EFFECTIVE APRIL 14, 2003
FAMILY FOCUS EYE CARE
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.
Family Focus Eye Care values you as a customer, and protection of your privacy is very important to us.
In conducting our business, we will create and maintain records that contain protected health
information about you and the health care provided to you as a member of our health plans.
“Protected health information” or “PHI” is information about you, including information about
where you live, that can reasonably be used to identify you and that relates to your past, present
or future physical or mental health or condition, the provision of health care to you or the
payment for that care.
We protect your privacy by:
• limiting who may see your PHI;
• limiting how we may use or disclose your PHI;
• informing you of our legal duties with respect to your PHI;
• explaining our privacy policies; and
• adhering to the policies currently in effect.
This Notice describes our privacy practices, which include how we may use, disclose, collect,
handle, and protect our members’ protected health information. We are required by certain
federal and state laws to maintain the privacy of your protected health information. We also are
required by the federal Health Insurance Portability and Accountability Act (or “HIPAA”)
Privacy Rule to give you this Notice about our privacy practices, our legal duties, and your rights
concerning your protected health information.
This Notice takes effect on April 14, 2003, and will remain in effect until we replace or modify
Copies of this Notice
You may request a copy of our notice at any time. If you want more information about our
privacy practices, or have questions or concerns, please contact us by calling the
contact information at the end of this Notice.
Changes to this Notice
The terms of this Notice apply to all records that are created or retained by us which contain your
PHI. We reserve the right to revise or amend the terms of this Notice. A revised or amended
Notice will be effective for all of the PHI that we already have about you, as well as for any PHI
we may create or receive in the future. We are required by law to comply with whatever Privacy
Notice is currently in effect. You will be notified of any material change to our Privacy Notice
before the change becomes effective. When necessary, a revised Notice will be mailed to the
address that we have on record for the contract holder of your member contract, and will also be
posted on our web site at www.Family Focus Eye Care.com.
Potential Impact of State Law
The HIPAA Privacy Rule generally does not “preempt” (or take precedence over) state privacy
or other applicable laws that provide individuals greater privacy protections. As a result, to the
extent state law applies, the privacy laws of a particular state, or other federal laws, rather than
the HIPAA Privacy Rule, might impose a privacy standard under which we will be required to
operate. For example, where such laws have been enacted, we will follow more stringent state
privacy laws that relate to uses and disclosures of the protected health information concerning
HIV or AIDS, mental health, substance abuse/chemical dependency, genetic testing,
reproductive rights, etc.
How We May Use and Disclose Your Protected Health Information (PHI)
In order to administer our health benefit programs effectively, we will collect, use and disclose
PHI for certain of our activities, including payment of covered services and health care
The following categories describe the different ways in which we may use and disclose your
PHI. Please note that every permitted use or disclosure of your PHI is not listed below. However,
the different ways we will, or might, use or disclose your PHI do fall within one of the permitted
categories described below.
Payment: We may use and disclose your PHI for all payment activities including, but not
limited to, collecting premiums or to determine or fulfill our responsibility to provide health care
coverage under our health plans. This may include coordinating benefits with other health care
programs or insurance carriers, such as Medicare or Medicaid. For example, we may use and
disclose your PHI to pay claims for services provided to you by doctors or hospitals which are
covered by your health plan(s), or to determine if requested services are covered under your
Health Care Operations: We may use and disclose your PHI to conduct and support our
business and management activities as a health insurance issuer. For example, we may use and
disclose your PHI to determine our premiums for your health plan, to conduct quality assessment
and improvement activities, to conduct business planning activities, to conduct fraud detection
programs, to conduct or arrange for medical review, or to engage in care coordination of health
We may also use and disclose your PHI to provide you with reminders to obtain preventive
health services, and to inform you of treatment alternatives and/or health related benefits and
services that may be of interest to you.
Marketing: We may use your PHI to make a marketing communication to you that is in the
form of (a) a face-to-face communication, or (b) a promotional gift of nominal value.
Release of Information to Plan Sponsors: Plan sponsors are employers or other organizations
that sponsor a group health plan. We may disclose PHI to the plan sponsor of your group health
plan as follows:
• We may disclose “summary health information” to your plan sponsor to use to obtain
premium bids for providing health insurance coverage or to modify, amend or
terminate its group health plan. “Summary health information” is information that
summarizes claims history, claims expenses, or types of claims experience for the
individuals who participate in the plan sponsor’s group health plan;
• We may disclose PHI to your plan sponsor to verify enrollment/disenrollment in your
group health plan;
• We may disclose your PHI to the plan sponsor of your group health plan so that the
plan sponsor can administer the group health plan; and
• If you are enrolled in a group health plan, your plan sponsor may have met certain
requirements of the HIPAA Privacy Rule that will permit us to disclose PHI to the
plan sponsor. Sometimes the plan sponsor of a group health plan is the employer. In
those circumstances, we may disclose PHI to your employer. You should talk to your
employer to find out how this information will be used.
Research: We may use or disclose your PHI for research purposes if certain conditions are met.
