Martin G. Ellis OD - Privacy Notice

Privacy Notice

I UNDERSTAND THAT, UNDER THE HEALTH INSURANCE PORTABLILITY & ACCOUNTABILITY ACT OF 1996 (HIPPA), I HAVE CERTAIN RIGHTS TO PRIVACY REGARDING MY PROTECTED HEALTH INFORMATION, I UNDERSTAND THAT THIS INFORMATION CAN AND WILL BE USED TO:

CONDUCT, PLAN AND DIRECT MY TREATMENT AND FOLLOW-UP
AMONG THE MULIPLE HEALTHCARE PROVIDERS WHO MAY BE
INVOLVED IN THAT TREATMENT DIRECTLY AND INDIRECTLY
OBTAIN PAYMENT FROM THIRD-PARTY PAYERS
*CONDUCT NORMAL HEALTHCARE OPERATIONS SUCH AS QUALITY
ASSESSMENTS AND PHYSICIAN CERTIFICATION.

I UNDERSTAND THAT I MAY REQUEST IN WRITING THAT YOU
RESTRICT HOW MY PRIVATE INFORMATION IS USED OR DISCLOSED TO CARRY OUT TREATMENT, PAYMENT OR HEALTH CARE OPERATIONS. I ALSO UNDERSTAND YOU ARE NOT REQUIRED TO AGREE TO MY REQUESTED RESTRICTIONS BUT IT YOU DO AGREE THEN YOU ARE BOUND TO ABIDE BY SUCH RESTRICTIONS.

		Martin G. Ellis OD
	Home Locations Our Practice Our Services Eye Care Articles	Privacy Notice I UNDERSTAND THAT, UNDER THE HEALTH INSURANCE PORTABLILITY & ACCOUNTABILITY ACT OF 1996 (HIPPA), I HAVE CERTAIN RIGHTS TO PRIVACY REGARDING MY PROTECTED HEALTH INFORMATION, I UNDERSTAND THAT THIS INFORMATION CAN AND WILL BE USED TO: CONDUCT, PLAN AND DIRECT MY TREATMENT AND FOLLOW-UP AMONG THE MULIPLE HEALTHCARE PROVIDERS WHO MAY BE INVOLVED IN THAT TREATMENT DIRECTLY AND INDIRECTLY OBTAIN PAYMENT FROM THIRD-PARTY PAYERS *CONDUCT NORMAL HEALTHCARE OPERATIONS SUCH AS QUALITY ASSESSMENTS AND PHYSICIAN CERTIFICATION. I UNDERSTAND THAT I MAY REQUEST IN WRITING THAT YOU RESTRICT HOW MY PRIVATE INFORMATION IS USED OR DISCLOSED TO CARRY OUT TREATMENT, PAYMENT OR HEALTH CARE OPERATIONS. I ALSO UNDERSTAND YOU ARE NOT REQUIRED TO AGREE TO MY REQUESTED RESTRICTIONS BUT IT YOU DO AGREE THEN YOU ARE BOUND TO ABIDE BY SUCH RESTRICTIONS.