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Forms & Policies

At NECO Center for Eye Care, privacy about your health information is our priority. Our policies have been established to assist and protect patients and staff and to ensure we are HIPPA compliant.

Patient Forms and Policies

The following forms and policies are provided to assist and protect patients and staff. They are available to view online or to download. Please note that forms that require a signature must be downloaded and signed before sending via email or presented at our clinics. 


HIPPA Privacy Rule

The HIPAA Privacy Rule (Health Insurance Portability and Accountability Act of 1996) created national standards to help protect a patient's personal health information (PHI) and medical records and how they are transmitted electronically.  NECO Center for Eye Care adheres to a strict set of practices to protect your health information and comply with HIPAA Privacy Regulations. You may download a copy of our privacy policy here.


Patients Bill of Rights

  1. INFORMATION DISCLOSURE
    You have the right to receive accurate and easily understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something,assistance will be provided so you can make informed health care decisions.

  2. CHOICE OF PROVIDER PLANS
    You have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care.

  3. ACCESS OF EMERGENCY SERVICES
    If you have severe pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty.

  4. PARTICIPATION IN TREATMENT DECISIONS
    You have the right to know all your treatment options and to participate in decisions about your care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.

  5. RESPECT AND NONDISCRIMINATION
    You have a right to considerate, respectful and nondiscriminatory care from your doctors, health plan representatives, and other health care providers.

  6. CONFIDENTIALITY OF HEALTH INFORMATION
    You have the right to talk in confidence with health care providers and to have your healthcare information protected. You also have the right to review and copy your own medical record and request that your provider amend your record if it is not accurate, relevant, or complete.

  7. COMPLAINTS AND APPEALS
    You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the conduct of health care personnel, and the adequacy of health care facilities.

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