Monarch Bay Optometry

 Dr. Irene M. Lin-Dilorinzo, O.D., Incorporated

This notice describes how health information about you can be used and disclosed.  Please review it carefully. 

Our legal duty: 

We are required by law to maintain the privacy of your health information.  We are also required to give you this Notice.  We reserve the right to change our privacy practices, provided such changes are permitted by applicable law.  You may request a copy of our Notice at any time. 

Uses and Disclosures of Health Information:  We use and disclose health information about you for treatment, payment and healthcare operations.  For example,

Treatment:  We may use or disclose your health information to an optician, ophthalmologist or other health care provider providing treatment to you for: a) the provision, coordination, or management of health care and related services by health care providers; b) consultation between health care providers relating to a patient; c) the referral of a patient for health care from one health care provider to another; or d) recall information.

Payment:  We may use or disclose your health information to obtain payment for services we provide to you.  This may include: a) billing and collection activities and related data processing; b) actions by health plan or insurer to obtain premiums or to determine or fulfill its responsibilities for coverage and provisions of benefits under its health plan or insurance agreement, determinations of eligibility or coverage, adjudication or subrogation of health benefit claims; c) medical necessity and appropriateness of care reviews, utilization review activities and d) disclosure to consumer reporting agencies of information relating to collection of premiums or reimbursement.

Healthcare Operations:  We may use or disclose your health information in connection with our healthcare operations, including things such as quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.

Your authorization:  You may give us written authorization to use your health information or to disclose it to anyone for any purpose.  You may revoke your authorization at any time, in writing.  Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.  Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.

Marketing Health Products or Services:  We will not use your health information for marketing purposes without your prior written authorization.  We may provide you with information regarding products or services that we offer related to your health care needs.  We will never sell your health information without your prior authorization.

To You, Your Family and Friends:  We must disclose your health information to you as described in the Patient Rights section.  We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so or, if you are not able to agree, if it is necessary in our professional judgment.

Persons Involved with Care:  We may use or disclose health information to notify, or assist in the notification of (including identifying and locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death.  If you are present, we will provide you with the opportunity to object to such uses or disclosures.  In the event of emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing health information that is directly relevant to the persons involvement in your healthcare.  We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up a filled prescription, medical supplies, x-rays, or other similar forms of health information.

Access:  You have a right to review or get copies of your health information, with limited exceptions.  You must make a request in writing to obtain access to your health information.  You may obtain a form to request access by contacting us.  We reserve the right to charge you a reasonable cost-based fee for expenses such as copies or staff time.  You may also request access by sending us a letter.  If you prefer, we will prepare a summary or an explanation of your health information for a reasonable fee.

Disclosure Accounting:  You have a right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations, where you have provided an authorization and certain other activities, for the last six years, but not for disclosures made prior to April 14, 2003. 

Restriction:  You have a right to request that we place additional restrictions on our use or disclosure of your health information.  We are not required to agree with these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).

Alternative Communication:  You have a right to request in writing that we communicate with you about your health information by alternative means or to alternative locations.  Your request must specify the alternative means or location, and provide satisfactory explanation of how payments will be handled under the alternative means or location you request.

Amendment:  You have the right to request that we amend your health information.  Your request must be in writing, and it must explain why the information should be amended.  We may deny your request under certain circumstances.

Electronic Notice:  If you receive this Notice on our website or by email, you are entitled to receive this Notice in written form.