Effective April 14, 2003

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

General Rule
We respect our legal obligation to keep health information that identifies you private. This notice describes how we protect your health information and what rights you have regarding it.

We may use your health information in our office or disclose it outside of our office, without your written permission, for purposes of treatment, payment, and healthcare operations.

• Treatment means providing or coordinating your health care by one or more health care providers such as when we set your appointment, provide examinations, materials, medications, or referrals.
• Payment activities occur when we confirm insurance coverage, send a bill to you or your insurance company, or send information to payment collection agencies.
• Health care operations include the business activities any medical practice perform such as personnel decisions, business planning, and managed care program decisions.

In some limited situations, the law allows or requires us to disclose your health information without your permission. Most of those situations do not routinely occur in an optometric office but can include reports to the FDA and other federal or state agencies and disclosures to business associates who agree to keep your health information private.

Office Procedures
We may call or send a postcard to remind you of your scheduled appointments, or that it is time to make a routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise we may call your place of employment to notify you that your glasses and/or contacts are ready or an appointment is available. We may leave a message on your phone answering system or with the individual who answers your phone at home or work.

Because of physical limitations, especially in our frame selection area, information about your glasses or contacts will be openly discussed but sensitive health related conversations such as about your diabetes, high blood pressure, glaucoma, or other health conditions will be limited to a more private area when available.

Unless you object we will also share relevant information about your care with your family or friends who are helping you with your eye care.

Other Disclosures
We will not make any other disclosures of your health information unless you sign a written authorization form.

Your Rights Regarding Your Health Information
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to our Contact Person at the address shown at the bottom of this page:

• You can ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or healthcare operations. We are by law not required to agree to a requested restriction but if we agree we must abide by it.
• You can ask us to communicate with you by an alternate way or at an alternate location.
• You can ask to see or to get photocopies of your health information unless restricted by law.
• You can ask us to amend your health information if you think that it is incorrect or incomplete.
• You can ask for a list of the disclosures that we have made of your health information.
• You can ask for a copy of this Notice of Privacy Practices.

Our Notice of Privacy Practices
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time in compliance with and as allowed by law. If we change this notice, the new privacy practices will apply to your health information that we already have, as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our website.

Complaints
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to HIPPA Contact Person at the address shown at the bottom of this page.

Steven Hogue, O.D., Inc.
2421 Pleasant Avenue
Hamilton, Ohio  45015 
(513) 892-2020
Fax (513) 893-2020