The privacy of your medical information is important to us.
We
understand
that your medical information is personal and we are committed to protecting
it.
This
notice will tell you about the ways we may use and share medical information
about you.
We also describe your rights and certain duties we have regarding the use
and
disclosure
of medical information. Our Legal Duty-Law Requires Us to keep your medical
information
private and give you this notice describing our legal duties, privacy
practices,
and
your rights regarding your medical information. Notice of Change to Privacy
Practices:
Before we make an important change in our privacy practices, we will change
this
notice
and make the new notice available upon request. Use and Disclosure of Your
Medical
Information. The following section describes different ways that we use and
disclose
medical information. Not every use or disclosure will be listed. However, we
have listed
all of the different ways we are permitted to use and disclose medical
information. We
will not use or disclose your medical information for any purpose not listed
below,
without your specific written authorization. Any specific written
authorization
you
provide may be revoked at any time by writing to us. For Treatment: We may
use
medical
information about you to provide you with medical treatment or services. We
may
disclose
medical information about you to doctors, nurses, technicians, medical
students,
or
other people who are taking care of you. We may also share medical
information
about you
to your other health care providers to assist them in treating you.
Notifications: We
may use and disclose medical information to notify or help notify: a family
member, your
personal representative or another person responsible for your care. We will
share
information about your location, general condition, or death. If you are
present, we
will get your permission if possible before we share, or give you the
opportunity to
refuse permission. In case of emergency, we will share only the health
information that
is directly necessary for your healthcare, according to our professional
judgment. We
will also use our professional judgment to make decisions in your best
interest
about
allowing someone to pick up medicine, medical supplies, x-ray or medical
information for
you. Acknowledgement of Receipt and General Consent I acknowledge that I
have
reviewed a
copy of Optical Academy, Your Eye Exam in Your School. I further consent to
the
release
of my health information for purposes of treatment, payment and health care
operations
and as authorized or required by law under the circumstances described in
the
Notice of
Privacy Practices. We will send you notifications/reminders of you the event
you
have registered
via email and sms. You may receive email updates about Optical Academy. You
may
subscribe
anytime by clicking unsubscribe in the email you receive, or responding STOP
via
sms.
By submitting this electronic form you confirm that you have read this
agreement
and
agree to its terms and also serves as an acknowledgement that you have
received
the
HIPPA notice form described above.
