NOTICE OF PRIVACY POLICIES
Family Eyecare of Roswell
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Introduction At Family Eyecare of Roswell, we are committed to treating and using protected health information about
you responsibly.
This Notice of Health Information Practices describes the personal information we collect, and how and when we use or
disclose that information. It also describes your rights as they relate to your protected health information. This Notice is
effective Immediately and applies to all protected health information as defined by federal regulations.
Understanding Your Health Record Each time you are visited by Family Eyecare of Roswell., a record of your visit is
made. Typically, this record contains a summary of the service or equipment we provided for you. This information,
often referred to as your health record, serves as a:
• Basis for planning your care and treatment,
• Means of communication among the many health professionals who contribute to your care, • Legal document
describing the care you received,
• Means by which you or a third-party payer can verify that services billed were actually provided,
• A tool in educating heath professionals,
• A source of information for public health officials charged with improving the health of this state and the nation,
• A source of data for our planning,
• A tool with which we can assess and continually work to improve the care we render Understanding what is in your
record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when,
where, and why others may access your health information, and make more informed decisions when authorizing
disclosure to others Your Health Information Rights
Although your health record is the physical property of Family Eyecare of Roswell., the information belongs to you. You
have the right to:
• Obtain a paper copy of this notice of information practices upon request,
• Inspect and copy your health record
• Amend your health record
• Obtain an accounting of disclosures of your health information
• Request communications of your health information by alternative means or at alternative locations,
• Request a restriction on certain uses and disclosures of your information
• Revoke your authorization to use or disclose health information except to the extent that action has already been
taken.
Our Responsibilities Family Eyecare of Roswell is required to:
• Maintain the privacy of your health information,
• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and
maintain about you,
• Abide by the terms of this notice,
• Notify you if we are unable to agree to a requested restriction, and
• Accommodate reasonable requests you may have to communicate health information by alternative means or at
alternative locations. We reserve the right to change our practices and to make the new provisions effective for all
protected health information we maintain.
Should our information practices change, we will post a revised notice in our office. We will not use or disclose your
health information without your authorization, except as described in this notice. We will also cease to use or disclose
your health information after we have received a written revocation of the authorization according to the procedures
included in the authorization.
For More Information or to Report a Problem If have questions and would like additional information, you may contact
our Privacy Officer, Dr. Maurice E Zadeh 770-992-6789
Examples of Disclosures for Treatment, Payment and Health Operations We will use your health information for
treatment. For example: Information obtained by the nurse or other member of your health care team will be recorded in
your record and used to determine the course of treatment that should work best for you.
We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include
information that identifies you, as well as your diagnosis, procedures, and supplies used. We will use your health
information for regular health operations.
For example: Members of the staff, the risk or quality improvement manager, or members of the quality improvement
team may use information in your health record to assess the care and outcomes in your case and others like it. This
information will then be used in an effort to continually improve the quality and effectiveness of the service we provide.
Business associates:
There are some services provided in our organization through contacts with business associates such as a billing
service. When these services are contracted, we may disclose your health information to our business associate so
that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered.
To protect your health information, however, we require the business associate to appropriately safeguard your
information. Notification:
We may use or disclose information to notify or assist in notifying a family member, personal representative, or another
person responsible for your care. Communication with family: Health professionals, using their best judgment, may
disclose to a family member, other relative, close personal friend or any other person you identify, health information
relevant to that person’s involvement in your care or payment related to your care.
Research: We may disclose information to researchers when their research has been approved by an institutional
review board that has reviewed the research proposal and established protocols to ensure the privacy of your health
information.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with
respect to food, supplements, product and product defects, or post marketing surveillance information to enable
product recalls, repairs, or replacement. Workers compensation:
We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating
to workers compensation or other similar programs established by law.
Public health: As required by law, we may disclose your health information to public health or legal authorities charged
with preventing or controlling disease, injury, or disability.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response
to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health
oversight agency, public health authority or attorney, provided that a work force member or business associate
believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical
standards and are potentially endangering one or more patients, workers or the public.
Family Eyecare of Roswell is not responsible for, the content of the sites which you can access
from www.familyeyecareofroswell.com Additionally, the Site expressly disclaims any and all liability for
third party links or resources on the Site and any claims of negligence arising from same. Family Eyecare of Roswell
provides links for educational purposes.