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HIPAA PRIVACY FORM

  • HIPAA PRIVACY NOTICE

    Our practice is dedicated to maintaining the privacy of your individually protected health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. Your PHI may be used for your medical treatment and may be used in the Healthcare Operations of our business. An example of this may be filing a claim to your insurance company.

    You have many rights under HIPAA and our complete policy explains those rights in detail. Examples of those rights include the following. You have the right to restrict certain uses of your PHI. You have the right to inspect and copy your PHI. You have the right to receive an accounting of disclosures of PHI. Our practice has posted a complete copy of our current HIPAA Privacy Notice, and you may request a copy of our most current notice at any time.

    I have read and understand this modified version of Family EyeCare Clinic’s HIPAA notice. I am aware and agree with the complete copy of this notice that is posted. I am also aware that a complete version of this notice is available upon my request.

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Dr Figler has enjoyed the many years of seeing patients at Family EyeCare Clinic and Kane and Figler Optometry and appreciated their confidence in his skills. The growth of his own practice in Slavic Village requires more of his attention located at 7211 Broadway Ave Cleveland, OH or call 216-641-0055 or visit his website broadwayoptical.net. We wish him the best of luck from the Family EyeCare Clinic.

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