Privacy Notice
Notice of Privacy effective 10/15/2002.
Edwin K. Larsen O.D , Leslie Griffith O.D.
1737 First St , Napa CA 94559.
(707)226-5446 fax (707)226-3772.
General rule. we respect our legal obligation to keep health information, that idenifys you , private. The law obligates us to give you notice of our privacy practices.
Generally, we can only use your health information in our office or disclose it outside of our office, without your written permission, for purpose of treatment, payment, or healthcare operations. In most other situations, we will not use or disclose your health information unless you sign a written authorization form. In some limited situations, the law allows or requires us to disclose your health information without written authorization.
Uses or disclosures of Health Information Examples:
Sometimes we ask for copies of your health information from another professional that you have seen before.
we may use your health information within our office or disclose you information outside our office for payment purposes.examples:
Appointment reminders.
We may call to remind you of your scheduled appts. We may also call to notify you of other treatments or services available at our office to help you.
Uses & Disclosures without authorization
In some limited situations the law allows or requires us to disclose your health information without your permission. Not all of these situations will apply to us some may never even happen in our office at all. Such uses or disclosures are:
A state or federal law that mandates certain health information be reported for a specific purpose.
Public health purposes , such as a contagious disease reporting, investigation, or surveillance.
Disclosures to governmental authorities about victims ofsuspected abuse, neglect,or domestic violence.
Uses and disclosures for health oversight activities , such as licensing of docors, audits by medical or medicare, or investigation of possible violations of healthcare laws.
Diclosures for judicial and administrative proceedings , such as subpoenas.
Disclosures for law enforcement purposes, such as a suspected victim of crime.
Diclosures to a medical examiner to idenify a dead person or to dtermine the cause of death, or to a funeral director to aid in burial: or to organizations that handle tissue or organ donors.
Uses or disclosures for health related research
Uses and Disclosures to prevent a serious threat to health or safety.
Uses or disclosures for a specialized goverment function, such as the protection of the president or high ranking official, or the health of members of foriegn service.
Disclosures to worker's compensation programs.
Disclosures to business associates who perform healthcare operations for us and who agree to keep your info private.
Other disclosures
We will not make any other uses or disclosures of your health info unless you sign a written authorization form.You may revoke it at any time if you do choose to sign one.
You right regarding your health information
the law gives you may rights regarding your health information.
you can ask us to restrict our uses and disclosures for purpose of treatment (except emergency treatment) payment or healthcare operations. we do not have to agree to do this, but if we agree , we must honor the restictions you want. A written request to be sent to Edwin K. larsen ATTN: Mary. at our address or fax number.
You can ask us to communicate with you in a confidential way , such as phoning you at work rather then at home, or by mailing info to a different address. We will try to accomidate your requests if they are reasonable, and if you pay us for any extra costs. If you want to ask for confidential communications, send a written request to
Edwin K. Larsen O.D: Attn Mary.
You can ask for photo copies of your health info. By law there are a few limited situations in which we can refuse tp permit access or copying. Normally you will be able to get copies within 30 days.You may have to pay for photocopies in advance.
You can ask us to amend your health if you think its incorrect or incomplete. If we agree we will amend the info within 60 days. If we do not agree, you can write a statment on your position and we will include it with your health info.Please send your written request to Edwin K. Larsen O.D. attn Mary.
You can get a list of the disclosures that we have made to your health information within the last 6 years( or shorter if you want), except the disclosures for treatment, payment , or health care operations.
Our notice of privacy practices
By law we must abide by the terms of our notice of privacy practices until we choose to change it. we reserve the right to change this notice at any time in compliance with and as allowed by law. If we change this notice, we will post the new notice and also have copies in our office.
Complaints
If you think we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil rights. We will not retaliate against you if you make a complaint. If you want to complain to us send a written complain to Edwin K . Larsen O.D.
For more information about our privacy practices, call or visit Edwin K Larsen O.D. attn Mary at our office. 1737 First st , Napa, CA 94559. fax (707)226-3772. You may request additional copies of our privacy policies by stopping by our office.
Edwin K. Larsen O.D , Leslie Griffith O.D.
1737 First St , Napa CA 94559.
(707)226-5446 fax (707)226-3772.
General rule. we respect our legal obligation to keep health information, that idenifys you , private. The law obligates us to give you notice of our privacy practices.
Generally, we can only use your health information in our office or disclose it outside of our office, without your written permission, for purpose of treatment, payment, or healthcare operations. In most other situations, we will not use or disclose your health information unless you sign a written authorization form. In some limited situations, the law allows or requires us to disclose your health information without written authorization.
