Notice of Privacy Practices

Welcome to Midwest Eye Clinic. This Notice of Privacy Practices ("Notice") outlines how we may use or disclose your health information and how you can access such information. Please review this carefully.

Your "health information" is generally any information identifying you and created, received, maintained, or transmitted by us in providing health care items or services.

We are committed to maintaining the privacy of your health information in compliance with HIPAA and other laws. This includes notifying affected individuals following a breach of unsecured health information.

USES AND DISCLOSURES WITHOUT YOUR AUTHORIZATION

Common reasons for using or disclosing your health information include treatment, payment, or health care operations. For example, scheduling appointments, conducting eye tests, or billing procedures.

OTHER DISCLOSURES AND USES WITHOUT YOUR AUTHORIZATION

In limited situations, the law may allow or require us to use or disclose your health information without your consent. These include reporting health information for specific purposes mandated by state or federal law, public health activities, disclosures to governmental authorities, judicial and administrative proceedings, law enforcement purposes, and more.

SPECIFIC USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Certain uses and disclosures of your health information require your authorization, such as marketing activities, the sale of health information, and psychotherapy notes.

YOUR RIGHTS

You have rights concerning the confidentiality of your health information, including the right to request restrictions on its use and disclosure, receive confidential communications, inspect or copy your health information, request amendments, receive an accounting of disclosures, and designate another party to receive your health information.

CHANGES TO THIS NOTICE

We reserve the right to change our privacy practices and will post any revisions prominently in our facility. Copies of this Notice are available upon request.

ACKNOWLEDGEMENT OF RECEIPT

I acknowledge that I am aware of the provider's Notice of Privacy Practices posted at Midwest Eye Clinic. The policy summarizes the way my identifiable health information may be used or disclosed. It states my rights with respect to my medical information. I understand that Midwest Eye Clinic has the right to revise these information policies and to amend the Notice of Privacy Practices. I understand that if the Notice is revised, the revised notice will be posted at Midwest Eye Clinic. I also understand that I may obtain a current Notice of Privacy Practices at any time from the office manager at Midwest Eye Clinic.