Accreditated Surgerical Center Located In The San Francisco Oakland Bay Area

Eye MD Laser and Surgery Center was established in 1999 in Oakland, California. In 2010 it received AAAHC accreditation, one of the few in California to receive this distinction. AAAHC (The Accreditation Association for Ambulatory Health Care, Inc.) inspects, surveys and accredits centers that are able to comply with the highest nationalpatient care standards.

Eye MD Laser and Sugery Center is commited:

Patient Rights and Resonsibilities/HIPAA

1. Receive the care necessary to help regain or maintain his or her maximum state of health.

2. Expect personnel who care for the patient to be friendly,considerate, respectful, and qualified through education and experience and perform the services for which they are responsible with the highest quality of service and when the need arises,reasonable attempts are made for healt.

3. Expect full recognition of individuality, including privacy in treatment and care. In addition, all communications and records will be kept confidential.hcare professionals and other staff to communicate in the language or manner primarily used by the patient.

4. Complete information, to the extent known by the physician, regarding diagnosis, treatment and prognosis, as well as alternative treatments or procedures and the possible risks and side effects associated with treatment.

5. Be fully informed of the scope of the services available at the facility including but not limited to; provisions for after-hours and emergency care, payment policies, fees for services rendered, the credentials of health care professionals, information regarding the absence of malpractice insurance coverage, or their right to change their provider if other providers are available.

6. Be a participant in decisions regarding the intensity and scope of treatment. If the patient is unable to participate in those decisions, the patient's rights shall be exercised by the patient's designated representative or other legally designated person.

7. Refuse treatment to the extent permitted by law and be informed of the medical consequences of such a refusal. The patient accepts responsibility for his or her actions should he or she refuses treatment or not follows the instructions of the physician or facility. Exercise his or her rights without being subjected to discrimination or reprisal.

8. Approve or refuse the release of medical records to any individual outside the facility, except in the case of transfer to another health facility, or as required by law or third-party payment contract. Personal records are accessible.

9. Be informed of human experimentation or other research/educational projects affecting his or her care or treatment and can refuse participation in such experimentation or research without compromise to the patient's usual care.

10. Express grievances/complaints and suggestions at any time. To file a complaint or grievance at any time, please notify:

Attn: Administrator
Eye MD Laser & Surgery Center
481 30th Street Oakland, CA 94609 email:@eyemdlaser.com
Accreditation Association for Ambulatory Health Care
5250 Old Orchard Road, Suite 200 Skokie, IL 60077 email:info@aaahc.org
Attn: Deputy Director
California Department of Public Health
Center for Health Certification Division
PO Box 997377 MS 3000
Sacramento, CA 95899
Complaints (800) 236-9747
General Information (916) 558-1784
The Office of Medicare BeneficiaryOmbudsman

For Medicare Beneficiaries - Medicare Ombudsman:

11. Change primary or specialty physicians or if other qualified physicians are available and to be informed if a physician does not have malpractice coverage. Eye MD Laser & Surgery Center requires that all physicians possess malpractice coverage. The patient has a right to request his or her surgeon's credentials.

12. Have an advance directive, such as a living will or healthcare proxy. A patient who has an advance directive must provide a copy to the facility and his or her physician so that his or her wishes may be known and honored, upon transfer to a higher level of care from the Eye MD Laser & Surgery Center. Eye MD Laser & Surgery Center does not honor advance directives pertaining to the termination of life support functions.

13. Be fully informed before any transfer to another facility or organization.

14. Express those spiritual beliefs and cultural practices that do not harm others or interfere with the planned course of medical therapy for the patient.

15. Not to be subjected to misleading marketing or advertising regarding the competence and capabilities of Eye MD Laser & Surgery Center.

16. Be free from any form of abuse or harassment.

Patient Responsibilities:

The Patient Is Responsible for:

1. Providing caregivers with the most accurate and complete information regarding present complaints, past illnesses and hospitalizations, all medications, including over-the-counter and dietary supplements, and unexpected changes in the patient's condition or any other patient health matter, including allergies and sensitivities.

2. Informing Eye MD Laser & Surgery Center about and living will,medical power of attorney, or advance directive that could affect his or her care. Eye MD Laser & Surgery Center does not honor any of these health-care directives.

3. Reporting whether he or she clearly understands the planned course of treatment and what is expected of him or her.

4. Keeping appointments and, when unable to do so for any reason, for notifying the facility and physician.

5. Being considerate of other patients and personnel and for assisting in the control of noise, and other distractions, including respecting the property of others and the facility.

6. Observing prescribed rules of the facility during his or her stay and treatment and, if instructions are not followed, forfeiting the right to care at the facility and being responsible for the outcome.

7. Promptly fulfilling his or her financial obligations to the facility and accepting personal financial responsibilities for charges not covered by insurance.

8. Payment to the facility for copies of the medical records the patient may request, if applicable.

9. Identifying any patient safety concerns.

10. Provide a responsible adult to transport him or her home from the facility.

11. Plan to have a responsible adult stay with him or her for the first 24 hours after surgery.


HIPAA Notice of Privacy Practices:


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

Uses and Disclosures of Protected Health Information:

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and any other use required by law.


We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you


Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations:

We may use or disclose, as needed, your protected health information in order to support the business activities you're your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, communicable Disease; Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers' Compensation: Inmates: Required Uses and Disclosers: Under the law, we must make disclosers 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 164.500.

Other Permitted and Required Uses and Disclosures:

Will be Made Only With Your Consent,

Authorization or Opportunity to Object unless required by law.

You may revoke the authorization,

at any time, in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use of disclosure indicated in the authorization.

Your Rights:

Following is a statement of your rights with respect to your protected health information.

You have the right to inspect and copy your protected health information.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled 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.

You have the right to request a restriction of your protected health information.

This means you may ask us not to use or disclose any part of your protected health information for the purposes 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 notification purposes as described in this Notice of Privacy Practices. Your request 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 may request. If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us,

upon request, even if you have agreed to accept this notice alternatively i.e. electronically.

You may have the right to have your physicians amend your protected health information.

If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.

We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.


You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint.

We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on/or before April 14, 2003

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our main phone number.

Physicians or entities with a financial intrest in Eye MD Laser and Surgery Center

David Bui, M.D. Carol Capener, M.D. Sophia Chen, M.D. Stephen Cohen, M.D.
Stewart Daniels, M.D. David DeMartini, M.D. Christopher Dickens, M.D. Erich Horn, M.D.
E.J. Langham, M.D. Richard Lee, M.D. Scott E. Lee, M.D. Craig Leong, M.D.
Jane Loman, M.D. Steven Pascla, M.D. Stephen Post, M.D Subhransu Ray, M.D.
Paul Ryan, M.D. Rona Silkiss, M.D. Andrew Sorenson, M.D. Robert Sorenson, M.D.
George Tanaka, M.D. Clark Tsai, M.D. David Vastine,M.D. Allen Verne, M.D.
Michael Wang, M.D. Hubert Wong, M.D. Patricia Wong, M.D. Alta Bates-Summit Medical Center