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Notice of Privacy Practices

Effective Date: July 1, 2022

Notice of Privacy Practices

WE PROTECT YOUR RIGHTS:

This notice describes in detail how our clinic, the Vision and Conceptual Development Center LLC (VCDC) will use medical information about our patients – be that you or your dependent – including how it may be disclosed and how you can access it. Please make sure to review this document carefully and ask our staff any questions or concerns you may have.

Our Promise to You

The VCDC is committed to protecting your protected health information, including what is generated at our clinic as well as what we receive from 3rd parties with whom we coordinate your care. Be assured that we respect your rights as outlined in the Health Insurance Portability and Accountability Act (HIPAA) and Maryland state privacy laws. Under these regulations, we:

  • Ensure full protection of your medical information by following all the outlined terms in this notice

  • Provide you resources and information to understand your rights and how we use your information

Who Abides by this Notice?

All doctors of optometry, vision therapists, licensed medical personnel, interns, trainees, students, administrative staff, and volunteers employed, contracted, or otherwise associated with the VCDC.

Medical Information Disclosure

Next, we will cover examples of how we may use and disclose your medical information. Please note that this list is not exhaustive.

 

There are two main categories of information generated by our clinic: (i) medical diagnosis and treatment notes, and (ii) financial statements.

  • Medical Diagnosis and Treatment

We may use or disclose medical information about you to provide you with medical treatment or services. Thus, the VCDC may share medical information about you with other internal personnel or 3rd party health care providers, agencies, or facilities that you authorize us for in order to provide or coordinate the different things you need, such as lens prescriptions, lab work, or MRI scans.

 

  • Financial Statements

We may use and disclose medical information about you so that the treatment and services you receive at the VCDC may be billed to you and payment collected from you, an insurance company or another third party. For example, at your request, we may need to give information to your health insurance company about medical services you received at the VCDC so your health insurance company will pay us or reimburse you directly.

We may use your medical information as part of our normal healthcare operations. This means that we may communicate internally about your patient records for administrative expediency, educational purposes, training, or performance improvement.

With your consent, we may share your medical information with other medical providers or authorized parties. For each entity, you will need to complete and sign a “Medical Records Release Authorization Form”. It has a validity span of one year and may be revoked by you at any time.

Marketing and Public Relations

Our patient management system defaults to opt you in for our appointment reminders and marketing email list that occasionally mails information about our clinic activities or other optometric news. You are free, at any point, to decline or unsubscribe from this list.

Additionally, we may contact you to provide information about your treatment and experience with the VCDC – such as in the form of testimonials or case studies – to support the VCDC’s public image, engage in research opportunities, enhance education materials, or provide better patient care at the VCDC.

For this purpose, we will supply you with a “Testimonial and/or PR Authorization Form” that may allow the VCDC to use your contact information, such as your name, age, address, the dates on which you received treatment at the VCDC, your treating physician’s and/or therapist’s name, your treatment outcome, and your image.

If we do contact you for public relations purposes, the communication you receive will have instructions on how you may ask for us not to contact you again for such purposes, also known as an “opt-out.”

Clinical Research

The VCDC reserves the right to conduct clinical research. All research projects conducted by the VCDC must be approved through a special review process to protect patient safety, welfare, and confidentiality. You will be thoroughly informed of your rights as a research subject and undergo a procedure before enrolling in any research studies conducted by the VCDC.

We may use and disclose medical information about our patients for research purposes under specific rules determined by the confidentiality provisions of applicable law. These studies will not affect your treatment or welfare, and your medical information will continue to be protected.

Additional Disclosures

Additional uses and disclosures of your medical information. We may use or disclose your medical information without your authorization or permission to the following entities, or for other purposes permitted or required by law, including:

  • As required by state and federal law

  • In the event of a disaster, to organizations assisting in a disaster- relief efforts so that your family can be notified

  • To prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person

  • To authorized federal officials for intelligence, counterintelligence, or other national security activities

  • When required by law, to the military if you are a member of the armed forces

  • For workers’ compensation or other similar programs providing benefits for work-related injuries or illnesses

  • To authorized federal officials so they may conduct special investigations or provide protection to the U.S. President or other authorized persons

  • To governmental, licensing, auditing, and accrediting agencies

  • To a correctional institution as authorized or required by law if you are an inmate or under the custody of law enforcement officials

  • To third parties referred to as “business associates” that provide services on our behalf, such as billing, software maintenance and legal services

  • Unless you say no, to anyone involved in your care or payment for your care, such as a friend, family member, or any individual you identify

  • For public health purposes

  • To courts and attorneys when we get a court order, subpoena or other lawful instructions from those courts or public bodies or to defend ourselves against a lawsuit brought against us

  • To law enforcement officials as authorized or required by law

Other Uses of Your Medical Information

The VCDC will disclose your medical information only with your explicit, written authorization in situations of use not covered by this privacy notice.

