Revision Date September 23, 2013





II.      This Notice is provided to you pursuant to the Health Insurance Portability and Accessibility Act of 1996 (“HIPAA”).  It is designed to tell you how we may, under federal law, use or disclose your health Information.  “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services’ are required to abide by the terms of this Notice of Privacy Practices.  We may change the terms of our notice, at any time.  The new notice will be effective for all protected health information that we maintain at that time.  Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our website at, calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.


III.          How we may use and disclose your protected health information.  We use and disclose health information for many different reasons.  For some of these uses or disclosures, we need your specific authorization.  Below, we describe the different categories of our uses and disclosures and give you some examples of each category.


A.            We May Use or Disclose Your Health Information for Purposes of Treatment, Payment or Healthcare Operations [with/without] a Consent and Here is One Example of Each:

Treatment.  We will use your protected health information to provide, coordinate, or manage your health care and any related services.  Your health information may be used by our physicians and staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. 

Payment.  Your health information may be used to seek payment from your health plan, other sources of coverage such as automobile insurer, or credit card companies that you may use to pay for services. 

Healthcare Operations.  Your health information may be used as necessary to support the day-to-day activities and management of The Eye Care Center.  For example, information on the services you received may be used to support budgeting and financial reporting and activities to evaluate and promote quality to insure that our practice is meeting state and federal guidelines and laws designated to protect your health care information. 


B.                   We May Use or Disclose Your Health Information Under the Following Circumstances without Obtaining Your Prior Consent or Authorization:


For Treatment, Payment or Healthcare Operations.  See above.

When a disclosure is required by federal, state, or local law, judicial or administrative proceedings, or law enforcement.

To provide it to you.

For Public Health Purposes.  We may use or disclose your Health Information to provide information to state or federal public health authorities, as required by law to prevent or control disease, injury or disability; to report child abuse or neglect; report domestic violence; report to the Food and Drug Administration problems with products and reactions to medications; and report disease or infection exposure.

For Health Oversight Activities.  We may use or disclose your Health Information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.

To Law Enforcement Personnel.  We may use or disclose your Health Information to a law enforcement official to identify or locate a suspect, fugitive, material witness or missing person, comply with a court order or subpoena and other law enforcement purposes.

To Coroners or Funeral Directors.  We may use or disclose your Health Information for purposes of communicating with coroners, medical examiners and funeral directors.

For Purposes of Organ Donation.  We may use or disclose your Health Information for purposes of communicating to organizations involved in procuring, banking or transplanting organs and tissues.

In Order to Conduct Research.  We may use or disclose your Health Information in order to conduct research that has been approved by our Institutional Review Board.

For Public Safety.  We my use or disclose your Health Information in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

To Aid Specialized Government Functions.  If necessary, we may use or disclose your Health Information for military or national security purposes. 

For Worker’s Compensation.  We may use or disclose your Health Information necessary to comply with worker’s compensation laws.

Appointment Reminders and Health-Related Benefits or Services.  We may use PHI to provide appointment reminders or give you information about treatment alternatives or other health care services or benefits we offer.

Change of Ownership.  In the event that our practice is sold or merged with another organization, your Health Information/record will become property of the new owner.

To Correctional Institutions or Law Enforcement Officials, if You are in Inmate.


C.            Uses and Disclosures Require You to Have the Opportunity to Object.


To Notify and/or Communicate with your Family.  Unless you object, we may use or disclose your PHI in order to notify your family or assist in notifying your family, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death.  If you are unable or unavailable to agree or object, our health professionals will use their best judgment in any communications with your family and others.

Emergencies.  We may use or disclose your PHI in an emergency treatment situation.  If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. 

Third Party Business Associates.  We will share your PHI with third party business associates that perform various activities (e.g. billing, transcription services) for the practice.  Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your PHI.

Communication Barriers.  We may use and disclose your PHI if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines that you intend to consent to use or disclosure under the circumstances.


D.            For All Other Circumstances, We May Only Use or Disclose Your Health Information After You have Signed an Authorization.  If you authorize us to use or disclose your Health Information for another purpose, you may revoke your authorization in writing at any time.   If you are an emancipated minor, we must receive specific written authorization to release PHI to another person, including your parent or guardian, unless otherwise permitted by law.

Your Rights
You have the right to request restrictions on the uses and disclosures of your Health Information, such as:

For treatment, payment and health care operations,

To individuals involved in your care or payment related to your care, or

To notify or assist individuals locate you or obtain information about your condition.

However, although we will carefully consider all requests for additional restrictions on how we will use or disclose your PHI, we are not required to grant your request unless Your request relates solely to disclosure of your PHI to a health plan or other payor for the sole purpose of payment or health care operations for a health care item or service that you have paid us for in full and out of pocket. Requests for restrictions must be in writing.  If we accept your request for a restriction, we will put any limits in writing and abide by them except in emergency situations.  Under certain circumstances, we may terminate our agreement to a restriction.

·            You have the right to receive your Health Information through confidential means through a reasonable alternative means or at an alternative location.

·            You have the right to inspect and copy your Health Information.  We may charge you a reasonable cost-based fee to cover copying, postage and/or preparation of a summary.

·            You have a right to request that we amend your Health Information that is incorrect or incomplete.  We are not required to change your health information if we believe he information is accurate and complete and will provide you with information about our denial and how you can disagree with the denial. We maintain the information you have asked us to change but we did not create or author it, for example, your medical records from another doctor; the information is not part of the designated record set or otherwise unavailable for inspection.

·            Requests for amendments must be in writing.  We generally respond to your request within thirty (30) days from receipt.

·            You have a right to receive an accounting of disclosures of your Health Information made by us, except that we do not have to account for disclosures made for treatment, payment, health care operations, information provided to you, notification and communication with family, certain government functions, appointment reminders and fund raising as described in section III of this Notice of Privacy Practices.

·         You have a right to a paper copy of this Notice of Privacy Practices.  If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer.

·         You have the right to request PHI access report maintained in an electronic format within three year period.  The first access report you request within a period of twelve (12) months is free.  Any subsequent requested access records report may result in a reasonable charge.

You have the right to know if there has been a breach of your PHI. We take seriously the confidentiality of your information, so we will notify you in the event a breach occurs involving or potentially involving your unsecured PHI and what steps you may need to take to protect yourself.


V.  Complaints.  If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with us or the Secretary of Health and Human Services.  You may file a complaint with us by notifying our privacy officer at 973-743-1331 of your complaint.  We will not retaliate against you for filing a complaint.


VI. Electronic Notice

This Notice of Privacy Practices is also available on our web page at


VII. This notice was published and becomes effective on Revision Date September 23, 2013

Contact Us.We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form.