SOUTH BAY FAMILY VISION OPTOMETRY
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Privacy Notice


SOUTH BAY FAMILY VISION
O P T O M E T R Y
13416 HAWTHORNE BLVD., SUITE B,
HAWTHORNE, CALIFORNIA 90250  
(310) 978-3937
FAX: (310) 978-1895

23545 CRENSHAW BLVD., SUITE 105,
TORRANCE, CALIFORNIA 90250  
(310) 326-8278
DR. JAMES W. KELSEY AND ASSOCIATES, OPTOMETRISTS
VISION EXAMINATIONS FOR CHILDREN THROUGH SENIORS  EYE DISEASE DETECTION  CONTACT LENSES  FASHION EYEWEAR

SOUTH BAY FAMILY VISION'S PRIVACY POLICY
This policy ensures that confidentiality of protected health information is maintained for all South Bay Family Vision  patients, and provides South Bay Family Vision patients with notice of South Bay Family Vision's information practices.
Definitions
 Protected Health Information means any information that is created or received by South Bay Family Vision which identifies an individual and relates to the past, present or future physical or mental health or condition of that individual.
 Eligibility Information means information, whether written or oral, which describes a patient or a patient's eligibility for past or future vision care services and the extent to which those services are covered under the patient's plan. Eligibility information does not include
Protected Health Information.
Scope / Policy
South Bay Family Vision shall not disclose any Protected Health Information about a patient collected or received in connection with a vision care transaction unless the disclosure is permitted or required by law, and is:
 To the patient or the patient's legal representative or guardian, upon presentation to South
Bay Family Vision of a valid Social Security or Patient Identification number or
 With the written authorization of the patient, or the patient's legal representative or
guardian, provided the authorization is:
 Dated
 Signed by the patient or the patient's legal guardian and  Obtained one (1) year or less prior to the date a disclosure is sought or
 To a medical care institution or medical professional for the purpose of:
 Verifying coverage or benefits
 Informing an individual of a medical problem of which the individual may not be aware
or
 Conducting an operations or services audit to verify the patients treated by the medical
professional or at the medical care institution provided only such information is
disclosed as is reasonably necessary to accomplish the foregoing purposes or
 To an insurance institution, health care organizations, or self-insurer, provided the
information disclosed is limited to that which is reasonably necessary
 To detect or prevent criminal activity, fraud, material misrepresentation or material
nondisclosure in connection with insurance transactions or
 For either the disclosing or receiving entity to perform its function in connection with an
insurance transaction involving the patient or
 To an insurance or healthcare regulatory authority or
 To a law enforcement or other governmental authority
 To protect the interests of South Bay Family Vision in preventing or prosecuting the
perpetration of fraud upon it or
 If South Bay Family Vision reasonably believes that illegal activities have been
conducted by the patient or
 Made for the purpose of conducting actuarial or research studies, provided:
 No patient may be identified in any actuarial or research report
 Materials allowing the patient to be identified are returned or destroyed as soon as
they are no longer needed and
 The actuarial or research organizations agrees not to disclose the information unless
the disclosure would otherwise be permitted by this section if made by an insurance
institution, agent or insurance support organization or
 To an internal or external professional peer review organization for the purpose of
reviewing the service or conduct of a medical care institution or provider or
 To a governmental authority for the purpose of determining the patient's eligibility for
vision or health benefit for which the governmental authority may be liable or
 in response to a facially valid administrative or judicial order, including a search warrant or
subpoena or
 To a health maintenance organization, health plan, or insurer, when South Bay Family
Vision is acting as a subcontractor to that organization, and the patient is covered by
South Bay Family Vision pursuant to his/her enrollment in that organization. In that
circumstance, all Protected Health Information maintained by South Bay Family Vision by
virtue of the contract with the organization will be made available to the organization or
 Otherwise permitted or required by law.
In addition to those circumstances described above, Eligibility Information is provided in the
following circumstances where permitted or required by law:
 To a South Bay Family Vision doctor, a patient, a patient's current spouse, a patient's
eligible dependent, or the legal guardian of an eligible dependent, upon presentation
to South Bay Family Vision of a patient's valid Social Security or patient identification
number
SOUTH BAY FAMILY VISION
O P T O M E T R Y
Privacy Procedures
 All South Bay Family Vision employees, upon employment, agree to abide by South Bay
Family Vision's policy and procedure of "Confidentiality of Information" which details the
importance of confidentiality of medical records, personal information, insurance claims
and other materials. The consequences of violating this policy include disciplinary action
up to and including dismissal from employment.
 Any patient specific information or medical record is considered confidential and is shared
only with those parties who have the authority to receive such information, as provided for
above.
 If disclosure is required through a court order or subpoena, the order or subpoena is first
reviewed by South Bay Family Vision to determine the legitimacy of the order, the purpose
for the disclosure, and limitations on the information disclosed.
 All patient specific medical information is stored for the appropriate length of time as
required by legal statutes and company policy, in files that are locked and made
accessible only for the purposes stated above.
 System stored patient specific medical and personal information is protected through
system security measures designed to protect against access by unauthorized staff.
Additionally, South Bay Family Vision is monitoring the status of proposed regulations
pursuant to the Health Insurance Portability and Accountability Act, and will implement
such security measures mandated by the final regulations. South Bay Family Vision
currently employs industry standard system security measures to protect electronically
stored and transmitted information.
 South Bay Family Vision doctors' offices shall maintain the integrity and confidentiality of
Protected Health Information in the record against loss, defacement, tampering or use by
unauthorized persons. The contracted doctor's office shall maintain a policy of
confidentiality regarding patient medical record information.
 If South Bay Family Vision becomes aware of a confidentiality violation by a member
doctor, either through an onsite visit or through a complaint/grievance, the Quality
Assurance Committee and South Bay Family Vision staff determines the proper steps
needed to restore confidentiality. Human Resources is consulted if the violation was
perpetrated through a South Bay Family Vision employee.
 This policy shall be provided to any member, client, or South Bay Family Vision doctor
upon request.
SOUTH BAY FAMILY VISION
O P T O M E T R Y.

Contact Us
13624 Hawthorne Blvd. Ste. 201
Hawthorne, CA 90250
Phone: 310-978-3937
Office Hours
Mon    9:00 am - 5:30 pm
Tue     9:00 am - 5:30 pm
Wed    9:00 am - 5:30 pm
Thu     9:00 am - 5:30 pm
Fri       9:00 am - 5:30 pm
Sat      9:00 am - 2:00 pm
Notice of Privacy Practices
Website by Eyefinity
  • Home
  • Our Practice
  • Our Services
    • Lens Prescriptions
    • Eyeglasses
    • Contact Lenses
    • Special Events
  • Patient Forms
  • Promotions
  • LASIK EYE SURGERY
  • Location