Notice of Privacy Practices

Effective Date: July 1, 2025
Last Updated: July 1, 2025

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.

We are committed to protecting the privacy and confidentiality of your medical information. In accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), this Notice of Privacy Practices ("Notice") describes how we may use and disclose your health information and your rights with respect to that information.

Our Commitment to Your Privacy

We will protect and respect the privacy and confidentiality of your medical information, as it is personal. We record the care and services you receive at our facilities. We need this record to give you complete and comprehensive care. This Notice applies to the records we maintain for your care at our facilities and describes your rights.

We are required by law to:

• Make sure that medical information that identifies you is kept private.
• Give you this Notice of our legal duties and privacy practices concerning your medical information.
• Notify you if there is a breach of your unsecured medical information.
• Follow the terms of the Notice currently in effect.

Who Will Follow This Notice

This notice describes the privacy practices of all providers, departments, and units of our organization, which includes employees, staff, trainees, volunteers, and other workers. All these entities, sites, and locations follow the terms of this Notice and may share your health information with each other for treatment, payment, or health care operations described in this Notice.

How We May Use and Disclose Your Medical Information

We may use and disclose your medical information as listed below. Not every possible use or disclosure will be listed. However, all the ways we may use and disclose information fall into one of these areas.

For Treatment. We may use and disclose medical information to provide, coordinate, or manage your care-related services. For example, we may disclose medical information to doctors, nurses, technicians, or other personnel, including people outside of our facilities, who are involved in your medical care and need the information to provide you with medical care.

For Payment. We may use and disclose medical information so that we, or others, may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example, we may give your health plan information about you so that they will pay for your treatment or to determine the amount of your copayment or coinsurance.

For Health Care Operations. We may use or disclose your medical information to carry out our general or certain business activities. These activities include, but are not limited to, quality assessment/improvement activities, training and education, risk management, legal consultation, and licensing.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services. We may use and disclose medical information to contact you to remind you that you have an appointment with us or to share information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care. With your agreement, we may share medical information with a person who is involved in your medical care or payment for your care, such as a family member or close friend. If you are unable to agree, we may share information if we believe it is in your best interest.

Research. Under certain circumstances, we may use and disclose medical information for research. All research projects are subject to a special approval process to ensure patient privacy is protected.

How We May Use and Disclose Your Medical Information: Special Situations

As Required by Law. We will disclose medical information when required by international, federal, state, or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Business Associates/Third Parties. We may disclose medical information to our business associates who perform functions on our behalf (e.g., billing services, IT support). Our business associates are obligated by contract and law to protect the privacy of your information.

Organ and Tissue Donation. We may release medical information to organizations that handle organ procurement or transplantation to facilitate organ, eye, or tissue donation.

Veterans and Military. If you are an armed forces member, we may release medical information as military command authorities require.

Workers’ Compensation. We may release medical information for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.

Public Health Activities and Safety Issues. We may disclose medical information for public health activities, such as preventing or controlling disease, injury, or disability; reporting births and deaths; reporting child abuse or neglect; or notifying a person who may have been exposed to a disease.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.

Lawsuits and Disputes. We may disclose medical information about you in response to a court or administrative order, subpoena, or other lawful process.

Law Enforcement. We may release medical information if asked to do so by a law enforcement official, as required or permitted by law.

Coroners, Medical Examiners, and Funeral Directors. We may disclose medical information consistent with applicable law to a coroner, medical examiner, or funeral director as necessary to carry out their duties.

Uses and Disclosures that Require Your Authorization

We will not use or disclose your medical information for most marketing purposes or sell your medical information unless we first obtain your prior written authorization. Any use or disclosure not covered in this Notice will be made only with your written permission. You may revoke this permission at any time.

Your Medical Information Rights

You have the following rights regarding the medical information we maintain about you:

• Right to Inspect and Receive a Copy. You have a right to inspect and receive a copy of your medical information. You must submit your request in writing. We may Have up to 30 days to make information available to you and charge a reasonable, cost-based fee.
• Right to Notification of a Breach. You have the right to be notified following a breach of your unsecured protected health information.
• Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend it. You must submit your request in writing and provide a reason that supports your request. We may say no to a request if you ask us to amend information that we did not create, that is not part of the records to make decisions about you, that is not part of the information which you are permitted to inspect or receive a copy of or information that is accurate and complete.
• Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have made of your medical information. You must submit your request in writing.
• Right to Request Restrictions. You have the right to request a restriction on the medical information we use or disclose for treatment, payment, or healthcare operations. We are not required to agree to your request, except where you have paid for a service or item "out-of-pocket" in full and request that we not disclose information about that service to your health plan.
• Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. Your request must be in writing.
• Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice at any time.

Revisions to This Notice

We may update this Notice to show any changes in our privacy practices. We reserve the right to make the updated Notice effective for medical information we already have about you and any information we receive in the future. The revised Notice will be posted in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with us, please contact our Privacy Officer. You will not be penalized for filing a complaint.

Premier Eye Group Privacy Officer
Mail:
Privacy Officer
Premier Eye Group
3130 Central Park West Suite 6544B
Toledo, Ohio 43617

Phone: 419-273-7400
Email: [email protected]

Office for Civil Rights (OCR)

You may also file a written complaint with the U.S. Department of Health and Human Services.

Mail:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201

Email: [email protected]