LaserPro Eye and Skin Laser Medical Center
Dr Steven Ma MD
Dr. Hannah Vu MD
Dr. Linda Vu MD

To our patients This notice describes how health information about you may be used and disclosed and how you can get access to your health information. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Please review this notice carefully.
Our commitment to your privacy Our practice is dedicated to protecting the confidentiality, integrity and security of your personal medical information, in accordance with legal requirements. We realize that these laws are complicated but we must provide you with notice of our legal duties and privacy practices.

Use and disclosure of your health information in certain special circumstances The following circumstances may require us to use or disclose your health information:

1. Treatment.
We may use information about you to provide you with quality medical treatment and services. We may share your medical information with a facility such as a hospital, laboratory, pharmacy, diagnostic service, or other healthcare provider to efficiently coordinate your treatment plan.

2. Payment.
Your medical information may be used for claims management and to obtain payment from you, your insurance carrier, or a third party. We will exchange data with you, your insurance carrier, or a responsible third party to determine eligibility for benefits and to secure payment for services rendered. We may also disclose to your insurance carrier about treatment or procedures you will to receive to obtain prior approval or to determine benefit coverage.

3. Health Care Operations.
We may use and disclose your medical information for health care operations, necessary to run the organization in an effort to continually improve the quality and effectiveness of the care we provide. We may use your information, or combine it with other patients’ information, to review our treatments and services, and to evaluate our physicians and staff. Operations include services provided by business associates (BAs), i.e., transcription and information systems maintenance. BAs may be given medical information in order to do their job. We require these outside entities and BAs to appropriately safeguard your information.

4. Appointment reminders.
We may use and disclose medical information in order to contact you to remind you of appointments or follow-up at one of our facilities. We may leave reminder messages for you at your home, either on your answering machine or with a family member. We may also mail postcards, or send email, to you confirming that you have an appointment or need follow-up.

5. Treatment Alternatives and Health Related Products.
We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives, health related products or services offered by LaserPro Eye and Skin Laser Medical Center, or send you educational materials.

6. Communication with Friends and Family.
We may disclose your relevant medical information to a close personal friend, a family member who is involved in your care, to someone who helps pay for your care, or to any person you identify. We may use or disclose your relevant medical information to notify your friends or family members of your location, your general condition, or in the event of your death. If you do not want us to use or disclose your medical information for these purposes, you may object by notifying us in writing. If you are unavailable or unable to object due to incapacity or emergency, our staff will use their professional judgment and common practice to determine relevant medical information to disclose in your best interest.

7. To Avert a Serious Threat to Health or Safety and for Public Health Purposes.
We may disclose your medical information to appropriate agencies to prevent serious threat to your health and safety, or the health and safety of the public or other person. As required by law, we may disclose your medical information to public health authorities for purposes related to: a. Preventing or controlling disease, injury or disability b. Reporting child, elder, or dependent adult abuse or neglect c. Reporting domestic violence d. Reporting problems with products and reactions to medications e. Reporting disease and infection exposure f. Reporting deaths.

8. Deceased Person Medical Information.
In the event of your death, we may disclose your medical information to coroners, medical examiners and funeral directors as necessary to carry out their duties.

9. If required, to do so by law enforcement officials.
We may disclose your medical information to a law enforcement official for the following reasons: a. In response to a court order, subpoena, search warrant or summons b. To identify or locate a suspect, fugitive, material witness, or missing person c. About a death we believe to be the result of criminal conduct d. About criminal conduct at our facilities.

10. If you are a member of U.S. or foreign military (including veterans), if required by the appropriate authorities.

11. To federal officials for intelligence and national security activities authorized by law.

12. To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.

13. For Workers Compensation and similar programs.

14. Health Oversight Activities.
We may disclose your medical information for activities authorized by law. These oversight activities include audits, investigations, inspections and physician licensure .The activities are necessary for the government to monitor the health care system, government programs, and compliance with laws.

Other Uses of Medical Information Other uses and disclosures of your medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose your medical information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, this will stop any further use or disclosure of your medical information for the purposes that you originally authorized, except if we have already acted in reliance on your authorization.

Your rights regarding your health information

1. You can request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. We will accommodate reasonable requests.

2. You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care of or the payment for your care, such as family members and friends. You must submit this request in writing. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.

3. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to our office and we are authorized by HIPAA to charge for the cost of copying, mailing, or other costs associated with your request.

4. You may ask us to amend your health information if you believe it is incorrect or incomplete, and as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to our office. You must provide us with a reason that supports your request.

5. Right to an Accounting of Disclosures. You have the right to make a written request to us for a list of those instances where we have disclosed medical information about you (an “accounting of disclosures”) other than for treatment, payment, health care operations, or where you specifically authorized a disclosure. You may submit your written request to our Medical Records department. Your request must state a time period desired for the accounting which may not be longer than six years and may not include disclosures dated before April 14, 2003. The first request in a twelve-month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost before you incur any charge.

6. Right to a copy of this notice. You are entitled to receive a copy of this Notice of Privacy Practices. You may ask us to give you a copy of this Notice at any time. To obtain a copy of this notice, contact the Privacy Officer.

7. Right to file a complaint. 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 our practice, contact the Privacy Officer. All complaints must be submitted in writing. Under no circumstances will you be penalized or retaliated against for filing a complaint.

8. Right to provide an authorization for other uses and disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.

Changes to this Notice of Privacy Practices Laser Pro Eye and Skin Laser Medical Center reserves the right to change this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all medical information we maintain, including medical information that was created or received prior to the date of the change. We will provide you with revised notices by posting the current notice in our facilities or by providing copies of the current notice showing the effective date. Laser Pro Eye and Skin Laser Medical Center is required by law to abide by the notice currently in effect.

If you have any questions regarding this notice or our health information privacy policies, do not hesitate to ask.