Notice of Privacy Practices
Questions about your privacy? Contact Urban Eyes Vision Care at (303) 433-5820 or info@urbaneyes.net
THIS NOTICE DESCRIBES HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AND HOW YOU CAN GET ACCESS TO SUCH INFORMATION.
Please read it carefully.
Your “health information,” for purposes of this Notice, is generally any information that identifies you and is created, received, maintained, or transmitted by us in the course of providing health care items or services to you.
We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other applicable laws to maintain the privacy of your health information, to provide individuals with this Notice of our legal duties and privacy practices with respect to such information, and to abide by the terms of this Notice. We are also required by law to notify affected individuals following a breach of their unsecured health information.
USES AND DISCLOSURES OF INFORMATION WITHOUT YOUR AUTHORIZATION
The most common reasons why we use or disclose your health information are for treatment, payment, or health care operations.
Treatment
Examples of how we use or disclose your health information for treatment purposes include:
Setting up an appointment for you
Testing or examining your eyes
Prescribing glasses, contact lenses, or eye medications and faxing them to be filled
Showing you low vision aids
Referring you to another doctor or clinic for eye care, low vision aids, or services
Getting copies of your health information from another professional that you may have seen before us
Payment
Examples of how we use or disclose your health information for payment purposes include:
Asking you about your health or vision care plans, or other sources of payment
Preparing and sending bills or claims
Collecting unpaid amounts, either ourselves or through a collection agency or attorney
Health Care Operations
“Health care operations” mean those administrative and managerial functions that we must carry out in order to run our office.
Examples include:
Financial or billing audits
Internal quality assurance
Personnel decisions
Participation in managed care plans
Defense of legal matters
Business planning
Outside storage of our records
OTHER DISCLOSURES AND USES WE MAY MAKE WITHOUT YOUR AUTHORIZATION OR CONSENT
In some limited situations, the law allows or requires us to use or disclose your health information without your consent or authorization. Not all of these situations will apply to us; some may never come up at our office at all.
Such uses or disclosures include:
When a state or federal law mandates that certain health information be reported for a specific purpose
For public health purposes, such as contagious disease reporting, investigation, or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices
Disclosures to governmental authorities about victims of suspected abuse, neglect, or domestic violence
Uses and disclosures for health oversight activities, such as for the licensing of doctors; audits by Medicare or Medicaid; or investigation of possible violations of health care laws
Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies
Disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else
Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations
Uses or disclosures for health-related research
Uses and disclosures to prevent a serious threat to health or safety
Uses or disclosures for specialized government functions, such as for the protection of the president or high-ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service
Disclosures of de-identified information
Disclosures relating to workers’ compensation programs
Disclosures of a “limited data set” for research, public health, or health care operations
Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures
Disclosures to “business associates” and their subcontractors who perform health care operations for us and who commit to respect the privacy of your health information in accordance with HIPAA
[Specify other uses and disclosures affected by state law]
Unless you object, we will also share relevant information about your care with any of your personal representatives who are helping you with your eye care.
Upon your death, we may disclose to your family members or to other persons who were involved in your care or payment for health care prior to your death, such as your personal representative, health information relevant to their involvement in your care, unless doing so is inconsistent with your preferences as expressed to us prior to your death.
SPECIFIC USES AND DISCLOSURES OF INFORMATION REQUIRING YOUR AUTHORIZATION
The following are some specific uses and disclosures we may not make of your health information without your authorization:
Marketing Activities
We must obtain your authorization prior to using or disclosing any of your health information for marketing purposes unless such marketing communications take the form of face-to-face communications we may make with individuals or promotional gifts of nominal value that we may provide.
If such marketing involves financial payment to us from a third party, your authorization must also include consent to such payment.
Sale of Health Information
We do not currently sell or plan to sell your health information and we must seek your authorization prior to doing so.
