Effective: October 12, 2016
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.
At Notal Vision, we understand that information about you and your health is personal. Because of this, we strive to maintain the confidentiality of your health information. We continuously seek to safeguard that information through administrative, physical and technical means, and otherwise abide by applicable federal and state laws and requirements on the use or disclosure of your health information and your rights with respect to your information.
When you are a ForeseeHome Subscriber, we may use or disclose your health information for certain purposes without your written authorization, including treatment, payment, and health care operations.
Treatment. We keep a record of the health information you provide us, either directly or through our ForeseeHome remote monitoring device. We may use or disclose your information for purposes of treating you. For example, we may use your information to monitor your vision and identify certain changes in it, or to call you if you are not using the ForeseeHome monitoring device often enough. We may disclose such information to your health care provider so that he/she can treat your vision condition. We may also use or disclose your information to provide information about treatment alternatives or other health care products or services we may offer.
Payment. We document the health care services and products we provide to you. We may use or disclose your information to obtain payment for such health care services and products. For example, we may disclose information to your insurance company or other payor to receive prior approval or payment for treatment.
Health Care Operations. We may use or disclose your information for certain activities that are necessary to operate our business, to improve the services we provide, for business planning and management, and for customer service. For example, we may use your health information to review and improve the ForeseeHome AMD monitoring device and our diagnostic services and to evaluate the performance of our staff.
Other Uses or Disclosures. We may also use or disclose your health information for certain other purposes, including:
To comply with federal, state or local laws, such as disclosure or reporting of abuse, neglect, or certain other events.
For public health activities such as reporting certain diseases or tracking medical devices.
For health oversight activities such as audits, licensure actions, or fraud investigations.
To respond to certain law enforcement requests, or to respond to court orders, warrants, subpoenas or other process in judicial or administrative proceedings.
To coroners, medical examiners, funeral directors, or organ procurement organizations, as necessary for them to fulfill their duties.
For research purposes, if certain requirements are met, to balance privacy and research needs.
To avert a serious threat to your health or safety or the health and safety of others.
For certain specialized government functions such as national security, military, intelligence, protective services, or correctional institutions.
For workers’ compensation purposes, as allowed by such laws.
Unless you object, or instruct us otherwise, we may also disclose your personal or health information to a member of your family, friend, or other person who is involved in your health care or payment for that care. We will limit the disclosure to information relevant to that person’s involvement in your care or payment.
All other uses and disclosures, not described in this Notice, may only be done with your written authorization. For example, we will obtain your authorization before we use or disclose your health information for marketing purposes or before we would sell your information. You may revoke your authorization at any time by submitting a written notice to the Privacy Officer, identified below. However, this will not affect prior uses and disclosures made in reliance on
In some cases, state law may require that we apply extra protections to some of your health information.
Notal Vision is required by law to:
Maintain the privacy of your health information.
Notify you of our legal duties and privacy practices with respect to your health information.
Notify affected individuals following a breach of unsecured health information.
Abide by the terms of our Notice currently in effect.
We reserve the right to change our privacy practices, and make the new practices and Notice effective for all the health information we maintain. Revised notices will be posted on our website. You can also obtain a copy of the current Notice from our Privacy Officer, our web site or by placing a request through our contact center.
You have certain rights concerning your health information. The law entitles you to:
All requests should be submitted in writing to our Privacy Officer, identified below
If you believe that your privacy rights have been violated, you may file a complaint with us or with the Office for Civil Rights, of the U.S. Department of Health and Human Services. We will not retaliate or penalize you for filing a complaint.
To file a complaint with us, contact our Privacy Officer, identified below, or call the Confidential Reporting line at 1-855-691-8600.
This Notice describes the privacy practices of Notal Vision, any affiliates, employees, and other members of its workforce, with respect to your health information in Notal Vision’s possession. Your personal health care providers may have different policies or Notices regarding their use and disclosure of your health information in their possession.
If you need further information about this Notice, desire to exercise any right discussed above, or want to object to or complain about any use or disclosure, please contact our Privacy Officer:
George E. Sanborn
Medical Director, Independent Diagnostic Testing Facility | Notal Vision
7717 Coppermine Drive Manassas, VA 20109
Toll Free Number: 855-691-8600
The ForeseeHome is intended for use in the detection and characterization of central and paracentral metamorphopsia (visual distortion) in patients with age-related macular degeneration, as an aid in monitoring progression of disease factors causing metamorphopsia including but not limited to choroidal neovascularization (CNV). It is intended to be used at home for patients with stable fixation.
The ForeseeHome AMD Monitoring Program is only available by physician order and is intended to be used as an addition to regular eye exams.
The ForeseeHome AMD Monitoring Program is covered by Medicare, subject to its coverage requirements for the test, to assess patients with dry AMD who are at risk of developing wet AMD.