NOTICE OF PRIVACY PRACTICES:
Optical Expressions, Inc.
Green Mountain Mall
2000 Memorial Drive, St. Johnsbury, VT 05819
Phone: 802-748-3536
Sandy Butkovich, (Public Information Officer)
Effective Date of Notice: April 14, 2003
 
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.
 
Use and Disclosure of Health Information
 
Optical Expressions may use your protected health information (PHI) as defined in the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for the purposes of providing you treatment, obtaining payment for your care, contact health care operations, and for other purposes that are permitted or required by law. Under HIPAA regulations, we do not need to obtain written authorization to use health information for treatment, payment, and health care operations; however, several Vermont state laws require patient consent before health information is used or disclosed by health care providers. Optical Expressions is dedicated to maintaining the privacy your protected health information.

The following is a summary of the circumstances under which and purposes for welfare your health information may be used and disclosed for treatment, payment, and healthcare operations:

To Provide Treatment: Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses, or eye medications and possibly faxing them filled; showing you low vision aids; referring you to another doctor or clinic for eye low vision aids or services; or getting copies of your health information from another professional that you may have seen before us.

To Obtain Payment: Examples of how we use or disclose your health information payment purposes are: asking you about your health or vision care insurance plan and other sources of payment; preparing and sending claims or bills; and collecting unpaid amounts (either ourselves or through small claims court or through a collection agency.

To Conduct Health Care Operations: "Health care operations" mean those administration and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: quality assessment activities; financial or billing audits; professional review and performance evaluation; training programs for students and staff, licensing or credentialing active business planning and development; outside storage of records.

We routinely use your health information inside our office for purposes of treatment payment, and healthcare operations without special permission. Vermont state law requires patient consent before health information is used or disclosed by health care providers. If we need to use or disclose your health information outside of our office for the following reasons, we will first obtain your written consent: 1.) Before we release copies of your health record information to another health care provider. 2.) Where to request copies of your health record information from another health care provider.

Appointment Reminders: Optical Expressions may use and disclose your health information to call or write to you to remind you of your scheduled appointments, to remind you that it is time to make a routine appointment. Unless you tell us otherwise, we will mail you an appointment reminder on a post card, and/or leave you a reminder message on your home answering machine or with someone who answers your phone when you are not at home. We will use the least amount of protected health information as necessary to make the communication.

Treatment Options and Services: Optical Expressions may use or disclose your private health information to provide you with information about treatment alternative or other health-related benefits and services that may be of interest to you.

The following is a summary of the circumstances under which and purposes for which your health information may be used and disclosed without your written authorization to which you have the opportunity to object to:

Others involved in your healthcare: Unless you object, we may disclose to a member your family, a relative, a close friend or any other person you identify, your protection health information that directly relates to that person's involvement in your health you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. An example of this might be when a friend or family member comes to office to pick up glasses or contact lenses; we will dispense these as a convenience to the patient. The following is a summary of the circumstances under which and purposes for w your health information may be used and disclosed without first receiving your written authorization or the opportunity to agree or object is not required:

Required by Law: Optical Expressions will disclose your health information when a federal, state, or local law mandates that certain health information be reported for a specific purpose. Public Health Risks: We may disclose your protected health information for public activities and purposes to a public health authority that is required or permitted by receive the information. The disclosure will be made for the purpose of controlling and reporting disease, injury or disability.

Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease.

Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events and product defects or problems; to track products; to enable product recalls and make repairs or replacements.

Abuse or Neglect: We may disclose your protected health information to a public authority that is authorized by law to receive reports of child abuse or neglect. Also we may disclose your health information if we believe that you have been a victim of neglect, or domestic violence. HIPAA requires that we notify the adult of the report of disclosure, unless we determine that the notification might place the individual at serious harm.

Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspect Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, and civil rights laws. Judicial and Administrative Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, such as in response to subpoenas or orders of courts or other administrative agencies.

Law Enforcement: As permitted or required by state law, Optical Expressions may disclose your health information to a law enforcement official for certain law enforcement purposes as follows: as required by law for reporting certain types of wounds or in to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; in an emergency, in order to report a crime that has happened somewhere else.

Coroners, Funeral Directors, and Organ Donation: We may disclose health inform a medical examiner to identify a dead person or to determine cause of death; or to funeral directors, as authorized by law, to aid in your burial. We may disclose health information to organizations that handle organ, eye, or tissue donations.

In the Event of a Serious Threat to Health or Safety: Optical Expressions, consistent with state and federal laws, may disclose your health information if we believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your or safety or to the health or safety of the public.

