Privacy Notice
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.
THIS NOTICE IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.
Right to Notice
As a patient, you have the right to adequate notice of the uses and disclosures of your
protected health information. Under the Health Insurance Portability and Accessibility Act
(HIPAA), DR KAWATA] can use your protected health information for treatment,
payment and health care operations.
a) Treatment - We may use or disclose your health information to a physician or other
healthcare provider providing treatment to you.
b) Payment - We may use and disclose your health information to obtain payment for services
we provide you.
c) Health care operations - We may use and disclose your health information in connection
with our healthcare operations. Healthcare operations include quality assessment and
improvement activities, reviewing the competency or qualifications of healthcare
professionals, evaluating provider performance, conducting training programs, accreditation,
certification, licensing or credentialing activities.
Your Authorization
Most uses and disclosures that do not fall under treatment, payment, health care operations
will require your written authorization. Upon signing, you may revoke your authorization (in
writing) through our practice at any time.
Emergency Situations
In the event of your incapacity or an emergency situation, we will disclose health information to
a family member, or another person responsible for your care, using our professional
judgment. We will only disclose health information that is directly relevant to the person's
involvement in your healthcare.
Marketing
We will not use your health information for marketing communications without your written
authorization.
Required by Law
We may also use or disclose your health information when we are required to do so by law.
Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably believe
that you are a possible victim of abuse, neglect, or domestic violence or the victim of other
crimes. We may disclose your health information to the extent necessary to avert a serious
threat to your or other people's health or safety.
National Security
We may disclose the health information of Armed Forces personnel to military authorities
under certain circumstances. We may disclose health information to authorized federal
officials required for lawful intelligence, counterintelligence and other national security
activities. We may disclose health information of inmates or patients to the appropriate
authorities under certain circumstances.
Appointment Reminders
We may use or disclose your health information to provide you with appointment reminders
via phone, e-mail or letter.
Your Rights as a Patient
You have the right to restrict the disclosure of your protected health information (in writing).
The request for restriction may be denied if the information is required for treatment, payment
or health care operations.
-You have the right to receive confidential communications regarding your protected health
information.
-You have the right to inspect and copy your protected health information.
-You have the right to amend your protected health information.
-You have the right to receive an account of disclosures of your protected health information.
-You have the right to a paper copy of this notice of privacy practices.
Legal Requirements
DR KAWATA is required by law to maintain the privacy of your protected health
information. We are required to abide by the terms of this notice as it is currently stated, and
reserve the right to change this notice. The policies in any new notice will not be in effect until
they are posted to this site, or are available within our office.
Complaints
If you have complaints regarding the way your protected health information was handled, you
may submit a complaint in writing to our office. You will not be retaliated against in any manner
for a complaint.
Contact Information
For further information about [Practice Name here]'s privacy policies, please contact DR KAWATA at the following address or phone number:
ERIC J. KAWATA O.D., INC.
101 E. LINCOLN AVE # 103
ANAHEIM, CA 92805
714-535-7515
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
THIS NOTICE IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.
Right to Notice
As a patient, you have the right to adequate notice of the uses and disclosures of your
protected health information. Under the Health Insurance Portability and Accessibility Act
(HIPAA), DR KAWATA] can use your protected health information for treatment,
payment and health care operations.
a) Treatment - We may use or disclose your health information to a physician or other
healthcare provider providing treatment to you.
b) Payment - We may use and disclose your health information to obtain payment for services
we provide you.
c) Health care operations - We may use and disclose your health information in connection
with our healthcare operations. Healthcare operations include quality assessment and
improvement activities, reviewing the competency or qualifications of healthcare
professionals, evaluating provider performance, conducting training programs, accreditation,
certification, licensing or credentialing activities.
Your Authorization
Most uses and disclosures that do not fall under treatment, payment, health care operations
will require your written authorization. Upon signing, you may revoke your authorization (in
writing) through our practice at any time.
Emergency Situations
In the event of your incapacity or an emergency situation, we will disclose health information to
a family member, or another person responsible for your care, using our professional
judgment. We will only disclose health information that is directly relevant to the person's
involvement in your healthcare.
Marketing
We will not use your health information for marketing communications without your written
authorization.
Required by Law
We may also use or disclose your health information when we are required to do so by law.
Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably believe
that you are a possible victim of abuse, neglect, or domestic violence or the victim of other
crimes. We may disclose your health information to the extent necessary to avert a serious
threat to your or other people's health or safety.
National Security
We may disclose the health information of Armed Forces personnel to military authorities
under certain circumstances. We may disclose health information to authorized federal
officials required for lawful intelligence, counterintelligence and other national security
activities. We may disclose health information of inmates or patients to the appropriate
authorities under certain circumstances.
Appointment Reminders
We may use or disclose your health information to provide you with appointment reminders
via phone, e-mail or letter.
Your Rights as a Patient
You have the right to restrict the disclosure of your protected health information (in writing).
The request for restriction may be denied if the information is required for treatment, payment
or health care operations.
-You have the right to receive confidential communications regarding your protected health
information.
-You have the right to inspect and copy your protected health information.
-You have the right to amend your protected health information.
-You have the right to receive an account of disclosures of your protected health information.
-You have the right to a paper copy of this notice of privacy practices.
Legal Requirements
DR KAWATA is required by law to maintain the privacy of your protected health
information. We are required to abide by the terms of this notice as it is currently stated, and
reserve the right to change this notice. The policies in any new notice will not be in effect until
they are posted to this site, or are available within our office.
Complaints
If you have complaints regarding the way your protected health information was handled, you
may submit a complaint in writing to our office. You will not be retaliated against in any manner
for a complaint.
Contact Information
For further information about [Practice Name here]'s privacy policies, please contact DR KAWATA at the following address or phone number:
ERIC J. KAWATA O.D., INC.
101 E. LINCOLN AVE # 103
ANAHEIM, CA 92805
714-535-7515