HIPAA Notice of Privacy Practices

This Notice of Privacy Practices is a draft and requires attorney review. It is not the practice's final legal notice.

This notice describes how medical information about you may be used and disclosed, how you can get access to this information, and our responsibilities under the Health Insurance Portability and Accountability Act (HIPAA). Please review it carefully.

We may use and disclose your protected health information for treatment, payment, and health care operations. For example, we may share information with another provider involved in your care, use information to bill you or your health plan, and use information for quality assessment, staff training, licensing, and practice administration.

We may also use or disclose information when permitted or required by law, including for public health and safety activities, health oversight, workers' compensation, law enforcement, judicial or administrative proceedings, organ and tissue donation, research subject to legal safeguards, services of coroners or funeral directors, and to avert a serious threat to health or safety.

We may contact you about appointments, treatment alternatives, health-related services, benefits, or certain fundraising activities as permitted by law. You may tell us not to contact you for fundraising.

Uses and disclosures not described in this notice generally require your written authorization. Most uses and disclosures of psychotherapy notes, uses for marketing, and disclosures that constitute a sale of protected health information require authorization where applicable. You may revoke an authorization in writing, except to the extent we have already acted in reliance on it.

Subject to applicable law, you may exercise the following rights concerning your protected health information:

• Inspect or obtain an electronic or paper copy of your medical and billing records, usually within the period required by law. A reasonable, cost-based fee may apply.
• Ask us to correct health information you believe is incorrect or incomplete. We may deny a request in certain circumstances and will explain a denial in writing.
• Request confidential communications by asking us to contact you in a specific way or at a specific location.
• Ask us to limit how we use or disclose information. We are not always required to agree, except for certain disclosures to a health plan when you paid for the item or service in full out of pocket and the law requires us to honor the request.
• Receive an accounting of certain disclosures made during the applicable lookback period.
• Obtain a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone with legal authority, such as a medical power of attorney or legal guardian, to act for you.
• File a complaint without retaliation if you believe your privacy rights have been violated.

We are required by law to maintain the privacy and security of protected health information, provide this notice of our legal duties and privacy practices, and follow the notice currently in effect.

We will notify affected individuals following a breach of unsecured protected health information when notification is required by law. We will not use or disclose information other than as described here unless you authorize us in writing.

We may change this notice and make the revised notice effective for health information we already hold and information we receive in the future. The current notice will be available at our offices and on this website.

To ask a question, exercise a right, or file a privacy complaint, contact Inland Family Optometry by calling (909) 345-6100 or writing to 8977 Foothill Blvd, Suite C, Rancho Cucamonga, CA 91730; or by calling (909) 345-9809 or writing to 5250 Philadelphia St, Suite D, Chino, CA 91710.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.