Military Activity and National Security: In certain circumstances, the Federal regulations authorize Optical Expressions to use or disclose your health information for specific government functions; such as the protection of the president; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service.

Worker's Compensation: Your protected health information may be disclosed by law to authorized to comply with worker's compensation laws.

Marketing: Optical Expressions does not need a signed patient authorization for the following marketing purposes: in order to make a marketing communication about our own health care products or services, in connection with treatment of an individuals discussed in a face to face encounter, or given as a promotional gift of nominally.

Business Associates: We will share your protected health information with a third "business associate" that performs accounting activities for Optical Expressions. Whenever an arrangement between our office and a business associate involves or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your health information.

Disclosures required by Vermont state law: Vermont law requires reporting in the following situations: child abuse; abuse, neglect, or exploitation of vulnerable adults; arm related injuries; communicable diseases; cancer; lead poisoning; duty to warn of harm cases. We will disclose information limited to the relevant requirements of the law.

The following is a summary of the circumstances under which and purposes for when your health information will be used and disclosed only after Optical Expressions has obtained your written authorization:

Under federal regulations, no authorization is required when we use or disclose pr health information to make a marketing communication if it concerns products or services of nominal value, if it occurs in a face to face communication, or if it consists of health related products and services that we provide. For any other marketing purposes we will first obtain your written authorization.

For any reason, other than listed previously in this Notice of Privacy Practices, Optical Expressions will not disclose your protected health information without your written authorization. Some examples of when authorizations are required: disclosures to employers, schools, attorneys, camps, life, auto, or disability insurance (unless required by law).

The content of an authorization form is determined by federal law. Sometimes, WE initiate the authorization if the disclosure is our idea, sometimes, you may initiate the process if it is your idea for us to send your information to someone else. If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign once, you may revoke it at any time unless we have already acted in reliance upon it. Revocation must be in writing. Send them to the public information officer named at the beginning of this Notice.

Your Rights With Respect to your Health Information: You have the following rights regarding your protected health information:
» You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that contained in a designated record set for as long as we maintain the protected health information. A "designated record set "contains medical and billing records and arrangement records that your doctor and the practice use for making decisions about you. If you want to review or get copies of your health information, send a written request to the public information officer shown at the beginning of this Notice. Our practice may deny any request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
» You have the right to have your doctor amend your protected health information think it is incorrect or incomplete. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. If we agree, we will amend the information within 60 days of when you ask us. In certain cases; for example, if we think the information is correct and was not created by our practice, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with of any such rebuttal. If you want to ask us to amend your health information, send a written request to the public information officer at the address shown at the beginning of this Notice.
» You have the right to ask us to restrict our uses and disclosures for purposes of treatment, payment, and healthcare operations. Your request must state the specific restriction requested and to whom you want the restriction to apply. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To request a restriction, send a written request to the public information officer at the address posted at the beginning of this Notice.
» You have the right to ask us to communicate with you in a confidential way; such as phoning you at home rather than work, or by mailing health information to an address other than your home address. Optical Expressions will accommodate these requests if they are reasonable. You do not have to give us a reason for your request. To assure confidential communication, send a written request to the public information office address shown at the beginning of this Notice.
» You have the right to receive an accounting of disclosures we have made, if any of your protected health information. This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices. Accounting is not required for disclosures we may have made to you, incidental disclosures, disclosures you have authorized, or disclosures required by law. You have the right to receive specific information regarding disclosures that OCCUR after April 14, 2003 up to a six year time frame. In order to obtain an accounting copy of disclosures, you must submit your request in writing to the public information office to the address shown at the beginning of this Notice.
» You have a right to a paper copy of this notice. You have a right to ask us to give you, separate copy of this Notice at any time, even if you have previously received an electronic or paper copy. To obtain a paper copy of this notice, contact Sandy Butkovich at 802 748-3536.

Our Notice of Privacy Practices:
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this Notice at any time as allowed by law to change this Notice, the new privacy practices will apply to your health information already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will provide you with a revised copy, we will post the new Notice in our waiting room, we will have copies available in our office and we will post it on our Web site.

Complaints:
If you think we have not properly respected the privacy of your health information, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services, Office for Civil Rights. If you want to complain to us, send copies complaint to Sandy Butkovich, Public Information Officer, 2000 Memorial Drive, Suite 6, St. Johnsbury, Vermont 05819. You will not be retaliated against in any way for filing a complaint.

	St. Johnsbury: 802-748-3536 • Berlin: 802-223-2090 OPEN: Monday - Friday 8:30am to 7:00pm • Saturday 8:30am to 5:00pm