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.
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), AC Lens must take steps to protect the privacy of your "protected health information" (PHI). PHI includes information that we have created or received regarding your health or payment for your health. It includes both your medical records and personal information such as your name, social security number, address, and other identifying information. AC Lens is required to maintain the privacy of your PHI, to follow the terms of this Notice, and to provide you with access to this Notice of our legal duties and privacy practices with respect to your PHI. Additional copies of this Notice may be obtained online at http://www.aclens.com/npp.asp. To request a paper copy of this Notice, call 1-888-248-5367.
How AC Lens May Use or Disclose Your PHIWe protect the privacy of your health information. For some activities, we must have your written authorization to use or disclose your PHI. However, the law permits AC Lens to use or disclose your health information for the following purposes without your authorization:
When AC Lens May Not Use or Disclose Your PHIExcept as described in this Notice or as permitted by law, we will obtain your written authorization before using or disclosing PHI about you. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.
You Have the Following Rights With Respect to Your Health Information
Changes to this Notice of Privacy PracticesAC Lens reserves the right to change this Notice at any time. We reserve the right to apply the revised Notice to all PHI we already maintain, as well as any information we receive in the future. If we change any of the practices described in this Notice, we will post the revised Notice at http://www.aclens.com/.
For More Information or to Report a ProblemThis Notice describes how we will treat your personal health information pursuant to the requirements of the Federal HIPAA privacy rules. State privacy laws may impose certain additional requirements. For a more complete description of state privacy issues, please go to the Notice posted athttp://www.aclens.com/npp.asp If you have questions or would like additional information about our privacy practices, you may contact the Privacy Office by emailing email@example.com, by phone at (614) 921-1131 or by writing to: Privacy Office, AC Lens, 4265 Diplomacy Dr, Columbus, OH 43228 If you believe your privacy rights have been violated, you can file a complaint with AC Lens's Privacy Office or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint and AC Lens will maintain information in a manner consistent with company policies.