YOUR RIGHTS TO PROVIDE AN AUTHORIZATION FOR OTHER USES AND DISCLOSURES
Other uses and disclosures of your health information that are not described in this Notice will be made only with your written authorization.
You may give us written authorization permitting us to use your health information or to disclose it to anyone for any purpose.
We will obtain your written authorization for uses and disclosures of your health information that are not identified in this Notice or are not otherwise permitted by applicable law.
We must agree to your request to restrict disclosure of your health information to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law and such information pertains solely to a health care item or service for which you have paid in full, or for which another person other than the health plan has paid in full on your behalf.
To the extent we have your substance use disorder patient records that are subject to 42 CFR Part 2, we will not use or share information in those records in civil, criminal, administrative, or legislative proceedings against you without (1) your consent or (2) a court order and subpoena.
Any authorization you provide to us regarding the use and disclosure of your health information may be revoked by you in writing at any time.
We may be required to disclose health information as necessary for purposes of payment for services received by you prior to the date you revoked your authorization.
YOUR INDIVIDUAL RIGHTS
You have many rights concerning the confidentiality of your health information.
You have the right:
To Request Restrictions
To request restrictions on the health information we may use and disclose for treatment, payment, and health care operations.
To request restrictions, please send a written request to us at the address below.
To Receive Confidential Communications
You have the right to receive confidential communications of health information about you in any manner other than described in our authorization request form.
We reserve the right to determine if we will be able to continue your treatment under such restrictive authorizations.
To Inspect or Copy Your Health Information
You have the right to inspect or copy your health information.
If you request a copy of your health information, we may charge you a fee for the cost of copying, mailing, or other supplies.
In certain circumstances, we may deny your request to inspect or copy your health information, subject to applicable law.
To Amend Your Health Information
If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information.
We may deny your request if the health information:
Is not in writing or does not provide a reason to support your request
Was not created by us, unless the person that created the information is no longer available to make the amendment
Is not part of the health information kept by or for us
Is not part of the information you would be permitted to inspect or copy
Is accurate and complete
To Receive an Accounting of Disclosures
You have the right to receive an accounting of disclosures of your health information.
Not all health information is subject to this request. Your request must state a time period for the information you would like to receive, no longer than 6 years prior to the date of your request.
Your request must state how you would like to receive the report, either paper or electronically.
To Designate Another Party to Receive Your Health Information
If your request for access of your health information directs us to transmit a copy of the health information directly to another person, the request must be made by you in writing to the address below and must clearly identify the designated recipient and where to send the copy.
CONTACT PERSON
Our contact person for all questions, requests, or for further information related to the privacy of your health information is:
Name: Alpa A. Patel O.D.
Address: 3620 W 29th Ave.
Denver, CO 80211
COMPLAINTS
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights.
We will not retaliate against you if you make a complaint.
If you want to complain to us, send a written complaint to the office contact person at the address, fax, or email shown above. If you prefer, you can discuss your complaint in person or by phone.
SMS COMMUNICATIONS
By providing your mobile phone number, you consent to receive SMS messages from Urban Eyes Vision Care related to appointment reminders, appointment confirmations, scheduling updates, office notifications, account notifications, and other practice-related communications. Marketing messages will only be sent if you have separately opted in to receive them.
Message frequency may vary. Message and data rates may apply.
Reply STOP to opt out of SMS messages at any time. Reply HELP for assistance.
No mobile information will be shared with third parties or affiliates for marketing or promotional purposes. Information sharing with subcontractors that provide support services, such as customer service, is permitted. Text messaging originator opt-in data and consent will not be shared with any third parties.
For additional information about our SMS program, please review our SMS Terms & Conditions.
CHANGES TO THIS NOTICE
We reserve the right to change our privacy practices and to apply the revised practices to health information about you that we already have.
Any revision to our privacy practices will be described in a revised Notice that will be posted prominently in our facility.
Copies of this Notice are also available upon request at our reception area.
Notice Revised and Effective: 09/2026