Privacy Notice
How We Use And Disclose Your Protected Health Information:
Uses and Disclosures for Treatment, Payment, and Health Care Operations. After we make a good
faith effort to provide you with this Notice, we may use your personal health information in the
following ways:
1. For Treatment. We will use and disclose your personal health information to plan, provide, and
coordinate your health care services. Examples of how we use or disclose information for
treatment purposes are: setting up an appointment for you testing or examining your eyes
prescribing glasses, contact lenses, or eye medications and faxing them to be filled showing
you low vision aids referring you to another doctor or clinic for eye care or low vision aids or
services and getting copies of your health information from another professional that you may
have seen before us.
2. For Payment. We will use and disclose your personal health information to obtain payment for
health care services we have provided to you. Examples of how we use or disclose your health
information for payment purposes are: asking you about your health or vision care plans, or
other sources of payment preparing and sending bills or claims and collecting unpaid amounts
(either ourselves or through a collection agency or attorney).
3. For Health Care Operations. We may use or disclose your protected health information for our
health care operations. Examples of how we use or disclose your health information for health
care operations are: financial or billing audits internal quality assurance personnel decisions
participation in managed care plans defense of legal matters business planning and outside
storage of our records.
Uses and Disclosures of Your Personal Health Information With Your Authorization. For purposes
other than treating you, obtaining payment for your care, or our own health care operations, we will
obtain your written authorization prior to using or disclosing your personal health information (unless
we are required or permitted by law to use or disclose your information as set out below). You have the
right to revoke any authorization you have given us at any time. If you have any questions about
written authorizations, please contact our Privacy Officer at the address or telephone number below.
Our Privacy Officer will provide you with information about giving or revoking your authorization for
us to use or disclose your personal health information.
Uses and Disclosures We May Make Unless You Object or Express Restrictions. Unless you object,
we may contact you to provide appointment reminders or information about treatment or treatment
alternatives or other health-related benefits and services that may be of interest to you. Before we send
you any marketing materials, we will obtain your written authorization. We may also use or disclose
your personal health information to notify a family member, close friend, or another person responsible
for your care, provided that you have the opportunity to agree or object. If you are unable to agree or
object, we may disclose this information as necessary if we determine that it is in your best interest
based upon our professional judgment.
Uses and Disclosures We Are Permitted or Required to Make Without Your Authorization. We may
use and disclose your personal health information without obtaining your written authorization in the
following situations:
1. Business Associates. There are some services that we provide through contacts with our
business associates who work on our behalf. In such situation, we may disclose your personal
health information to our business associates so that they can perform the jobs we asked them to
do. We require all business associates to also safeguard your information in accordance with
applicable law.
2. Uses and Disclosures Required by Law. We may use or disclose your personal health
information to the extent that we are required by law to do so. The use or disclosure that will be
made is in full compliance with the applicable law governing the disclosure.
3. Public Health Activities. We may use or disclose your personal health information for public
health activities and purposes in compliance with applicable laws for the purpose of controlling
disease, injury, or disability. We may also disclose your health information to a public authority
authorized to receive reports of child abuse or neglect to report information about products or
services under the jurisdiction of the U.S. Food and Drug Administration to alert authorities of
persons who may have been exposed to a communicable disease or who may otherwise be at
risk of contracting or spreading a disease or condition and to your employer for certain workrelated
illnesses or injuries.
4. Victims of Abuse, Neglect, or Domestic Violence. We may disclose personal health information
about an individual whom we reasonably believe to be a victim of abuse, neglect, exploitation,
or domestic violence to a government authority, including a social service or protective service
agency authorized by law to receive reports of child abuse, neglect, exploitation, or domestic
violence. Any such disclosures will be made in accordance with and limited to the requirements
of law.
5. Health Oversight Activities. We may make disclosures of your personal health information to a
health oversight agency charged with overseeing the health care system. Disclosures will be
made only for activities authorized by law.
6. Judicial and Administrative Proceedings. We may disclose your personal health information in
the course of any judicial or administrative hearing in response to an order of a court or
administrative tribunal, or in response to a subpoena, discovery request, or other lawful process
where we receive satisfactory assurance that you have been notified of the request and have
been given time to object and other appropriate precautions have been taken. In all cases, we
sill take reasonable steps to protect the confidentiality of your health information.
7. Law Enforcement. We may disclose your personal health information for a law enforcement
purpose to law enforcement officials in compliance with and as limited by applicable law.
8. Coroners, Medical Examiners, and Funeral Directors. We may disclose personal health
information to funeral directors in accordance with applicable law.
9. Organ Donation. As allowed by law, we may disclose personal health information to organ
procurement organizations for organ, eye, or tissue donation purposes.
10. Research. We may use or disclose your personal health information without your authorization
for research purposes when such research has been approved by an institutional review board
that has reviewed the research to ensure the privacy of your personal health information, or as
otherwise allowed by law.
11. Limited Government Functions. We may disclose your personal health information to certain
government agencies charged with special government function, as limited by applicable law.
For example, we may disclose your health information to authorized federal officials for the
conducting of national security activities, as required by law.
12. Health and Safety. We may disclose your personal health information to prevent or lessen a
serious threat to any person's or the public's health or safety. In all cases, disclosures will only
be made in accordance with applicable law.
13. Workers' Compensation. We may disclose your personal health information to judicial or
administrative proceeding in response to orders, subpoenas, and other valid legal process.
