Privacy Notice
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION FROM US. A COMPLETE COPY OF THIS INFORMATION IS AVAILABLE FROM OUR OFFICE. EXAMPLES OF HOW WE MIGHT HAVE TO USE YOUR INFORMATION: 1. TO ANOTHER HEALTH CARE PROVIDER IF NECESSARY TO REFER YOU TO THEM FOR CARE 2. YOUR TREATMENT AND BILLING RECORDS TO YOUR INSURANCE OR EMPLOYER FOR PAYMENT OF YOUR SERVICES 3. FOR USE IN OUR OFFICE FOR QUALITY ASSURANCE 4. TO CONTACT YOU FOR APPOINTMENTS, GREETINGS, THANK YOU'S, OR INFORMATION ABOUT YOUR GLASSES/CONTACTS. A MESSAGE WILL BE LEFT IF YOU ARE NOT AVAILABLE.
YOU HAVE THE RIGHT TO REFUSE TO GIVE US THIS AUTHORIZATION. YOU WILL BE ASKED TO SIGN A CONSENT WHEN YOU COME TO OUR OFFICE FOR CARE. YOU HAVE THE RIGHT TO REQUEST INFORMATION OF ANYTIME WE RELEASE INFORMATION, THOUGH WE WILL ALWAYS ASK YOU FOR CONSENT FIRST. IF WE SHOULD CHANGE TERMS OF OUR NOTICE, WE WILL CONTACT YOU IN WRITING, MAIL, OR WHEN YOU COME NEXT FOR TREATMENT.
PLEASE LET US KNOW IF THERE IS AN ENTITY TO WHOM YOUR INFORMATION SHOULD NOT BE RELEASED. WE WILL PROTECT YOUR PRIVACY IN ALL WAYS TO THE VERY, VERY BEST OF OUR ABILITY. THE ONLY TIME YOUR INFORMATION CAN BE USED BY OUR OFFICE WITHOUT CONSENT IS IN THE CASE OF EMERGENCY, IF WE PROVIDE SERVICES TO YOU AS AN INMATE, OR REQUIRED BY LAW. YOU MAY REVOKE YOUR AUTHORIZATION AT ANY TIME BY CONTACTING US AT SPIVEY EYE CLINIC 45 HOSPITAL DRIVE MCKENZIE TN 38201.
PLEASE FEEL FREE TO ASK US ANY QUESTIONS BY EMAIL, PHONE, OR IN PERSON!! WE KEEP FULL COPIES OF OUR HIPAA COMPLIANCE POLICY FOR YOU AT THE FRONT DESK AND IN OUR RECEPTION AREA.
YOU HAVE THE RIGHT TO REFUSE TO GIVE US THIS AUTHORIZATION. YOU WILL BE ASKED TO SIGN A CONSENT WHEN YOU COME TO OUR OFFICE FOR CARE. YOU HAVE THE RIGHT TO REQUEST INFORMATION OF ANYTIME WE RELEASE INFORMATION, THOUGH WE WILL ALWAYS ASK YOU FOR CONSENT FIRST. IF WE SHOULD CHANGE TERMS OF OUR NOTICE, WE WILL CONTACT YOU IN WRITING, MAIL, OR WHEN YOU COME NEXT FOR TREATMENT.
PLEASE LET US KNOW IF THERE IS AN ENTITY TO WHOM YOUR INFORMATION SHOULD NOT BE RELEASED. WE WILL PROTECT YOUR PRIVACY IN ALL WAYS TO THE VERY, VERY BEST OF OUR ABILITY. THE ONLY TIME YOUR INFORMATION CAN BE USED BY OUR OFFICE WITHOUT CONSENT IS IN THE CASE OF EMERGENCY, IF WE PROVIDE SERVICES TO YOU AS AN INMATE, OR REQUIRED BY LAW. YOU MAY REVOKE YOUR AUTHORIZATION AT ANY TIME BY CONTACTING US AT SPIVEY EYE CLINIC 45 HOSPITAL DRIVE MCKENZIE TN 38201.
PLEASE FEEL FREE TO ASK US ANY QUESTIONS BY EMAIL, PHONE, OR IN PERSON!! WE KEEP FULL COPIES OF OUR HIPAA COMPLIANCE POLICY FOR YOU AT THE FRONT DESK AND IN OUR RECEPTION AREA.