Kilmarnock Eyecare: Notice of Privacy Practices

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. If you have any questions, please contact our office. Your health information or PHI, is any information that identifies you and is created, received, maintained or transmitted by us in the course of providing health care services to you.

We are required by law to maintain the privacy of your protected health information, give you this notice of our duties and privacy practices regarding health information about you, and follow the terms of our notice that is currently in effect.

The most common reasons why we use and disclose your health information is for treatment, payment or health care operations. Listed are the ways we may use and disclose health information that identifies you without your authorization:

Treatment. For example, setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses, or eye medications and faxing them to be filled; showing you low vision aids; referring you to another doctor or clinic for eye care or low vision aids or services; or getting copies of your health information from another professional that you may have seen before us.
Payment. We may ask you about your health and vision care plans, or other sources of payment; use and disclose Health Information so that we may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received; and collecting unpaid amounts (either ourselves or through a collection agency or attorney).
Health care operations. We may use and disclose Health Information for health care operation purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, we may use and disclose information to make sure the care you receive is of the highest quality. Subject to the exception above if you pay for your care yourself, we also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operations.

We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we will ask you for special written permission. You may revoke such permission at any time by writing to us and stating that you wish to revoke permission you previously gave us.

In some limited situations, the law allows or requires us to use or disclose your health information without your consent or authorization. Not all of these situations will 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 purposes, such as contagious disease reporting, investigation or surveillance
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 the licensing of doctors
For audits by Medicare or Medicaid or 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 a victim of a crime
To provide information about a crime at our office
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
To funeral directors to aid in burial
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 disclosures 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 evaluation 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 associates” who perform health care operations for us and who commit to respect the privacy of your health information

We may use and disclose Health Information to contact you and to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

We will not, however, send you communications about health-related or non health-related products or services that are subsidized by a third party without your authorization. When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

Your rights regarding your health information:

Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Health Information, you must make your request, in writing, to our office.
Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to our office.
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to our office.
Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to our office. We are not required to agree to all such requests. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communication, you must make your request, in writing, to our office. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice in our office. To obtain a paper copy of this notice please request it in writing.
Right to Electronic Records. You have the right to receive a copy of your electronic health records in electronic form.
Right to Breach Notification. You have the right to be notified if there is a Breach of privacy such that your Health Information is disclosed or used improperly or in an unsecured way.

Changes to this notice:
We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future. Any revision to our privacy practices will be described in a revised notice that will be posted in our facility. Copies of this notice are also available upon request at our front desk.

Complaints:
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. All complaints must be made in writing. You will not be penalized for filing a complaint.

Privacy Contact Officer:

Danielle Hester
Effective: 02/01/2026