Privacy Notice

This notice describes how medical information about you may be used and disclosed, how to obtain this information, and your notice of rights to access your health records. Please review it carefully. 

Medical information may be used for:

  1. Your treatment – For example, your physician may forward a copy of your medical record to another physician who will be involved in your care.
  2. For payment – For example, an insurance clerk at Northwest Eye may send a copy of your medical record to your insurance company in order to process payment.
  3. For healthcare operations – For example, a supervisor may review copies of your medical record for the purposes of staff training in documentation or chart audit for billing compliance. Your protected health information may be used to support the business activities of our organization.

Northwest Eye is permitted or required, under specific circumstances, to use or disclose protected health information without the individual’s written authorization. Other uses and disclosures will be made only with the individual’s written authorization, and the individual may revoke such authorization. We may contact you to provide appointment reminders or information about treatment alternatives, or other health-related benefits and services that may be of interest to you.

  • You have the right to request restrictions on certain uses and disclosures of your protected health information, as provided by Privacy Regulations and our policy on restricting uses and disclosures. Northwest Eye is not required to agree to a requested restriction.
  • You have the right to receive confidential communications of protected health information, as provided by the Privacy Regulations and our policy on confidential communications, as applicable.
  • You have the right to inspect and receive a copy of your protected health information;
  • You have the right to amend your protected health information;
  • You have the right to receive an accounting of disclosures of protected health information; and
  • The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.

We will maintain the privacy of protected health information and provide you with notice of our legal duties, your rights to your health records, and our privacy practices concerning protected health information. We are required to abide by the terms of the Notice currently in effect. We reserve the right to change the terms of this Notice and to make the new notice provisions effective for all protected health information that we maintain. The revised notice will be available on our web site and at each of your visits.

Northwest Eye Clinic will not use the patient database for the purpose of marketing or fund raising. You may file a complaint with Northwest Eye or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. To file a complaint with us, please contact our Privacy Officer. You will not be retaliated against for filing a complaint. Your can reach the Privacy Officer at 763-416-7600 or contact our Administration.