Secure Messaging Instructions
If you already have a Patient Portal account, then simply log in
If you do not already have an account, then select the Patient Portal Login button on this page to create one
Select "My Messages"
Select "New Message"
Under the "To:" dropdown menu, select Medical Staff and your doctor's name
Under the "Message Type:" dropdown menu, select Medical Staff Message
Type in the subject line and then your message
Review your message and click "Submit"
If you are submitting a prescription refill request please include: the name of the medication, your pharmacy and location, and whether you prefer a 30 or 90 day supply of medication
Notice of Privacy Practices (revised & effective 9/23/2013)
Wooster Ophthalmologists, Inc. (dba Wooster Eye Center / Wooster Optical / Eye Surgery Center of Wooster)
This notice describes how medical information about you may be used and disclosed and how you can gain access to this information. Please review it carefully.
Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services.
Our practice is required by law to follow specific rules on maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other purposes that are permitted or required by law.
Your Rights Under The Privacy Rule
Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff, or you may contact our Privacy Officer. Contact information is provided on the following page under Privacy Complaints.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices - We are required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. The Notice will also be posted or placed in a conspicuous location within the practice, and if such is maintained by the practice, on its web site.
You have the right to authorize other use and disclosure - This means you have the right to authorize any use or disclosure of PHI that is not specified within this notice. We would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider, or our practice has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request an alternative means of confidential communication – This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., mail, telephone), and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. We will allow reasonable requests.
You have the right to inspect and copy your PHI - This means you may inspect, and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.
You have the right to request a restriction of your PHI - This means you may ask us, in writing, not to use or share with a specific entity or person any part of your protected health information for the purposes of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment or required by law. In certain circumstances, we may deny your request for a restriction. You also have the right to request, in writing, that we not share information with your health plan regarding a specific treatment, item, or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of request, but we are permitted to require payment in full for those services at the time you make such a request, and our office will require that. This type of request should be made on the date the service is provided, since we would normally send the insurance claim containing this PHI on the morning after a service is provided.
You have the right to request an amendment to your protected health information - This means you may request a correction to your PHI for as long as we maintain this information. In certain cases, we may deny your request.
You have the right to request a disclosure accountability - This means that you may request a listing of disclosures that we have made, of your PHI, to entities or persons outside of our office.
You have the right to receive a privacy breach notice - You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.
How We May Use or Disclose Protected Health Information
Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.
Treatment - We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose PHI to other healthcare providers who may be involved in your care and treatment.
Special Notices - We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services offered by our office. You will have the right to opt out of certain special communications, such as fundraising, and any such communication will include instructions for opting out.
Payment - Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits.
Healthcare Operations - We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to, business planning and development, quality assessment and improvement, medical review, legal services, auditing functions and patient safety activities.
Health Information Organization - The practice may elect to use a health information organization, or other such organization, to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.
To Others Involved in Your Healthcare - Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person that you identify, your PHI that directly relates to that person’s involvement in your healthcare. If you are unable to agree or if you object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may also use our professional judgment In allowing a person to act on your behalf to pick up medications and medical or optical supplies, or other similar forms of PHI, making reasonable inferences of your best interests. We may use or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care, of your location, general condition, or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.
Other Permitted and Required Uses and Disclosures - We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker’s compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.
You have the right to complain to us or to the Secretary of the Department of Health and Human Services, if you believe your privacy rights have been violated by us. You may file a complaint with us by telephoning our Privacy Officer at
330-345-7200 or by mailing a complaint to Attn: Privacy Officer, Wooster Eye Center, 3519 Friendsville Rd., Wooster, OH 44691. We will not retaliate against you for filing a complaint; and the Privacy Officer will respond to your concerns, if you provide your contact information on the complaint form.
Effective Date: 9/23/2013
Publication Date: 9/23/2013
Wooster Ophthalmologists, Inc. (Wooster Eye Center and Eye Surgery Center of Wooster) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Wooster Ophthalmologists, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Wooster Ophthalmologists, Inc.:
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
Qualified sign language interpreters
Written information in other formats (e.g., large print)
• Provides free language services to people whose primary language is not English, such as:
Qualified phone interpreters
Information written in other languages
If you need these services, speak with one of our staff members or contact the Civil Rights Coordinator for Wooster Ophthalmologists, Inc., Ann Warner, Practice Administrator (Corporate Coordinator).
If you believe that Wooster Ophthalmologists, Inc. has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Ann Warner, Practice Administrator, Wooster Ophthalmologists, Inc., 3519 Friendsville Rd., Wooster, OH 44691; Phone - 330-345-7200, Fax - 330-345-8029, email - email@example.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Ann Warner, Practice Administrator, is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 330-345-7200.
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 330-345-7200.
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 033-543-0027
Wann du Deitsch (Pennsylvania German / Dutch) schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 330-345-7200).
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 330-345-7200.
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 330-345-7200.
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.
Gọi số 330-345-7200.
XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 330-345-7200.
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
330-345-7200 번으로 전화해 주십시오.
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 330-345-7200.
AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten.
УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 330-345-7200.
ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 330-345-7200.