Notice of
Privacy Practices
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), Antelope Valley
Family Optometry 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 of 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.
Require 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 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, letter or postcard.
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.