If you provide us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. Uses and disclosures made before your withdrawal are not subject to the revocation.

 

-- IMPORTANT NOTICE --
Unsecured Communication Channels

If you choose to communicate with the VCDC via unsecured electronic communication, such as email or text message, we may respond to you via the same communication channel we received.

Providing the VCDC your email address or cell phone number implies that we may send you emails, or text messages related to appointment reminders, surveys, or other general informational communications. The VCDC may send these messages to you unencrypted.

 

Be aware of the following risks of using unsecured electronic communications:

  • Misaddressed messages

  • Shared accounts

  • Forwarded messages to 3rd parties

  • Insecurely stored messages

 

By choosing to correspond with the VCDC via unsecured electronic communication, you are acknowledging and agreeing to accept these risks.

Never use email communications in a medical emergency.

 

 

Requesting Your Medical Records

The medical records generated at the VCDC are property of the VCDC. Nevertheless, you have various rights over your medical information, as detailed below:

 

  • Right to inspect and copy.

You have the right to inspect and/or receive a copy of your medical, billing records, or any other records that are used by us within your medical file to make decisions about you.

You have the right to request that we send a copy of your medical or billing records to a third party.To do so, you must complete a records release authorization and inform us of your request, preferably in writing.

Should your records be requested by a third party you have authorized, such as a law office, may charge a reasonable fee for providing a copy of your records.

We may deny access, under certain circumstances. You may request that we designate a licensed health care professional to review the denial. We will comply with the outcome of the review.

  • Right to request an amendment.

If you believe the medical information we have about you is incorrect or incomplete, you may ask us to amend the information.

You have the right to request that we make an amendment for as long as the information is kept by the VCDC.

 

You are required to submit your request in writing to the VCDC Privacy Officer as explained at the end of this Notice, with an explanation as to why the amendment is needed

.

If we accept your request, we will tell you we agree and we will amend your records. We cannot change what is in the record. We add the supplemental information by an addendum. With your assistance, we will notify others who have the incorrect or incomplete medical information.

If we deny your request, we will give you a written explanation of why we did not make the amendment and explain your rights.

We may deny your request if the medical information:

  • was not created by the VCDC (unless the person or entity that created the medical information is no longer available to respond to your request);

  • is not part of the medical and billing records kept by or for the VCDC;

  • is not part of the information which you would be permitted to inspect and copy;

  • is determined by us to be accurate and complete.

 

Note that the VCDC is free to destroy medical records from patients that have not been treated at our clinic in seven years. In the case of minors, this date is extended to seven years from the date of their eighteenth birthday.

 

Questions or Complaints

If you believe that your privacy rights have not been followed as directed by applicable law or as explained in this Notice, you may file a complaint with us. Please send any complaint to the VCDC Privacy Officer as detailed below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

If you have questions or would like further information about this Notice, please contact:

 

Vision and Conceptual Development Center Patient Privacy Officer

6900 Wisconsin Avenue, Suite 600
Chevy Chase, MD, 20815


Phone: 301-951-0320  Fax: 301-951-0370
E-mail: hipaa@visiontherapydc.com

 

 

Non-Discrimination Notice

The VCDC complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, religion, age, disability, sex, sexual orientation, or gender.

If you need language assistance, our staff will attempt to accommodate your needs or request an interpreter.

Acknowledgement of Receipt, Reading, and Understanding

To ensure that you have received, read, and understood the entirety of this form, we request that you initial each section within this document and sign it. If you would like to request an exception to signing this form, please let the front desk administrator know and we will document the date and time for your refusal.

If you need any assistance in understanding these materials, please contact our administrative staff and they will be happy to assist you.

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