Notice of Privacy Statement
GoodGlasses.com values your privacy. We have gone
to great lengths to insure that your information remains private. Our
web site prescription fields and shopping cart, including all your
credit card information, is secured by encryption. All of our computers
are equipped with the latest firewall technology.
The information you send will not be sold and we
are 100% HIPPA compliant meeting all government privacy standards. The
information released to us, including your: Name, Address, Telephone
number, Prescription information, Email address, and Credit Card
information, will be held in the strictest confidence.
Your prescription information may be shared with a
supplier in the event that a product will havee to be special ordered.
In addition, our business associates are obligated to protect the
privacy of your information.
In the event that you are involved in a lawsuit or
a dispute, we may disclose your information in response to a court or
administrative order. We may also disclose information in response to a
subpoena, discovery request, warrant, summons or other lawful process.
We may also disclose information to a third party for collections of
outstanding bills or money owed.
If you would like any further information please email firstname.lastname@example.org
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR LEGAL DUTY
We are required by applicable federal and state
law to maintain the privacy of your health information. We are also
required to give you this Notice about our privacy practices, our legal
duties, and your rights concerning your health information. We must
follow the privacy practices that are described in this Notice while it
is in effect. This notice will remain in effect until we replace it.
We reserve the right to change our privacy
practices and the terms of this Notice at any time, provided such
changes are permitted by applicable law. We reserve the right to make
the changes in our privacy practices and the new terms of our Notice
effective for all health information that we maintain, including health
information we created or received before we made the changes. This notice was in effect since April 14, 2003. In the event we make a material change in our privacy practices, we will change this Notice and provide it to you.
You may request a copy of our Notice at any time.
For more information about our privacy practices, or for additional
copies of this Notice, please contact us using the information listed
at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and healthcare operations. For example:
Treatment: We may use or disclose
your health information to an optician, ophthalmologist or other
healthcare provider providing treatment to you for: a) the provision,
coordination, or management of health care and related services by
health care providers; (b) consultation between health care providers
relating to a patient; (c) the referral of a patient for health care
from one health care provider to another; or (d) recall information.
Payment: We may use and disclose
your health information to obtain payment for services we provide to
you. This may include: (a) billing and collection activities and
related data processing; (b) actions by a health plan or insurer to
obtain premiums or to determine or fulfill its responsibilities for
coverage and provision of benefits under its health plan or insurance
agreement, determinations of eligibility or coverage, adjudication or
subrogation of health benefit claims; (c) medical necessity and
appropriateness of care reviews, utilization review activities; and (d)
disclosure to consumer reporting agencies of information relating to
collection of premiums or reimbursement.
Healthcare Operations: We may use
and disclose your health information in connection with our healthcare
operations. Healthcare operations include things such as quality
assessment and improvement activities, reviewing the competence or
qualifications of healthcare professionals, evaluating practitioner and
provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
Your Authorization: In addition to
our use of your health information for treatment, payment or healthcare
operations, you may give us written authorization to use your health
information or to disclose it to anyone for any purpose. If you give us
an authorization, you may revoke it in writing at any time. Your
revocation will not affect any use or disclosures permitted by your
authorization while it was in effect. Unless you give us a written
authorization, we cannot use or disclose your health information for
any reason except those described in this Notice.
Marketing Health Products or Services:
We will not use your health information for marketing communications
without your prior written authorization. We may provide you with
information regarding products or services that we offer related to
your health care needs. We will never sell your health information
without your prior authorization.
To You, Your Family and Friends: We must disclose
your health information to you, as described in the Patient Rights
section of this Notice. We may disclose your health information to a
family member, friend or other person to the extent necessary to help
with your healthcare or with payment for your healthcare, but only if
you agree that we may do so or, if you are not able to agree, if it is
necessary in our professional judgment.
