Main Optical 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.
When it comes to your Health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. You can ask us how to do this.
- We will provide a copy or a summary of your health information. We may charge a reasonable, cost-based fee for providing you the information.
Request Confidential Communications
- You can ask us to contact you in a specific way [for example, home or office phone] or to send mail to a different address.
- We will say yes to all reasonable requests
Ask Us To Limit What We Use or Share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get A Copy of This Privacy Notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a copy promptly.
Choose Someone to Act for You
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File A Complaint If You Feel Your Rights Are Violated
- You can complain if you feel we have violated your rights by contacting us at 937-773-8023.
- You can file a complaint with the U.S. Dept of Health and Human Services Office for Civil Rights by sending a letter to
200 Independence Avenue, S.W., Washington, D.C. 20201 or
Calling 1-877-696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints
- We will not retaliate against you for filing a complaint
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Include your information in a hospital directory
If you are unable to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your health information when needed to lessen a serious and imminent threat to your health or safety.
Other Uses and Disclosures/ How Do We Typically Use or Share Your Health Information
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
Example: A Doctor treating you for an injury asks another Doctor about your overall health condition
Run Our Organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill For Your Services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How Else Can We Use or Share Your Health Information?
We are allowed or required to share your information in other ways-usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the Law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy.hipaa/...
Help With Public Health and Safety Issues
We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
Comply With the Law
We will share information about you if State or Federal Laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with Federal Privacy Law
Address Workers’ Compensation, Law Enforcement, and other Government Requests
We can use or share health information about you:
- For worker’s compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond To Lawsuits and Legal Actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena
- We are required by law to maintain the privacy and security of your protected health information
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information
- We must follow the duties and privacy practices described in this notice and give you a copy of it
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind
This Main Optical Notice of Privacy Practices describes how we will protect your health information and describes what your rights are. This Privacy Practices describes how Main Optical will protect your Health information but is not intended to be all inclusive of all guidelines that pertain to all businesses. Health information transmitted to this Website by you may be transmitted from this Website to our business.
For more information see: