Advanced Eye Care logo

light blue and schedule appointment graphic with phone number

20/20

Patient Information

Appointments

Our office hours are Monday through Friday from 8:00 am to 5:00 pm. If you are having an eye care emergency and it is after hours, you may call our office and you will be directed to a 24 hour answering service who will then contact the on call physician.

Same day appointments are welcome.

Payment Policies

  1. Along with being Medicare participating providers, we have contracts with most insurance companies. If you are unsure that we are providers for your insurance company please contact our office.

    These are some of the health plans we participate in:

    AARP, Aetna, Altius, Beech St., Blue Cross Blue Shield, Blue Vision, CCN, Champus, Cigna, Davis Vision, DMBA, Educators Mutual, Evercare, Eyemed, Federal BCBS, First Health, GEHA, Great West, Healthwise, Humana, Mailhandlers, Medicaid, Medicare, Molina, Mutual of Omaha, PCN, PEHP, PHCS, Pyramid, Rio Grande, Secure Horizons, Select Access, Select Care, Select Care Plus, SelectMed, Sterling, Tall Tree, Tricare/Triwest, United Health Care, Unicare, Union Pacific Railroad, Valuecare

  2. We ask that you be prepared to pay your co-pay at the time of your visit. If we do not participate with your insurance company, or you do not have health insurance please discuss that with the office staff at the time you make your appointment.

The Health Insurance and Portability and Accountability Act (HIPPA)

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please read it carefully. If you have any questions about HIPPA please call our office at 801-263-2020.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you. This includes demographic information that may identify you, and information that relates to your past, present, or future physical or mental health, or condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to make changes to the terms of our notice at any time. This notice will be effective beginning April 14, 2003 for all protected health information that we maintain at the time of writing.

Uses And Disclosures Of Protected Health Information

You will be asked by Advanced Eye Care of Utah to sign an acknowledged form that you have received a copy of this notice. Once you have consented to the use and disclosure of your protected health information for treatment, payment, and health care operations, your Advanced Eye Care physician, his staff, and associates will use or disclose your protected health information as described in this notice. The physicians associated include those who are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to assist in getting reimbursement for you health care charges, and to support the operations of our practice.

The following are examples of the types of uses and disclosures of your protected health information that Advanced Eye Care of Utah is permitted to make once you have signed the acknowledgment form. These are meant to be examples, and are not all-inclusive.

Treatment

We will use and disclose your protected health information to provide, coordinate, or manage your health care and related services. This includes coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information, or one who would diagnose or treat you further. For example, the doctor who referred you to us, the hospital or surgical center where you would have surgery, or a home health or nursing care agency that provides care to you. In addition, we may disclose your protected health information to another doctor or health care provider, who, at the request of your physician, becomes involved in your care by providing a related diagnosis or treatment to your physicians.

Though we will take precaution, and use every possible and reasonable effort to protect your health information, we cannot be held accountable for accidental disclosures that are overheard verbally, or seen in writing.

Payment

Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves, or pays for the healthcare services we recommend for you. Such as: Making a determination of eligibility of coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.

Health Care Operations

We may use or disclose, as needed, your protected health information in order to support the business activities of our practice. These activities include, but are not limited to obtaining the minimum required information to carry out our business operations, quality, assessment efforts, training of medical students, licensing, marketing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to a medical student who would follow your physician as part of his/her studies. Upon check in we will ask your name, verify insurance, with any changes in insurance, address, and/or telephone number being hand written by you. We will call you by name in the reception area, or hallway as you are called into an exam room. We may use or disclose your protected health information within limitations, as necessary, to contact you to set up an appointment as requested by your physician or another healthcare provider.

We will share your protected health information with third party “business associates” that perform various activities for the practice (e.g. billing, transcription services, computer software and hardware technologists, etc.). Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives, or other health related benefits and services that may be of interest to you. For example, we may disclose your protected health information to Low Vision Services, or to a group that supports a pilot study for which you would be deemed a viable candidate to participate in innovative treatments that could be of benefit to you.

Uses And Disclosures Of Protected Health Information Based Upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written consent, or that of your authorized representative, unless otherwise permitted or required by law as described below. Our practice has a “Release of Medical Records” form which would constitute your written authorization which includes, health information that may be used, the name, and/or organization who may use or receive the information, the purpose for which it will be used, the extent of time for the use and disclosure, and must be signed by you, or your authorized representative. You, or your authorized representative may revoke each authorization at any time in writing, except to the extent that your physician, or our practice has taken an action in reliance on the use or disclosure indicated in the authorization. A fee may apply for the cost of copying, supplies, getting your medical record from storage, and staff time could be charged for anything that is indicated in the authorization, and must be received by our practice, along with your written consent, before any record would be released. The same fee could apply for use and disclosure of your protected health information made directly to you, or your authorized representative when an authorization is not required.

Other Permitted And Required Uses And Disclosures That May Be Made With Your Consent, Authorization, Or Opportunity To Object

We may use or disclose your protected health information in the following instances. You have the opportunity to agree to object the use of disclosure of all, or part of your protected health information. If you are not present, or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether this disclosure is in your best interest. In this case, only the protected health information that is relevant to your health are will be disclosed.

Others Involved In Your Healthcare

Unless you object, we may disclose your protected health information to an immediate family member, or to someone involved in your health care (for example: nursing care agency, or correctional officer) by phone. We may also disclose to immediate family members, relatives, close friends, or someone involved in your healthcare that accompanies you to the office on the day of any appointment or surgery. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest, bases upon our professional judgment. We may use or disclose protected health information to notify, or assist in notifying a family member, personal representative, or any other person that is responsible for your location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts.