Persons Involved in Care: We may
use or disclose health information to notify, or assist in the
notification of (including identifying or locating) a family member,
your personal representative or another person responsible for your
care, of your location, your general condition, or death. If you are
present, then prior to use or disclosure of your health information, we
will provide you with an opportunity to object to such uses or
disclosures, in the event of your incapacity or emergency
circumstances, we will disclose health information based on a
determination using our professional judgment disclosing only health
information that is directly relevant to the person’s involvement in
your healthcare. We will also use our professional judgment and our
experience with common practice to make reasonable inferences of your
best interest in allowing a person to pick up filled prescriptions,
medical supplies, x-rays, or other similar forms of health information.
Required by Law:
We may use or disclose your health information when we are required to
do so by law, including judicial and administrative proceedings.
Abuse or Neglect: We may disclose
your health information to appropriate authorities if we reasonably
believe that you are a possible victim of abuse, neglect, or domestic
violence or the possible victim of other crimes. We may disclose your
health information to the extent necessary to avert a serious threat to
your health or safety or the health or safety of others.
National Security: We may disclose
to military authorities the health information of Armed Forces
personnel under certain circumstances. We may disclose to authorized
federal officials health information required for lawful intelligence,
counterintelligence, and other national security activities. We may
disclose to correctional institution or law enforcement official having
lawful custody of protected health information of inmate or patient
under certain circumstances.
Appointment Reminders and Treatment Alternatives:
We may use or disclose your health information to provide you with
appointment reminders (such as voicemail messages, postcards, or
letters) or information about treatment alternatives or other
health-related benefits and services that may be of interest to you.
Access: You have the right to
review or get copies of your health information, with limited
exceptions. You may request that we provide copies in a format other
than photocopies. We will use the format you request unless we cannot
practicably do so. You must make a request in writing to obtain access
to your health information. You may obtain a form to request access by
using the contact information listed at the end of this Notice. We will
charge you a reasonable cost-based fee for expenses such as copies and
staff time. You may also request access by sending us a letter to the
address at the end of this Notice. If you request an alternative
format, we will charge a cost-based fee for providing your health
information in that format. If you prefer, we will prepare a summary or
an explanation of your health information for a fee. Contact us using
the information listed at the end of this Notice for a full explanation
of our fee structure.
Disclosure Accounting: You have
the right to receive a list of instances in which we or our business
associates disclosed your health information for purposes, other than
treatment, payment, healthcare operations, where you have provided an
authorization and certain other activities, for the last 6 years, but
not for disclosure made prior to April 14, 2003.
If you request this accounting more than once in a 12-month period, we
may charge you a reasonable, cost-based fee for responding to these
Restriction: You have the right to
request that we place additional restrictions on our use or disclosure
of your health information. We are not required to agree to these
additional restrictions, but if we do, we will abide by our agreement
(except in an emergency).
Alternative Communication: You
have the right to request in writing that we communicate with you about
your health information by alternative means or to alternative
locations. Your request must specify the alternative means or location,
and provide satisfactory explanation how payments will be handled under
the alternative means or location you request.
Amendment: You have the right to request that we
amend your health information. Your request must be in writing, and it
must explain why the information should be amended. We may deny your
request under certain circumstances.
Electronic Notice: If you receive this Notice on a
Web site or by electronic mail (e-mail), you are entitled to receive
this Notice in written form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us.
If you are concerned that we may have violated
your privacy rights, or you disagree with a decision we made about
access to your health information or in response to a request you made
to amend or restrict the use or disclosure of your health information
or to have us communicate with you by alternative means or at
alternative locations, you may complain to us using the contact
information listed at the end of this Notice. You also may submit a
written complaint to the U.S. Department of Health and Human Services.
We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
We support your right to the privacy of your
health information. We will not retaliate in any way if you choose to
file a complaint with the U.S. Department of Health and Human Services.
Contact Person: Geoffrey Chase
Telephone: 303-532-5707 Fax: 866-800-8809
Address: 5639 Slick Rock CT Boulder, Colorado 80301