Before we disclose your PHI for research purposes without your written permission, an
Institutional Review Board (a board responsible under federal law for reviewing and approving
research involving human subjects) or Privacy Board reviews the research proposal to ensure
that the privacy of your PHI is protected, and to approve the research.
Required by Law: We may disclose your PHI when required to do so by applicable law. For
example, the law requires us to disclose your PHI:
• When required by the Secretary of the U.S. Department of Health and Human
Services to investigate our compliance efforts; and
• To health oversight agencies, to allow them to conduct audits and investigations of
the health care system, to determine eligibility for government programs, to
determine compliance with government program standards, and for certain civil rights
Public Health Activities: We may disclose your PHI to public health agencies for public health
activities that are permitted or required by law, such as to:
• prevent or control disease, injury or disability;
• maintain vital records, such as births and deaths;
• report child abuse and neglect;
• notify a person about potential exposure to a communicable disease;
• notify a person about a potential risk for spreading or contracting a disease or
• report reactions to drugs or problems with products or devices;
• notify individuals if a product or device they may be using has been recalled; and
• notify appropriate government agency(ies) and authority(ies) about the potential
abuse or neglect of an adult patient, including domestic violence.
Health Oversight Activities: We may disclose your PHI to a health oversight agency for
activities authorized by law, such as: audits; investigations; inspections; licensure or disciplinary
actions; or civil, administrative, or criminal proceedings or actions. Health Oversight agencies
seeking this information include government agencies that oversee: (i) the health care system;
(ii) government benefit programs; (iii) other government regulatory programs; and (iv)
compliance with civil rights laws.
Lawsuits and Other Legal Disputes: We may disclose your PHI in response to a court or
administrative order, subpoena, discovery request, or other lawful process once we have met all
administrative requirements of the HIPAA Privacy Rule.
Law Enforcement: We may disclose your PHI to law enforcement officials under certain
conditions. For example, we may disclose PHI:
• to permit identification and location of witnesses, victims, and fugitives;
• in response to a search warrant or court order;
• as necessary to report a crime on our premises;
• to report a death that we believe may be the result of criminal conduct; or
• in an emergency, to report a crime.
Coroners, Medical Examiners, or Funeral Directors: We may release PHI to a coroner or
medical examiner. This may be necessary, for example, to identify a deceased person or to
determine the cause of death. We also may disclose, as authorized by law, information to funeral
directors so that they may carry out their duties.
Organ and Tissue Donation: We may use or disclose your PHI to organizations that handle
organ and tissue donation and distribution, banking, or transplantation.
To Prevent a Serious Threat to Health or Safety: As permitted by law, we may disclose your
PHI if we believe that the disclosure is necessary to prevent or lessen a serious and imminent
threat to the health or safety of a person or the public.
Military and National Security: We may disclose to military authorities the PHI of Armed
Forces personnel under certain circumstances. We may disclose to authorized federal officials
PHI required for lawful intelligence, counter-intelligence, and other national security activities.
Inmates: If you are a prison inmate, we may disclose your PHI to the prison or to a law
enforcement official for: (1) the prison to provide health care to you; (2) your health and safety,
and the health and safety of others; or (3) the safety and security of the prison.
Workers’ Compensation: As part of your workers’ compensation claim, we may have to
disclose your PHI to a worker’s compensation carrier.
To You: When you ask us to, we will disclose to you your PHI that is in a “designated record
set.” Generally, a designated record set contains medical, enrollment, claims and billing records
we may have about you, as well as other records that we use to make decisions about your health
care benefits. You can request the PHI from your designated record set as described in the
section below called “Your Privacy Rights Concerning Your Protected Health Information.”
To Your Personal Representative: If you tell us to, we will disclose your PHI to someone who
is qualified to act as your personal representative according to any relevant state laws. In order
for us to disclose your PHI to your personal representative, you must send us a completed
Family Focus Eye Care Personal Representative Designation Form or documentation that supports the
person’s qualification according to state law (such as a power of attorney or guardianship). To
request the Family Focus Eye Care Personal Representative Designation Form, please contact Member
Services at the telephone number listed on the back of your Member Identification card, print the
form from our web site at www.Family Focus Eye Care.com, or write us at the address at the end of this
Notice. However, the HIPAA Privacy Rule permits us to choose not to treat that person as your
personal representative when we have a reasonable belief that: (i) you have been, or may be,
subjected to domestic violence, abuse or neglect by the person; (ii) treating the person as your
personal representative could endanger you; or (iii) in our professional judgment, it is not in your
best interest to treat the person as your personal representative.
To Family and Friends: Unless you object, we may disclose your PHI to a friend or family
member who has been identified as being involved in your health care. We also may disclose
your PHI to an entity assisting in a disaster relief effort so that your family can be notified about
your condition, status, and location. If you are not present or able to agree to these disclosures of
your PHI, then we may, using our professional judgment, determine whether the disclosure is in
your best interest.
Parents as Personal Representatives of Minors: In most cases, we may disclose your minor
child’s PHI to you. However, we may be required to deny a parent’s access to a minor’s PHI
according to applicable state law.
