Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Chadwick Low Vision Center is required by law to:

• Maintain the privacy and security of your protected health information
• Give you this notice of our legal duties and privacy practices
• Follow the terms of the notice currently in effect
• Let you know promptly if a breach occurs that may have compromised the privacy or security of your information

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.

We may use your health information and share it with other professionals who are treating you. For example, we may review findings from your eye doctor, or share information about the eyewear or devices we provide so your care stays coordinated.

We may use and share your health information to bill and get payment from health plans or other payers. For example, we may give your health plan information about the lenses or devices we provided.

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good.

We have to meet many conditions in the law before we can share it for these purposes:

• When required by law, including to the Department of Health and Human Services if it wants to confirm we are complying with federal privacy law
• For public health and safety, such as reporting product problems or recalls, preventing disease, reporting suspected abuse, neglect, or domestic violence, or preventing a serious threat to someone’s health or safety
• For health oversight activities authorized by law, such as audits, investigations, and inspections
• In response to lawsuits and legal actions, such as a court or administrative order or a subpoena
• For law enforcement purposes or with a law enforcement official, as permitted by law
• For workers’ compensation claims
• With medical examiners, coroners, or funeral directors, and for organ and tissue donation requests
• For research, when approved through a process that protects your privacy
• For special government functions, such as military, national security, and presidential protective services

If we receive substance use disorder treatment records protected by federal law (42 CFR Part 2), those records, or testimony about their contents, will not be used or shared in a civil, criminal, administrative, or legislative proceeding against you without your written consent or a court order.

Information we share as permitted by law may be shared again by the person or organization that receives it and may no longer be protected by federal privacy law.

You can ask to see or get a paper or electronic copy of your health and billing records. We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

You can ask us to correct health information you think is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.

You can ask us to contact you in a specific way, such as by a different phone number, or to send mail to a different address. We will say yes to all reasonable requests.

You can ask for a list (accounting) of the times we’ve shared your information for six years prior to the date you ask, who we shared it with, and why. This list will not include disclosures for treatment, payment, and operations, and certain other disclosures. We will provide one list a year for free and may charge a reasonable, cost-based fee for additional requests within 12 months.

You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically.

If you have given someone medical power of attorney or someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will confirm they have this authority before we take action.

If you feel your privacy rights have been violated, you can file a complaint with us by contacting our Privacy Officer using the information below.

You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting hhs.gov/ocr/privacy/hipaa/complaints.

We will not retaliate against you for filing a complaint.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available at our office, on our website, and by request.

Chadwick Low Vision Center
596 Main Street, Suite A, Schwenksville, PA 19473
(484) 232-8810 · hello@chadwicklowvision.com