Emergencies

We may use or disclose your protected health information in an emergency treatment situation. If this happens, our practice will try to obtain your consent as soon as reasonably possible after the delivery of treatment. If you physician, or another physician in the practice is required by law to treat you, or the physician has attempted to obtain your consent, but is unable to obtain it, he/she may still use or disclose your protected health information to treat you.

Communication Barriers

We may use or disclose your protected health information if your physician, another physician in the practice, or staff member attempts to obtain consent from you but is unable to do so due to substantial communication barriers, if it is determined by the physician, using professional judgment, that you intend to consent to use or disclose under the circumstances.

Other Permitted And Required Uses And Disclosures That May Be Made Without Your Consent, Authorization, Or Opportunity To Object

We may use or disclose your protected health information in the following situations without your consent. These situations include:

Required By Law

We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law, and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such disclosures.

Public Health

We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury, or disability. We may also disclose your protected health information if directed by public health authority to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases

We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contacting or spreading the disease or condition.

Health Oversight

We may disclose protected health information to a health oversight agency for activities by law such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil right laws.

Abuse And Neglect

We may disclose protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect, or domestic violence to the government entity or agency authorized to receive such information. In this case, the disclosure will be made within the requirements of applicable federal and state laws.

Food And Drug Administration

We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic deviations, or to track products to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required.

Legal Proceedings

We may disclose protected health information in the course of any judicial or administrative proceedings, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request, or other lawful process.

Coroners, Funeral Directors, and Organ Donations

We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.

Research

We may disclose your protected health information to researchers when their research as been approved by an institutional review board that has critiqued the research proposal and established protocols to ensure the privacy of your protected health information.

Criminal Activity

Consistent with applicable federal and state laws, we may disclose your protected health information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety or a person, or the public. We may also disclose protected health information, if it is necessary, for the law enforcement authorities to identify or apprehend an individual.

Military Activity And National Security

When the appropriate conditions apply, we may use or disclose your protected health information of individuals who are Armed Forces Personnel (1) for activities deemed necessary by appropriate military command authorities (2) for the purpose of a determination by the Department of Veteran Affairs of your eligibility for benefits (3) to foreign military authority if you are a member of that foreign military services, We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities including, for the provision of protective services to the President or others legally authorized.

Inmates

We may use or disclose your protected health information if you are an inmate of a correctional facility, and your physician created or received your protected health information in the course of providing care to you.

Workers Compensation And State Disability

Your protected health information may be disclosed by us, as authorized to comply with workers compensation laws, state disability regulations, and other similar legally established programs.

Required Uses And Disclosures

Under the law, we must make disclosures to you, and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.00 et. Seq.

Your Rights

The following is a statement of your rights with respect to your protected health information, and a brief description of yow you may exercise these rights.

You Have The Right To Inspect Your Protected Health Information

This means that you may inspect the protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical billing, billing records, and any other records that your physician and the practice use for making decisions about you. However under federal law, you may not inspect or copy the following records: Psychotherapy notes, information complied in reasonable anticipation of/or use in a civil, criminal, or administrative action or proceeding and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewed. In some circumstances, you may have a right to have this decision reviewed. Please contact our office if you have any questions about access to your medical record.

You Have The Right To Request A Restriction Of Your Protected Health Information

This means that you ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care, or for the notification purposes as described in the Notice of Privacy Practices. You must state the specific restriction requested, and to whom you want the restriction to apply. Your physician is not required to agree to a restriction that you request. If your physician believes that it is in your best interest to permit the use and disclosure of you protected health information, your protected health information will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restrictions you wish to request with your physician. You may request a restriction on the form “Patient Request to Restrict Use or Disclosure of Protected Health Information”, discuss it by phone, or discuss it in person with our office personal to ensure that it is noted.

You Have The Right To Request To Receive Confidential Communication From Us By Alternative Means Or At An Alternative Location

We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled, or specification of an alternative address or method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our office.

You Have The Right To Have Your Physician Amend Your Protected Health Information

This means that you may request in writing an amendment of protected health information about you in a designated record set for as long as we maintain this information. We will comply with your request in the event we find the information is false, inaccurate, or misleading. In certain cases we may deny your request for an amendment.

You Have The Right To Receive An Account Of Certain Disclosures We Have Made, If Any, Of Your Protected Health Information

This right applies to disclosures for purposes other than treatment, payment, or health care operations as described in the Notice of Privacy Practices. It excludes disclosures we may have made directly to you for a facility, directory, family members involved in your care, or for notification purposes. You have the right to receive specific information regarding the disclosures that occurred since April 14, 2003, or a shorter time frame. The accounting of disclosures will be at no cost to you.

Complaints

You may complain to us, or to the Secretary of Health and Human Services if you believe that your privacy rights have been violated by our practice. You may file a privacy complaint with us by asking for a “Complaint Form”, or by notifying our office of your complaint. We will not retaliate against you for exercising your right to file a complaint.

Contact Us

You may contact us at 801-263-2020 for further information regarding this Notice of Privacy Practices. You may also mail/e-mail your inquiries to our Salt Lake office.

We reserve the right to change our privacy practices, and to alter this notice according to those changes. Upon request, we will provide you with any revisions of the Notice of Privacy Practices.

Download Forms

In an effort to save you time and to expedite the check in process, the following forms may be downloaded and filled out before coming in for your first visit.

Click the buttons below to download these patient forms.

Patient InfoHippa Privacy