Uses or disclosures of Health Information Examples:
- when we set up an appt for you
- when our technician or doctor tests your eyes.
- When the docor prescribes glasses or contacts.
- When the docor prescribes medication.
- When our staff helps with your order of glasses or contacts.
- When we show you low vision aids.
- If we refer you to another doctor or clinic for eye care or low vision aids.
- If we send you rx for glasses or contacts to another professional to be filled.
- When we provide a prescription for medication to a pharmacist.
- When we phone to tell you your glasses or contacts are ready to be picked up.
Sometimes we ask for copies of your health information from another professional that you have seen before.
we may use your health information within our office or disclose you information outside our office for payment purposes.examples:
- when our staff asks you about health or vision plans that you belong to, or about other sourses of payment for our services.
- When we prepare bills to send you or your health or vision plan.
- When we process payment by credit card and when we try to collect unpaid amounts due
- When bills or clain for payment are mailed, faxed, or sent by computer to you or your health or vision plan.
- When we occasionally have to ask a collection agancy or attorney to help us with unpaid amounts due.We use and disclose your health information for healthcare operations in a number of ways. Examples: financial or billing audits, internal quality assurence, personnel decisions,to enable our doctors to participate in managed care plans, for the defense of legalmatters, to develope business plans, and for outside storage of our records.
Appointment reminders.
We may call to remind you of your scheduled appts. We may also call to notify you of other treatments or services available at our office to help you.
Uses & Disclosures without authorization
In some limited situations the law allows or requires us to disclose your health information without your permission. Not all of these situations will apply to us some may never even happen in our office at all. Such uses or disclosures are:
A state or federal law that mandates certain health information be reported for a specific purpose.
Public health purposes , such as a contagious disease reporting, investigation, or surveillance.
Disclosures to governmental authorities about victims ofsuspected abuse, neglect,or domestic violence.
Uses and disclosures for health oversight activities , such as licensing of docors, audits by medical or medicare, or investigation of possible violations of healthcare laws.
Diclosures for judicial and administrative proceedings , such as subpoenas.
Disclosures for law enforcement purposes, such as a suspected victim of crime.
Diclosures to a medical examiner to idenify a dead person or to dtermine the cause of death, or to a funeral director to aid in burial: or to organizations that handle tissue or organ donors.
Uses or disclosures for health related research
Uses and Disclosures to prevent a serious threat to health or safety.
Uses or disclosures for a specialized goverment function, such as the protection of the president or high ranking official, or the health of members of foriegn service.
Disclosures to worker's compensation programs.
Disclosures to business associates who perform healthcare operations for us and who agree to keep your info private.
Other disclosures
We will not make any other uses or disclosures of your health info unless you sign a written authorization form.You may revoke it at any time if you do choose to sign one.
You right regarding your health information
the law gives you may rights regarding your health information.
you can ask us to restrict our uses and disclosures for purpose of treatment (except emergency treatment) payment or healthcare operations. we do not have to agree to do this, but if we agree , we must honor the restictions you want. A written request to be sent to Edwin K. larsen ATTN: Mary. at our address or fax number.
You can ask us to communicate with you in a confidential way , such as phoning you at work rather then at home, or by mailing info to a different address. We will try to accomidate your requests if they are reasonable, and if you pay us for any extra costs. If you want to ask for confidential communications, send a written request to
Edwin K. Larsen O.D: Attn Mary.
You can ask for photo copies of your health info. By law there are a few limited situations in which we can refuse tp permit access or copying. Normally you will be able to get copies within 30 days.You may have to pay for photocopies in advance.
You can ask us to amend your health if you think its incorrect or incomplete. If we agree we will amend the info within 60 days. If we do not agree, you can write a statment on your position and we will include it with your health info.Please send your written request to Edwin K. Larsen O.D. attn Mary.
You can get a list of the disclosures that we have made to your health information within the last 6 years( or shorter if you want), except the disclosures for treatment, payment , or health care operations.
Our notice of privacy practices
By law we must abide by the terms of our notice of privacy practices until we choose to change it. we reserve the right to change this notice at any time in compliance with and as allowed by law. If we change this notice, we will post the new notice and also have copies in our office.
Complaints
If you think we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil rights. We will not retaliate against you if you make a complaint. If you want to complain to us send a written complain to Edwin K . Larsen O.D.
For more information about our privacy practices, call or visit Edwin K Larsen O.D. attn Mary at our office. 1737 First st , Napa, CA 94559. fax (707)226-3772. You may request additional copies of our privacy policies by stopping by our office.
