Phone: 630-553-5400
Fax: 630-553-5405
Email: yorkvilleeye@gmail.com
Our Address:
38 W. Countryside Pkwy
Yorkville, Il 60560
Get Directions
Mon & Tues: 9am-5pm
Wed & Thurs: 9am-6pm
Fri: 9am-4pm
Sat: 9am-12pm
We encourage you to contact us if you have any questions or would like more information.
Friend Us On Facebook! |
(If a copy is desired please request one from us)
Yorkville Eye Professionals
38W. Countryside Pkwy
Yorkville, Il 60560
Website: www.yorkvilleeyeprofessionals.com
Phone: 630-553-5400 Fax : 630-553-5405
Email: yorkvilleeye@gmail.com
Contact person: Office Manager or Dr. Ali or Dr. Khan
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 respect our legal obligation to keep health information that identifies your privacy. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your health information and what rights you have regarding it.
TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples include: for treatment purposes, setting up an appointment, testing or examining your eyes, prescribing glasses, contact lenses or eye medications and faxing or electronically sending them to be filled, referring you to another doctor or clinic for further eye care testing or treatment or getting or sending copies of your health information to another professional that you may have seen before us. Examples of how we use or disclose you 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). "Health care operations" means those administrative and managerial functions that we have to do in order to run our office. 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.
We routinely use your health information inside our office for these purposes without any special permission. We will also require scanning of your driver's license and any insurance cards for verification and identify fraud. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose you health information without your permission. Not all of these situationswill apply to us; some may never come up at our office at all. Such uses or disclosures are:
• When a state or federal law mandates that certain health information be reported for a specific purpose;
• For public health purpose, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices;
• Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
• Uses and disclosures for health oversight activities, such as for licensing of doctors; for audits by medicare or Medicaid; or for investigation of possible violations of health care laws;
• Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies; disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be victim of a crime; to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;
• Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
• Uses or disclosures for health related research;
• Uses and disclosures to prevent a serious threat to health or safety;
• Uses or disclosure for specialized government functions, such as for the protection of the president or high-ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluatin and health of members of the foreign service;
• Disclosures of de-identified information;
• Disclosures relating to worker's compensation programs; disclosures of a "limited data set" for research, public health or health care operations; incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
• Disclosures to "business associate" who perform health care operations for us and who commit to respect the privacy of your health information.
Unless you object, we will also share relevant information about your care with your family or caretaker who are helping with your eye or health care, helping to select glasses, contacts or are helping the medical prescription or other eye related tasks.
APPOINTMENT REMINDERS
We may call, write, email to remind you of scheduled appointments, or that it is time to make an appointment. We may also call, write or email to notify you of other treatments or services available at our office that might help you. Unless you tell us, otherwise we will mail or email you an appointment reminder and/or leave a reminder message on your home answering machine or with someone who answers your phone if you are not home.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your health information unless you sign a written "authorization form". Federal law determines the content of an "authorization form". Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it's your idea for us to send your information to someone else. Typically, in this situation will give us a properly completed authorization form, or you can use one of ours.
If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use of disclosure. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person or the doctor(s).
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives youmany rights regarding your health information. You can:
• Ask us to restrict our uses and disclosures for purpose of treatment(except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to the office address at the beginning of this Notice.
• Ask us to communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing requests if they are reasonable and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the office contact person shown at the beginning of this notice.
• Ask to see or get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. But for the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us. You may have to pay for photocopies in advance. If we deny your request, we will send you a written explanation and instructions about how to get an impartial review of our denial if one is legally available.
• Ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days form when you ask us. We will send the corrected information to persons who we know got the wrong information and others that you specify. If we do not agree, you can write a statement of your position and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law, we can have one 30 day extension of time to consider a request for amendment if we notify you in writing of the extension. If you want to ask us to amend your health information, send a written request including your reasons for the amendment, to the contact person at the beginning of this notice.
• Get additional copies of this Notice upon request. It does not matter whether you got one electronically or in paper form already. If you want additional paper copies please download it from our website or ask an associate.
OUR NOTICE OF PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Practices until we choose to change it. We reserve the right to change this notice at any time 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 the Notice of Privacy Practices, we will post the new notice in our office, have copies available and post it on our web.
COMPLAINTS
If you think that we have not properly respected the privacy of your health information please contact the office manager or doctors with your complaint. We will do everything in our power to address the issue and make changes to policies to protect your privacy. If you feel we have not addressed the issue you can complain to the US Dept. of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint.