Laser Surgery Center
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.
Cleveland Eye and Laser Surgery Center provides ambulatory surgical services. Due to the nature of these services, we are required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information (PHI), and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. We are also required to abide by the terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI: We may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples of our use of your PHI:
Patient Rights: As a patient, you have a number of rights with respect to you PHI, including:
Revisions to the Notice: We reserve the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all PHI we maintain. Any material changes to the Notice will be promptly posted in our facilities. You can get a copy of the latest version of this Notice by contacting our privacy official.
Your Legal Rights and Complaints: You have the right to file a complaint with the Ohio Department of Health. The Ohio Department of Health is the responsible agency for ambulatory surgical center’s complaint investigation. Complaints may be registered with the department by phone, 800-342-0553 or in writing to the Ohio Department of Health, PCSU, Second Floor, 246 North High Street, P.O. Box 118, Columbus, Ohio, 43216-0118. A complainant may provide his/her name, address, and phone number to the Department. Anonymous complaints may be registered. All complaints are confidential.
You also have the right to complain to us, or the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments, or complaints you may direct all inquiries to our privacy official.
Cleveland Eye and Laser Surgery Center
22715 Fairview Center Drive
Fairview Park, OH 44126