Progressive Vision Institute
NOTICE OF PRIVACY PRACTICES
SHORT FORM SUMMARY
This Notice is Effective as of: 01/01/2019
This is only a summary of our Notice of Privacy Practices. Please review the full Notice following the summary to learn how we use and disclose medical information about you and your rights concerning these uses and disclosures.
How We Use and Disclose Your Information
We will obtain your written authorization for any uses and disclosures of protected health information “PHI”, not described in the Notice of Privacy Practices.
Treatment, Payment, and Health Care Operations. We may use your PHI in order to provide your medical care; to bill for our services and to collect payment from you or your insurance company; and for the general operation of our business.
Marketing, Fundraising, and Sale of PHI. We will obtain your prior written authorization before sending you certain marketing communications. We may use or disclose your demographic information in order to contact you for our information without your prior written authorization.
We may use your PHI as otherwise authorized or required by lay for such purposes as:
- Public health reporting and oversight activities
- Judicial, administrative, or law enforcement proceedings
- Complying with workers’ compensation laws
- Communicating with your family or caregivers
- Sending appointment reminders
You Have the Right to:
- Request certain restrictions on our use and disclosure of your PHI.
- Request communications from us by specific means or locations.
- Inspect and copy your medical record.
- Ask us to correct the information in your medical record.
- Receive an accounting of disclosures of your PHI by our practice.
- Be notified in the case of breach of unsecured PHI.
Contact our Privacy Officer with any questions, comments, or complaints or to exercise any of your rights to Courtney Ranck, email@example.com 570-628-4444 ext. 142