Privacy Officer:
Melissa Huebner
575 E. University Parkway
Suite H-155
Orem, UT 84097
(801)225-3920
insighteyecare@gmail.com
Uses and Disclosures for Treatment, Payment, and Health Care Operations. After we make a good
faith effort to provide you with this Notice, we may use your personal health information in the
following ways:
1. For Treatment. We will use and disclose your personal health information to plan, provide, and
coordinate your health care services. Examples of how we use or disclose information for
treatment purposes are: setting up an appointment for you testing or examining your eyes
prescribing glasses, contact lenses, or eye medications and faxing them to be filled showing
you low vision aids referring you to another doctor or clinic for eye care or low vision aids or
services and getting copies of your health information from another professional that you may
have seen before us.
2. For Payment. We will use and disclose your personal health information to obtain payment for
health care services we have provided to you. Examples of how we use or disclose your health
information for payment purposes are: asking you about your health or vision care plans, or
other sources of payment preparing and sending bills or claims and collecting unpaid amounts
(either ourselves or through a collection agency or attorney).
3. For Health Care Operations. We may use or disclose your protected health information for our
health care operations. Examples of how we use or disclose your health information for health
care operations are: financial or billing audits internal quality assurance personnel decisions
participation in managed care plans defense of legal matters business planning and outside
storage of our records.
Uses and Disclosures of Your Personal Health Information With Your Authorization. For purposes
other than treating you, obtaining payment for your care, or our own health care operations, we will
obtain your written authorization prior to using or disclosing your personal health information (unless
we are required or permitted by law to use or disclose your information as set out below). You have the
right to revoke any authorization you have given us at any time. If you have any questions about
written authorizations, please contact our Privacy Officer at the address or telephone number below.
Our Privacy Officer will provide you with information about giving or revoking your authorization for
us to use or disclose your personal health information.
Uses and Disclosures We May Make Unless You Object or Express Restrictions. Unless you object,
we may contact you to provide appointment reminders or information about treatment or treatment
alternatives or other health-related benefits and services that may be of interest to you. Before we send
you any marketing materials, we will obtain your written authorization. We may also use or disclose
your personal health information to notify a family member, close friend, or another person responsible
for your care, provided that you have the opportunity to agree or object. If you are unable to agree or
object, we may disclose this information as necessary if we determine that it is in your best interest
based upon our professional judgment.
Uses and Disclosures We Are Permitted or Required to Make Without Your Authorization. We may
use and disclose your personal health information without obtaining your written authorization in the
following situations:
1. Business Associates. There are some services that we provide through contacts with our
business associates who work on our behalf. In such situation, we may disclose your personal
health information to our business associates so that they can perform the jobs we asked them to
do. We require all business associates to also safeguard your information in accordance with
applicable law.
2. Uses and Disclosures Required by Law. We may use or disclose your personal health
information to the extent that we are required by law to do so. The use or disclosure that will be
made is in full compliance with the applicable law governing the disclosure.
3. Public Health Activities. We may use or disclose your personal health information for public
health activities and purposes in compliance with applicable laws for the purpose of controlling
disease, injury, or disability. We may also disclose your health information to a public authority
authorized to receive reports of child abuse or neglect to report information about products or
services under the jurisdiction of the U.S. Food and Drug Administration to alert authorities of
persons who may have been exposed to a communicable disease or who may otherwise be at
risk of contracting or spreading a disease or condition and to your employer for certain workrelated
illnesses or injuries.
4. Victims of Abuse, Neglect, or Domestic Violence. We may disclose personal health information
about an individual whom we reasonably believe to be a victim of abuse, neglect, exploitation,
or domestic violence to a government authority, including a social service or protective service
agency authorized by law to receive reports of child abuse, neglect, exploitation, or domestic
violence. Any such disclosures will be made in accordance with and limited to the requirements
of law.
5. Health Oversight Activities. We may make disclosures of your personal health information to a
health oversight agency charged with overseeing the health care system. Disclosures will be
made only for activities authorized by law.
6. Judicial and Administrative Proceedings. We may disclose your personal health information in
the course of any judicial or administrative hearing in response to an order of a court or
administrative tribunal, or in response to a subpoena, discovery request, or other lawful process
where we receive satisfactory assurance that you have been notified of the request and have
been given time to object and other appropriate precautions have been taken. In all cases, we
sill take reasonable steps to protect the confidentiality of your health information.
7. Law Enforcement. We may disclose your personal health information for a law enforcement
purpose to law enforcement officials in compliance with and as limited by applicable law.
8. Coroners, Medical Examiners, and Funeral Directors. We may disclose personal health
information to funeral directors in accordance with applicable law.
9. Organ Donation. As allowed by law, we may disclose personal health information to organ
procurement organizations for organ, eye, or tissue donation purposes.
10. Research. We may use or disclose your personal health information without your authorization
for research purposes when such research has been approved by an institutional review board
that has reviewed the research to ensure the privacy of your personal health information, or as
otherwise allowed by law.
11. Limited Government Functions. We may disclose your personal health information to certain
government agencies charged with special government function, as limited by applicable law.
For example, we may disclose your health information to authorized federal officials for the
conducting of national security activities, as required by law.
12. Health and Safety. We may disclose your personal health information to prevent or lessen a
serious threat to any person's or the public's health or safety. In all cases, disclosures will only
be made in accordance with applicable law.
13. Workers' Compensation. We may disclose your personal health information to judicial or
administrative proceeding in response to orders, subpoenas, and other valid legal process.
Privacy Officer:
Melissa Huebner
575 E. University Parkway
Suite H-155
Orem, UT 84097
(801)225-3920
insighteyecare@gmail.com
