Effective Date: October 1, 2020
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.
Your medical information is personal. Barnet Dulaney Perkins Eye Center (“BDP”) and its employees are dedicated to maintaining the privacy of your personal health information (“PHI”), as required by applicable federal and state laws. These laws require us to provide you with this Notice of Privacy Practices and to inform you of your rights and our obligations concerning PHI, which is information that identifies you and that relates to your physical or mental health condition. We are required to follow the privacy practices described below while this Notice is in effect.
Permitted Disclosures of PHI. We may disclose your PHI for the following reasons:
Disclosures Requiring Written Authorization.
Changes to this Notice. We reserve the right to change this Notice at any time in accordance with applicable law. Prior to a substantial change to this Notice related to the uses or disclosures of your PHI, your rights or our duties, we will revise and distribute this Notice. The new notice will be available upon request, in our office, and on our website.
Acknowledgment of Receipt of Notice. We will ask you to sign an acknowledgment that you received this Notice.
Questions and Complaints. If you would like 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 regarding the use, disclosure, or access to you PHI, you may complain to us by contacting the Privacy Officer at the address and phone number 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 toile such a complaint upon request.
We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. Please direct any of your questions or complaint:
Questions / Concerns:
HIPAA Privacy Officer: Janice Miers, COA
63 S Rockford Drive, Ste. 220, Tempe, AZ 85281
Compliance Line: 602-508-4837
Barnet Dulaney Perkins Eye Center will in no way penalize you for filing a complaint.
Barnet Dulaney Perkins Eye Center does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy, contact our compliance officer, (602) 508-4837 / Arizona State Relay.
The doctors of Barnet Dulaney Perkins Eye Center may also be owners of Barnet Dulaney Perkins Eye Center.