Dilation
Patient consent
for pupil dilation
There is no extra charge for dilation and it is included in our
routine exam fees. Our Doctors strongly recommend that all of our patients get
their pupils dilated ANNUALLY for a more extensive examination of the inside
part of the eye. The dilation can detect signs of systemic disease(s) such as
diabetes, high blood pressure, tumors, etc. that can affect the eyes without
physical signs to the patient. It can also detect physical changes such as
cataracts, glaucoma, retinal tears, retinal detachments, etc. that can affect
your vision permanently.
Digital retinal photo
option
As a technology and documentation option to our patients, we are providing the
choice of a PHOTO of the retina (tissues of the eye that allows you to see) for
a discounted fee of $39 during your routine exam. If you have an insurance plan,
the copay for this procedure will vary according to your plan. The photo will be
saved in your personal record by the end of the exam. If you ever need access to
it, you will just need to request our staff to add it to your patient portal.
This option DOES NOT SUBSTITUTE for an actual dilated fundus exam, but it's a
good way to help our staff and patients accurately document any findings inside
the eye during the exam.
NOTE: If your pupils are too small to get a good view of the
retinalcamera, we will HAVE TO dilate your pupils before taking the photo. The
best retinal photos are taken after a dilation.
At times, even if you do not request this procedure, our staff and doctors may
perform this procedure depending on exam findings for insurance documentation
purposes.
Post dilation
process and details
Dilation drops last on average about 4 hours. The standard dilation drops at our
office rarely affect the distance vision but it temporarily increases light
sensitivity. Yes, you should be able to drive after your exam. Only reading may
be more difficult for those few hours. In the case that you need a higher dosage
dilation drop, you will be notified of the side effects for that particular eye
drop. Sunglasses are recommended when you go outside. Please ask for temporary
sunglasses from our office if you do not have sunglasses of your own.
Contact Lens
Evaluation
For contact lens wearers, this is an annual assessment which includes examination
tests and procedures which go beyond an eyeglass prescription: The measurement
of the corneal curvature, a modified health assessment of the eye and an
in-office trial with diagnostic contact lenses. A contact lens evaluation is
like an "upgraded add on" from the glasses examination. The contact lens
prescription is NOT the same as a glasses prescription.
Your contact lens evaluation includes:
- your updated glasses prescription
- a diagnostic pair of contact lenses
- follow up(s) if necessary
- your Contact Lens Rx
For patients who are interested in a contact lens evaluation but prefer not to
have one during their routine eye exam, they will have 60 days from the day of
the routine eye exam to do a contact lens evaluation without needing to repeat
the routine eye exam over again.
Policies, Consent and Submit Data
Notice of
privacy practices
THIS NOTICE DESCRIBES HOW HEALTH
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH
INFORMATION IS IMPORTANT TO US.
Our legal duty
We are required by applicable federal and state law to maintain the privacy of
your health information. We are also required to give you this Notice about our
privacy practices, our legal duties, and your rights concerning your health
information. We must follow the privacy practices that are described in this
Notice while it is in effect. This Notice takes effect April 14, 2003, and will
remain in effect until we replace it. We reserve the right to change our privacy
practices and the terms of this Notice at any time, provided such changes are
permitted by applicable law. We reserve the right to make the changes in our
privacy practices and the new terms of our Notice effective for all health
information that we maintain, including health information we created or
received before we made the changes. In the event we make a material change in
our privacy practices, we will change this Notice and provide it to you. You may
request a copy of our Notice at any time. For more information about our privacy
practices, or for additional copies of this Notice, please contact us using the
information listed at the end of this Notice.
Uses and
disclosures of health information
We use and disclose health information about you for treatment, payment, and
healthcare operations. For example:
Treatment: We may use or disclose your health information to an
optician, ophthalmologist or other healthcare provider providing treatment to
you for: a) the provision, coordination, or management of health care and
related services by health care providers; (b) consultation between health care
providers relating to a patient; (c) the referral of a patient for health care
from one health care provider to another; or (d) recall information.
Payment: We may use and disclose your health information to obtain
payment for services we provide to you. This may include: (a) billing and
collection activities and related data processing; (b) actions by a health plan
or insurer to obtain premiums or to determine or fulfill its responsibilities
for coverage and provision of benefits under its health plan or insurance
agreement, determinations of eligibility or coverage, adjudication or
subrogation of health benefit claims; (c) medical necessity and appropriateness
of care reviews, utilization review activities; and (d) disclosure to consumer
reporting agencies of information relating to collection of premiums or
reimbursement.
Healthcare Operations: We may use and disclose your health
information in connection with our healthcare operations. Healthcare operations
include things such as quality assessment and improvement activities, reviewing
the competence or qualifications of healthcare professionals, evaluating
practitioner and provider performance, conducting training programs,
accreditation, certification, licensing or credentialing activities.
