LAGUNA HILLS • SAN CLEMENTE
Orange County, California
800-974-EYES (3937)

Notice of Privacy Practices – Effective May 1, 2015

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.

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we’ll tell you why in writing within 60 days.

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 list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year at no charge, but may charge a cost-based fee if you ask for another within 12 months.

Get a copy of this privacy notice

You may ask for a paper copy of this notice at any time. We will provide you with a paper 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 our HIPAA Compliance Officer, 24401 Calle de la Louisa, Suite 300, Laguna Hills, CA 92653. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/

We will not retaliate against you for filing a complaint.

Our Uses and Disclosures

How do we typically use or share your health information?

We may use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Societal Wellbeing

We are allowed and sometimes required to share your information in other ways – usually in ways that contribute to the public good, such as for 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/understanding/consumers/index.html.

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

Do research

We can use or share your information for health research.

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.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when a person dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:
  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official/li>
  • With health oversight agencies for activities authorized by law/li>
  • For special government functions such as military, national security, and presidential protective services/li>

    Respond to lawsuits and legal actions

    We can share health information about you in response to a court or administrative order, or a subpoena.

    Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health 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, by letting us know in writing.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • For more information, visit

    The U.S. Department of Health & Human Services
    Office of Civil Rights
    200 Independence Avenue, S.W.
    Washington, D.C. 20201

    (202) 619-0257
    (877) 696-6775


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    As always, Harvard Eye is first and foremost concerned about what is best for each individual patient. Call us today for your personalized consultation!


    Harvard Eye Associates
    Laguna Hills Office

    Map and Directions
    24401 Calle de la Louisa
    Suites 300-312
    Laguna Hills, California 92653

    949-951-2020
    FAX: 949-356-1660
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    San Clemente Office

    Map and Directions
    665 Camino de los Mares
    Suites 102-103
    San Clemente, California 92673

    949-493-5411
    FAX: 949-356-1660

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