclosures or uses of your medical or health information on or after June 1, 2005. This office reserves the right to charge for such a listing of disclosure or usage or your medical or health information. You may request medical information about you in either written paper form, e-mail or by fax, but all such releases will be in a confidential form of your choosing. Your written request for release of your medical or health information must be in writing and must specifically state the manner in which you desire the information to be released to you.
You may request in writing that we do not disclose or use your medical and/or health information for treatment or payment or to those persons involved in your care except when specifically authorized by you. This office reserves the right to consider this request, but we are not legally required to accept the request. Any of all requests for appeals must be submitted, in writing, to the Northside Eye Care Privacy Officer. If you feel that your privacy rights may have been violated or you disagree with any decision of this office with regard to medical and/or health information, you may contact our Privacy Officer. You have the right to send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights.
Northside Eye Care appreciates the opportunity to provide your eye care needs.
Northside Eye Care
Robert H. Pierce, Jr., O.D.
116 Killgore Road, Suite 1
Ruston, LA 71270
318-251-3626
The intent of this notice is to describe how medical information about you may be used and disclosed and your right to have access to this information. Please read it carefully. If you have any questions, please address them to our Privacy Officer. Our reception desk personnel can assist you in this regard.
Northside Eye Care is a provider of eye care to our patients in a partnership relationship with a number of referring physicians, optometrists and other practitioners. Information about privacy practices addressed in this notice may be accessed by the following:
Any and all health care professionals, i.e. ophthalmologists, optometrists, ophthalmic technicians, optometric technicians, contact lens technicians, opticians, lab technicians, billing and insurance department personnel and
reception personnel in this office as well as any other affiliate office.
Any business associates who are partners of Northside Eye Care with whom we share your eye care and health information.
Our pledge to our patients
Northside Eye Care appreciates that medical information about you is personal and we are committed to protecting this information about you. Your medical information with this office is created from the care provided by our staff as well as services provided to you. This privacy notice applies to all records of your eye care and health care that we maintain, whether these records are created by the staff of this office or your personal or primary care physician. Your personal or primary care Physician may elect to have different policies in place regarding the use and disclosure of your medical information. This office is required under present law to:
Keep any and all medical health information about you private
Make this privacy policy available to you outlining your legal duties and privacy policies with regard to your medical and health data.
Strictly follow and enforce the privacy policy currently in effect.
How Northside Eye Care can use and disclose medical and health information
This office may use and disclose medical and health information for:
Treatment: sending of your medical and health information to another health care provider or to a specialist as part of a referral.
Obtaining payment for treatment: filing of insurance to your insurance company and/or Medicare or Medicaid.
Supporting our current medical operation: comparison of medical data for improving overall patient care and treatment procedures.
This office may use or disclose medical and/or health information without your prior authorization for several reasons. These reasons include public health purposes, abuse/neglect reporting, health care audits, research studies and workers compensation. We will also use or disclose your medical and health information when required by law. This office may also contact you regarding appointment reminders, possible treatment options, alternative health care and/or benefits of services that may be of benefit to you. This office will use or disclose medical and/or health information to a friend or family member who is directly involved in your medical care.
Patient rights regarding medical or health information
In most cases you have the right to request a copy of your medical information or to look at the information maintained by this office as part of your medical care. In order for you to do this, you must submit, in writing, a request to review your information or to receive copies of that information. If copies are requested, this office reserves the right to charge for those copies or for the mailing and/or handling of that information. In the event that this office denies your request to review or receive a copy of your medical or health information, you have a right to submit, in writing, a request for a review of the denial decision. At any time you have the right to correct or amend your information if you feel that the information obtained by this office is incorrect. This office reserves the right to deny your request to amend or correct your information if the amendment or correction was not directly created by this office or its? staff. Again, if your request to amend or correct is denied, you have a right to request, in writing, the decision by this office not to amend or correct your information. You have a right to a list of any or all requests where this office has used or disclosed your medical or health information other than those cases where you have authorized for treatment or insurance payment of services or treatment. The right to such a list is for any or all disclosures or uses of your medical or health information on or after June 1, 2005. This office reserves the right to charge for such a listing of disclosure or usage or your medical or health information. You may request medical information about you in either written paper form, e-mail or by fax, but all such releases will be in a confidential form of your choosing. Your written request for release of your medical or health information must be in writing and must specifically state the manner in which you desire the information to be released to you.
You may request in writing that we do not disclose or use your medical and/or health information for treatment or payment or to those persons involved in your care except when specifically authorized by you. This office reserves the right to consider this request, but we are not legally required to accept the request. Any of all requests for appeals must be submitted, in writing, to the Northside Eye Care Privacy Officer. If you feel that your privacy rights may have been violated or you disagree with any decision of this office with regard to medical and/or health information, you may contact our Privacy Officer. You have the right to send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights.
Northside Eye Care appreciates the opportunity to provide your eye care needs.
Northside Eye Care
Robert H. Pierce, Jr., O.D.
116 Killgore Road, Suite 1
Ruston, LA 71270
318-251-3626