NOTICE OF PRIVACY PRACTICES
Effective Date: 10/12/2026
N86W16275 Appleton Avenue | Menomonee Falls, WI 53051 | (262) 251-1570
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY SCHIFERL EYECARE HOLDINGS LLC DOING BUSINESS AS FALLS PREMIER EYECARE AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. Our Commitment to Your Privacy
Schiferl Eyecare Holdings LLC, doing business as Falls Premier Eyecare (“the Practice”), is committed to protecting the privacy and security of your personal health information.
We are required to comply with applicable federal and Wisconsin privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA) and Wisconsin Statutes §§ 146.82 and 146.83.
This Notice of Privacy Practices explains how we may use and disclose your protected health information (PHI), your rights regarding that information, and our responsibilities for safeguarding it.
Protected health information includes your medical and ocular history, examination findings, diagnoses, prescriptions, treatment plans, insurance information, billing records, and other individually identifiable information related to your health care.
2. How We May Use and Disclose Your Health Information
We may use or disclose your health information for the following purposes without obtaining a separate written authorization when permitted by applicable law.
Treatment
We may use or share your health information to provide, coordinate, and manage your eye care. Examples include:
- Sharing examination findings with your primary care physician, ophthalmologist, or another health care provider involved in your care.
- Sending prescription information to an optical laboratory to manufacture your eyeglasses.
- Communicating with contact lens manufacturers or suppliers to fulfill your contact lens prescription.
- Coordinating referrals and follow-up care.
Payment
We may use or disclose your information to obtain payment for services and products provided. Examples include:
- Submitting claims to your medical or vision insurance company.
- Verifying insurance eligibility and benefits.
- Obtaining prior authorizations.
- Processing payments, billing patients, and collecting outstanding balances.
Health Care Operations
We may use or disclose information to support the business and clinical operations of the Practice. Examples include quality improvement, staff training, record management, auditing, compliance reviews, and evaluating patient care.
We may share information with service providers performing functions on our behalf, such as electronic health record vendors, billing services, technology providers, and other business associates, subject to applicable privacy and security requirements.
Appointment Reminders and Care Communications
We may contact you by telephone, voicemail, text message, mail, patient portal, or email, as appropriate, regarding appointments, prescription orders, follow-up care, and other health care matters. You may request that we communicate with you through an alternative method or at a different location.
Family Members and Individuals Involved in Your Care
When permitted by applicable federal and Wisconsin law, we may share information directly relevant to your care or payment with family members, caregivers, or other individuals involved in your care. We will consider your preferences and any applicable legal restrictions.
Other Uses and Disclosures Permitted or Required by Law
Depending on the circumstances and applicable legal requirements, we may disclose health information for:
- Public health reporting and disease prevention.
- Reporting suspected abuse, neglect, or domestic violence.
- Health oversight activities, audits, and investigations.
- Judicial or administrative proceedings.
- Certain law enforcement purposes.
- Preventing or reducing a serious threat to health or safety.
- Workers’ compensation matters.
- Organ and tissue donation activities.
- Disclosures to coroners, medical examiners, or funeral directors.
- Research activities when legally authorized.
- Specialized government functions, such as military, national security, and correctional institution purposes.
- Disclosures to the U.S. Department of Health and Human Services when required to investigate or determine our compliance with HIPAA.
- Other disclosures required by federal or Wisconsin law.
We will disclose only the information authorized or required under the applicable circumstances.
3. Uses and Disclosures Requiring Written Authorization
Except as otherwise permitted or required by law, we will obtain your written authorization before using or disclosing your health information for purposes not described in this notice. Written authorization is generally required for:
- Marketing activities that require authorization under HIPAA.
- The sale of protected health information.
- Most uses or disclosures of psychotherapy notes, if any are maintained.
- Other uses or disclosures requiring authorization under applicable federal or Wisconsin law.
You may revoke an authorization in writing at any time, except to the extent we have already relied upon it or as otherwise permitted by law.
4. Your Rights Regarding Your Health Information
You have the following rights, subject to applicable legal requirements.
Right to Inspect and Obtain Copies
You may request to inspect or receive a copy of your health records, including records maintained electronically. We will respond within applicable legal time limits. Any fees charged will comply with HIPAA and Wisconsin law.
Right to Request Corrections
You may request an amendment to health information you believe is incorrect or incomplete. We may deny certain requests when permitted by law, but we will explain the reason for the denial and your available rights.
Right to Request Restrictions
You may request restrictions on how your information is used or disclosed for treatment, payment, or health care operations. We are not generally required to agree to every requested restriction. However, when you pay in full out of pocket for a health care service or item, we will honor a request not to disclose information about that service or item to your health plan for payment or health care operations, unless disclosure is required by law.
Right to Confidential Communications
You may request that we contact you through a specific communication method or at an alternative address. We will accommodate reasonable requests.
Right to an Accounting of Disclosures
You may request an accounting of certain disclosures of your health information, subject to applicable exceptions and legal requirements.
Right to a Paper Copy
You may request a paper copy of this notice at any time, even if you previously received it electronically.
Right to Choose a Personal Representative
A person legally authorized to act on your behalf may exercise applicable privacy rights for you. We may request documentation establishing that person’s authority. For minors, parental and guardian access will be determined under applicable federal and Wisconsin law.
Right to File a Complaint
You may file a complaint if you believe your privacy rights have been violated. You may file a complaint with us by contacting us in writing as described in Section 7, or with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for making a complaint.
5. Our Legal Responsibilities
Falls Premier Eyecare is required to:
- Maintain the privacy and security of your protected health information.
- Follow the terms of the Notice of Privacy Practices currently in effect.
- Provide you with information about our privacy practices and legal duties.
- Implement appropriate administrative, physical, and technical safeguards.
- Notify affected individuals following a breach of unsecured protected health information when required by law.
- Limit uses and disclosures of information as required by applicable law.
We will not use or disclose your information in a manner inconsistent with this notice unless you authorize it in writing or the disclosure is otherwise permitted or required by law.
6. Changes to This Notice
We reserve the right to revise this Notice of Privacy Practices and make revised provisions effective for all protected health information we maintain, including information obtained before the revision. The current notice will be available at our office, upon request, and on our website if applicable
7. Questions, Requests, and Complaints
For questions about this notice, requests involving your health information, or privacy complaints, please contact:
Lana Schiferl, OD | Falls Premier Eyecare | N86W16275 Appleton Avenue | Menomonee Falls, WI 53051 | (262) 251-1570 doctor@fallspremiereyecare.com