Privacy Notice
This Notice describes how health information about you may be used and disclosed and how you can access this information.
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, out legal duties, and your rights concerning your health information. This Notice takes effect April 1, 2003 and will remain in effect until we replace it. You may request a copy of this Notice at any time. For more information, please contact us at the address listed below.
HOW YOUR HEALTH INFORMATION MAY BE USED:
We use and disclose health information about you for treatment, payment, and healthcare operations.
For Example:
We may use or disclose your health information to a physician or healthcare worker providing treatment to you.
We may use or disclose your health information to obtain payment for services we provide to you.
We may use or disclose your health information to order glasses, contact lenses, or other items you requested.
We may use or disclose your health information in connection with our healthcare operations. This may include quality assessment and improvement activities, reviewing and evaluating provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
We must disclose your healthcare information to you, as described in the Patients Rights section. We may disclose your health information to a family member or friend to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.
We may disclose your health information to appropriate authorities if we reasonably believe you are a possible victim of abuse, neglect, domestic violence, or other crimes. This will be done to the extent necessary to avert a serious threat to the health or safety of you or others.
We may use and disclose health information to notify a family member, or another person responsible for your care, of your location and general condition in an emergency. If possible, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or in an emergency, we will disclose only health information, based on our professional judgment, that is directly relevant to that person's involvement in your healthcare.
We will use our best judgment to allow another person, selected by you, to pick up your glasses, contacts, or prescription.
We will not use your health information for marketing communications without your written authorization.
We may use or disclose your health information when we are required to do so by law.
We may disclose health information of Armed Forces personnel to military authorities under certain circumstances.
We may disclose health information to authorized state or federal officials for lawful intelligence, national security, or law enforcement activities.
We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).
Unless you give us a written authorization, we cannot use or disclose your personal information for any reason except those described in this Notice.
PATIENT RIGHTS:
You have the right to access your health information, with limited exceptions. You may make a request in writing to access your health information by using the contact information at the bottom of this Notice. If you request copies or a written report, we will charge $15 for staff time to locate, copy records or write the report, and any additional expenses such as postage. Additional fees may be added in some circumstances. These fees are subject to change without notice.
You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in emergency).
You have the right to request that we amend your health information. Your request must be in writing, and must explain why the information should be amended. We may deny your request under certain circumstances.
If you received this Notice electronically, you are entitled to receive this Notice in written form.
If you want more information about our privacy policies or have questions or concerns, please contact us. You may also file a written complaint with the U.S. Department of health and Human Services. Address available on request.
We support your right to the privacy of your healthcare information.
Contact Information:
Dr. Daniel Roy
1110 Main St.
Sanford, ME 04073
207-324-6281
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, out legal duties, and your rights concerning your health information. This Notice takes effect April 1, 2003 and will remain in effect until we replace it. You may request a copy of this Notice at any time. For more information, please contact us at the address listed below.
HOW YOUR HEALTH INFORMATION MAY BE USED:
We use and disclose health information about you for treatment, payment, and healthcare operations.
For Example:
We may use or disclose your health information to a physician or healthcare worker providing treatment to you.
We may use or disclose your health information to obtain payment for services we provide to you.
We may use or disclose your health information to order glasses, contact lenses, or other items you requested.
We may use or disclose your health information in connection with our healthcare operations. This may include quality assessment and improvement activities, reviewing and evaluating provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
We must disclose your healthcare information to you, as described in the Patients Rights section. We may disclose your health information to a family member or friend to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.
We may disclose your health information to appropriate authorities if we reasonably believe you are a possible victim of abuse, neglect, domestic violence, or other crimes. This will be done to the extent necessary to avert a serious threat to the health or safety of you or others.
We may use and disclose health information to notify a family member, or another person responsible for your care, of your location and general condition in an emergency. If possible, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or in an emergency, we will disclose only health information, based on our professional judgment, that is directly relevant to that person's involvement in your healthcare.
We will use our best judgment to allow another person, selected by you, to pick up your glasses, contacts, or prescription.
We will not use your health information for marketing communications without your written authorization.
We may use or disclose your health information when we are required to do so by law.
We may disclose health information of Armed Forces personnel to military authorities under certain circumstances.
We may disclose health information to authorized state or federal officials for lawful intelligence, national security, or law enforcement activities.
We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).
Unless you give us a written authorization, we cannot use or disclose your personal information for any reason except those described in this Notice.
PATIENT RIGHTS:
You have the right to access your health information, with limited exceptions. You may make a request in writing to access your health information by using the contact information at the bottom of this Notice. If you request copies or a written report, we will charge $15 for staff time to locate, copy records or write the report, and any additional expenses such as postage. Additional fees may be added in some circumstances. These fees are subject to change without notice.
You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in emergency).
You have the right to request that we amend your health information. Your request must be in writing, and must explain why the information should be amended. We may deny your request under certain circumstances.
If you received this Notice electronically, you are entitled to receive this Notice in written form.
If you want more information about our privacy policies or have questions or concerns, please contact us. You may also file a written complaint with the U.S. Department of health and Human Services. Address available on request.
We support your right to the privacy of your healthcare information.
Contact Information:
Dr. Daniel Roy
1110 Main St.
Sanford, ME 04073
207-324-6281