Your Authorization: In addition to our use of your health
information for treatment, payment or healthcare operations, you may give us
written authorization to use your health information or to disclose it to anyone
for any purpose. If you give us an authorization, you may revoke it in writing
at any time. Your revocation will not affect any use or disclosures permitted by
your authorization while it was in effect. Unless you give us a written
authorization, we cannot use or disclose your health information for any reason
except those described in this Notice.
Marketing Health Products or Services: We will not use your health
information for marketing communications without your prior written
authorization. We may provide you with information regarding products or
services that we offer related to your health care needs. We will never sell
your health information without your prior authorization.
To You, Your Family and Friends: We must disclose your health
information to you, as described in the Patient Rights section of this Notice.
We may disclose your health information to a family member, friend or other
person to the extent necessary to help with your healthcare or with payment for
your healthcare, but only if you agree that we may do so or, if you are not able
to agree, if it is necessary in our professional judgment.
Persons Involved in Care: We may use or disclose health information
to notify, or assist in the notification of (including identifying or locating)
a family member, your personal representative or another person responsible for
your care, of your location, your general condition, or death. If you are
present, then prior to use or disclosure of your health information, we will
provide you with an opportunity to object to such uses or disclosures. In the
event of your incapacity or emergency circumstances, we will disclose health
information based on a determination using our professional judgment disclosing
only health information that is directly relevant to the person's involvement in
your healthcare. We will also use our professional judgment and our experience
with common practice to make reasonable inferences of your best interest in
allowing a person to pick up filled prescriptions, medical supplies, x-rays, or
other similar forms of health information.
Required by Law: We may use or disclose your health information
when we are required to do so by law, including judicial and administrative
proceedings.
Abuse or Neglect: We may disclose your health information to
appropriate authorities if we reasonably believe that you are a possible victim
of abuse, neglect, or domestic violence or the possible victim of other crimes.
We may disclose your health information to the extent necessary to avert a
serious threat to your health or safety or the health or safety of others.
National Security: We may disclose to military authorities the
health information of Armed Forces personnel under certain circumstances. We may
disclose to authorized federal officials health information required for lawful
intelligence, counterintelligence, and other national security activities. We
may disclose to correctional institution or law enforcement official having
lawful custody of protected health information of inmate or patient under
certain circumstances.
Appointment Reminders and Treatment Alternatives: We may use or
disclose your health information to provide you with appointment reminders (such
as voicemail messages, postcards, or letters) or information about treatment
alternatives or other health-related benefits and services that may be of
interest to you.
Patient rights
Access: You have the right to review or get copies of your health
information, with limited exceptions. You may request that we provide copies in
a format other than photocopies. We will use the format you request unless we
cannot practicably do so. You must make a request in writing to obtain access to
your health information. You may obtain a form to request access by using the
contact information listed at the end of this Notice. We will charge you a
reasonable cost-based fee for expenses such as copies and staff time. You may
also request access by sending us a letter to the address at the end of this
Notice. If you request an alternative format, we will charge a cost-based fee
for providing your health information in that format. If you prefer, we will
prepare a summary or an explanation of your health information for a fee.
Contact us using the information listed at the end of this Notice for a full
explanation of our fee structure.
Disclosure Accounting: You have the right to receive a list of
instances in which we or our business associates disclosed your health
information for purposes, other than treatment, payment, healthcare operations,
where you have provided an authorization and certain other activities, for the
last 6 years, but not for disclosure made prior to April 14, 2003. If you
request this accounting more than once in a 12-month period, we may charge you a
reasonable, cost-based fee for responding to these additional requests.
Restriction: You have the right to request that we place additional
restrictions on our use or disclosure of your health information. We are not
required to agree to these additional restrictions, but if we do, we will abide
by our agreement (except in an emergency).
Alternative Communication: You have the right to request in writing
that we communicate with you about your health information by alternative means
or to alternative locations. Your request must specify the alternative means or
location, and provide satisfactory explanation how payments will be handled
under the alternative means or location you request.
Amendment: You have the right to request that we amend your health
information. Your request must be in writing, and it must explain why the
information should be amended. We may deny your request under certain
circumstances.
Electronic Notice: If you receive this Notice on our Web site or by
electronic mail (e-mail), you are entitled to receive this Notice in written
form.
Questions and
complaints
If you want more information about our privacy practices or have questions or
concerns, please contact us. If you are concerned that we may have violated your
privacy rights, or you disagree with a decision we made about access to your
health information or in response to a request you made to amend or restrict the
use or disclosure of your health information or to have us communicate with you
by alternative means or at alternative locations, you may complain to us using
the contact information listed at the end of this Notice.
You also may submit a written complaint to the U.S. Department of Health and
Human Services. We will provide you with the address to file your complaint with
the U.S. Department of Health and Human Services upon request. We support your
right to the privacy of your health information. We will not retaliate in any
way if you choose to file a complaint with us or with the U.S. Department of
Health and Human Services.
Contact Person: Dr. Toan Tran
Telephone: 940-369-7441
Fax: 940-369-7403
E-mail: managers@coeunt.com
Address: 1800 W. Chestnut St. STE 101, Denton, TX 76201