Effective Date: 09.23.2013
Revision Date: 01.29.2016
We understand that medical information about you is personal and we are committed to protecting it. We are required by law to maintain the privacy of your health information, to follow the terms of this Notice, and to provide you with this Notice of our legal duties and privacy practices with respect to your health information. We are required to follow the terms of the Notice that is currently in effect.How We May Use or Disclose Your Health Information:
You Have the Following Rights with Respect to Your Health Information.
Changes to this Notice of Privacy Practices
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our store locations. If we change our Notice, you may obtain a copy of the revised Notice by visiting our website at http://www.aclens.com/, or upon request at any of our store locations.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact the Privacy Officer at (614) 921-1131. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services, Office of Civil Rights, HIPAA, 200 Independence Avenue, S.W., Washington, DC 20201. To file a complaint with us, please contact: Privacy Officer, AC Lens, 4265 Diplomacy Dr, Columbus, OH 43228. All complaints must be submitted in writing. Forms also are available on-line at http://www.aclens.com/ and can be submitted by E-mail to: firstname.lastname@example.org or by phone to (614) 921-1131. There will be no retaliation for filing a complaint.