Right to Provide an Authorization for Other Uses and Disclosures
• Other uses and disclosures of your PHI that are not described above will be made
only with your written authorization.
• You may give us written authorization permitting us to use your PHI or disclose it to
anyone for any purpose.
• We will obtain your written authorization for uses and disclosures of your PHI that
are not identified by this Notice, or are not otherwise permitted by applicable law.
Any authorization that you provide to us regarding the use and disclosure of your PHI may be
revoked by you in writing at any time. After you revoke your authorization, we will no longer
use or disclose your PHI for the reasons described in the authorization. Of course, we are unable
to take back any disclosures that we have already made with your authorization. We may also be
required to disclose PHI as necessary for purposes of payment for services received by you prior
to the date when you revoke your authorization.
Your authorization must be in writing and contain certain elements to be considered a valid
authorization. For your convenience, you may use our approved Family Focus Eye Care Authorization
Form. To request the Family Focus Eye Care Authorization Form, please contact Member Services 503-585-6700.
Your Privacy Rights Concerning Your Protected Health Information (PHI)
You have the following rights regarding the PHI that we maintain about you. Requests to
exercise your rights as listed below must be in writing. For your convenience, you may use our
approved Family Focus Eye Care form(s).
Right to Access Your PHI: You have the right to inspect or get copies of your PHI contained in
a designated record set. Generally, a “designated record set” contains medical, enrollment,
claims and billing records we may have about you, as well as other records that we may use to
make decisions about your health care benefits. However, you may not inspect or copy
psychotherapy notes or certain other information that may be contained in a designated record
You may request that we provide copies of your PHI in a format other than photocopies. We will
use the format you request unless we cannot practicably do so. We may charge a reasonable fee
for copies of PHI (based on our costs), for postage, and for a custom summary or explanation of
PHI. You will receive notification of any fee(s) to be charged before we release your PHI, and
you will have the opportunity to modify your request in order to avoid and/or reduce the fee. In
certain situations we may deny your request for access to your PHI. If we do, we will tell you our
reasons in writing, and explain your right to have the denial reviewed.
Right to Amend Your PHI: You have the right to request that we amend your PHI if you
believe there is a mistake in your PHI, or that important information is missing. Approved
amendments made to your PHI will also be sent to those who need to know, including (where
appropriate) Family Focus Eye Care’s vendors (known as “Business Associates”). We may also deny your
request if, for instance, we did not create the information you want amended. If we deny your
request to amend your PHI, we will tell you our reasons in writing, and explain your right to file
a written statement of disagreement.
Right to an Accounting of Certain Disclosures: You may request, in writing, that we tell you
when we have disclosed your PHI (an “Accounting”). Any
accounting of disclosures will not include those we made:
• for payment, or health care operations;
• to you or individuals involved in your care;
• with your authorization;
• for national security purposes;
• to correctional institution personnel; or
• before April 14, 2003.
The first accounting in any 12-month period is without charge. We may charge you a reasonable
fee (based on our cost) for each subsequent accounting request within a 12-month period. If a
subsequent request is received, we will notify you of any fee to be charged, and we will give you
an opportunity to withdraw or modify your request in order to avoid or reduce the fee.
Right to Request Restrictions: You have the right to request, in writing, that we place
additional restrictions on our use or disclosure of your PHI. We are not required to agree to your
request. However, if we do agree, we will be bound by our agreement except when required by
law, in emergencies, or when information is necessary to treat you. An approved restriction
continues until you revoke it in writing, or until we tell you that we are terminating our
agreement to a restriction.
Right to Request Confidential Communications: You have the right to request, in writing, that
we use alternate means or an alternative location to communicate with you in confidence about
your PHI. For instance, you may ask that we contact you by mail, rather than by telephone, or at
work, rather than at home. Your written request must clearly state that the disclosure of all
or part of your PHI at your current address or method of contact we have on record could be an
endangerment to you. We will require that you provide a reasonable alternate address or other
method of contact for the confidential communications. In assessing reasonableness, we will
consider our ability to continue to receive payment and conduct health care operations
effectively, and the subscriber’s right to payment information. We may exclude certain
communications that are commonly provided to all members from confidential communications.
Examples of such communications include benefit booklets and newsletters.
Right to a Paper Copy of This Notice: You have the right to receive a paper copy of our Notice
of Privacy Practices. You can request a copy at any time, even if you have agreed to receive this
Notice electronically. To request a paper copy of this Notice, please contact Member Services
Your Right to File a Privacy Complaint
If you believe your privacy rights have been violated, or if you are dissatisfied with
Family Focus Eye Care’s privacy practices or procedures, you may file a complaint with the Family Focus Eye Care
Privacy Office and with the Secretary of the U.S. Department of Health and Human Services.
You will not be penalized for filing a complaint.
To file a privacy complaint with us, you may contact Member Services at:
Family Focus Eye Care
Attention: Travis Taylor OD
3400 State St. Ste G770
Salem OR 97301
 If you are enrolled in a self-insured group benefit program, this Notice is not applicable. If you
are enrolled in such a program, you should contact your Group Benefit Manager for information
about your group’s privacy practices.
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