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Federal HIPAA Notice

Notice of Privacy Practices

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.

Our Pledge Regarding Health Information

Puget Sound Eye Care ("PSEC") is required by federal law (HIPAA — Health Insurance Portability and Accountability Act of 1996) and state law to maintain the privacy of your protected health information (PHI) and to provide you with this notice describing our legal duties and privacy practices with respect to PHI.

We are required by law to abide by the terms of this notice currently in effect.

How We May Use and Disclose Your Health Information

We may use and disclose your health information for the following purposes without your authorization:

  • Treatment — coordinating eye care with referring optometrists, ophthalmologists, primary care physicians, corneal surgeons.
  • Payment — verifying insurance eligibility, submitting claims, responding to carrier inquiries.
  • Healthcare Operations — quality assurance, staff training, clinical audits, accreditation, licensing.
  • Appointment Reminders + Health Information — reminding you of appointments, providing care instructions, sending recall notices.
  • As Required by Law — federal, state, or local law (mandatory reporting, communicable disease).
  • Public Health Activities — disease control, FDA-mandated reporting, communicable disease tracking.
  • Health Oversight Activities — state licensing boards, federal regulators, CMS auditors.
  • Judicial and Administrative Proceedings — court orders, subpoenas, legal process.
  • Law Enforcement — limited circumstances (mandatory crime reporting, identifying suspects, missing persons).
  • Workers' Compensation — for workers' compensation claims when applicable.
  • Research — only with appropriate authorization or IRB-approved research protocols.

Uses Requiring Your Written Authorization

The following uses or disclosures of your PHI will be made only with your written authorization:

  • Most uses and disclosures of psychotherapy notes (if applicable)
  • Uses and disclosures for marketing purposes (beyond appointment reminders and recall notices)
  • Sale of your PHI

You may revoke an authorization at any time in writing, except to the extent we have already acted in reliance on it.

Your Rights Regarding Your Health Information

You have the following rights:

  • Right to Inspect and Copy — request to inspect or obtain a copy of your medical records.
  • Right to Amend — if you believe information in your medical record is incorrect or incomplete.
  • Right to Accounting of Disclosures — request a list of certain disclosures of your PHI we have made.
  • Right to Request Restrictions — on certain uses or disclosures of your PHI.
  • Right to Request Confidential Communications — communicate with you in a specific way.
  • Right to a Paper Copy of This Notice — request a paper copy at any time.
  • Right to be Notified of a Breach — be notified if your unsecured PHI is breached.

To exercise any of these rights, contact our HIPAA Privacy Officer:

Privacy Officer: Melinda Carlson, Office Manager
Email: privacy@pugetsoundeyecare.com
Phone: (206) 526-5222
Mail: 2501 N 45th Street, Seattle WA 98103

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer (contact above) or with the U.S. Department of Health and Human Services Office for Civil Rights:

  • Phone: 1-800-368-1019
  • Web: hhs.gov/ocr
  • Mail: 200 Independence Avenue, SW, Washington DC 20201

We will not retaliate against you for filing a complaint.

Changes to This Notice

We reserve the right to change this notice. We will post any changes on our website and in our offices. We will also provide a copy of the revised notice to patients upon request.

Acknowledgment

By signing in for any visit at PSEC, you acknowledge receipt of this Notice of Privacy Practices. A written acknowledgment is provided at your first visit and kept in your file.

Last updated 2026-05-25 · This document is subject to attorney review prior to live deployment per Washington state and federal compliance requirements.