Please answer the questions below regarding you or your immediate family (parents, grandparents, siblings, children) for the following:
Hacienda Park Optometry
4825 Hopyard Road, Suite F-1
Pleasanton, CA 94588
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).
Hacienda Park Optometry can use your protected health information as described below. Treatment – We may use or disclose your health information to a physician or other healthcare provider providing treatment to you. This includes faxing, emailing or phoning your prescription for medicine or medical devices to providers of these services.
Payment - We may use and disclose your health information to obtain payment for services we provide to you.
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.
Most uses and disclosures that do not fall under treatment, payment or healthcare operations will require your written authorization. You may revoke your authorization in writing through our practice at any time, except under the circumstances listed below:
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.
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 or abuse, neglect, 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 inmate or patients to the appropriate authorities under certain circumstances.
Appointment Reminders – We may use or disclose health information to provide you with appointment reminders via mail, phone, email or SMS.
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 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: Hacienda Park Optometry 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 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. For further information about our privacy policies, please contact our office at the address or phone number listed at the top of this notice.