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EyeWish Optometry
7075 Redwood Boulevard Suite F
Novato, CA 94945-4101


Office Hours
Monday - Friday 9am-6pm
Saturday 10am-4pm
Sunday closed


Contact us
Phone 1-415-897-2997
Fax 1-415-898-3626

Notice of Privacy Practice


Lora Pond Inc.and Tania Mantua
7075 Redwood Blvd., Ste. F, Novato CA 94945 
415-897-2997 eyewishopt.com
Shana Martinez, Privacy Official
Effective Date: 03/06/2020

We respect our legal obligation to keep health information that might identify you private. We are obligated by law to provide you with notice of our privacy practices and abide by the policies in it. This notice describes how we protect your health information and what rights you have regarding it.

Treatment, Payment, and Health Care Operations 

The most common reasons we would use or disclose your health information is for treatment, payment, or business operations. We routinely use and disclose your medical information within the office on a daily basis. We do not need specific permission to use or disclose your medical information in the following matters, although you have the right to request that we do not.

 

Examples of how we might use or disclose health information for treatment purposes might include:

Examples of how we might use or disclose health information for payment purposes might include:

Examples of how we might use or disclose health information for business operations might include:

Uses and Disclosures for Other Reasons Not Needing Permission

In some other limited situations, the law allows us to use or disclose your medical information without your specific permission. Most of these situations will never apply to you but they could.

Uses or Disclosures To Patient Representatives

It is the policy of Lora Pond Inc.and Tania Mantua for our staff to take phone calls from individuals on a patients behalf requesting information about making or changing an appointment; the status of eyeglasses, contact lenses, or other optical goods ordered by or for the patient. Lora Pond Inc.and Tania Mantua staff will also assist individuals on a patient's behalf in the delivery of eyeglasses, contact lenses, or other optical goods. During a telephone or in person contact, every effort will be made to limit the encounter to only the specifics needed to complete the transaction required. No information about the patient's vision or health status may be disclosed without proper patient consent. Lora Pond Inc.and Tania Mantua staff and doctors will also infer that if you allow another person in an examination room, treatment room, dispensary, or any business area within the office with you while testing is performed or discussions held about your vision or health care or your account that you consent to the presence of that individual.

Other Uses and Disclosures

We will not make any other uses or disclosures of your health information or uses and disclosures involving marketing unless you sign a written Authorization for Release of Identifying Health Information. The content of this authorization is determined by applicable state and federal law. The request for signing an authorization may be initiated by Lora Pond Inc.and Tania Mantua or by you as the patient. We will comply with your request if it is applicable to the federal policies regarding authorizations. If we ask you to sign an authorization, you may decline to do so. If you do not sign the authorization, we may not use or disclose the information we intended to use. If you do elect to sign the authorization, you may revoke it at any time. Revocation requests must be made in writing to the Privacy Officer named at the beginning of this Notice.

Your Rights Regarding Your Health Information

The law gives you many rights regarding your personal health information.

Breach Notification Policy

In the event of a reportable breach of patient information, Lora Pond Inc.and Tania Mantua agrees to abide by the breach notification requirements as established by the HIPAA Breach Notification Rule or specific State requirement. If a breach occurs, Lora Pond Inc.and Tania Mantua will take all necessary steps to remain in compliance with this rule including as applicable notification of individuals, Business Associates, the Secretary of Health and Human Services and prominent media outlets.

Whistleblower Protection Rule 

Lora Pond Inc.and Tania Mantua will take no action against any individual who provides information to the Office of Civil Rights, Office of the Inspector General or individual state Attorney General's Office regarding concerns related to the privacy and security procedures or actions at Lora Pond Inc.and Tania Mantua.

Changing Our Notice of Privacy Practices

By law, we must abide by the terms of this Notice of Privacy Practices until we choose to substantially change the Notice. We reserve the right to change this Notice at any time. If we change this Notice, the new privacy practices will apply to your existing health information as well as any additional information generated in the future. If we change this Notice, we will post a new Notice in our office and on our website.

Complaints

If you think that anyone at Lora Pond Inc.and Tania Mantua has not respected the privacy of your health information, we encourage you to discuss your concerns with to the Privacy Officer named at the beginning of this Notice. We request you submit your concerns in writing. We are more than happy to try to resolve any concern you may have. We want to resolve your concerns but you may also file a complaint with the U.S. Department of Health and Human Services, Office of Civil Rights or the state Attorney General's Office. We will not retaliate against you if you make such a complaint. 

Questions

If you have any questions or concerns we encourage you to contact the Privacy Officer at the number on this notice.