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HIPAA NOTICE OF PRIVACY PRACTICES - Effective Date:
April 14, 2003
I. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
II. This Notice is provided to you pursuant to the Health Insurance
Portability and Accessibility Act of 1996 (“HIPAA”). It is designed to
tell you how we may, under federal law, use or disclose your health
Information. “Protected Health Information” is information about you,
including demographic information, that may identify you and that relates
to your past, present or future physical or mental health or condition and
related health care services.
We are required to abide by the terms of this Notice of Privacy Practices.
We may change the terms of our notice, at any time. The new notice will be
effective for all protected health information that we maintain at that
time. Upon your request, we will provide you with any revised Notice of
Privacy Practices by accessing our website,
calling the office and requesting that a revised copy be sent to you in
the mail or asking for one at the time of your next appointment.
III. How we may use and disclose your protected health information. We use
and disclose health information for many different reasons. For some of
these uses or disclosures, we need your specific authorization. Below, we
describe the different categories of our uses and disclosures and give you
some examples of each category.
A. We May Use or Disclose Your Health Information for Purposes of
Treatment, Payment or Healthcare Operations [with/without] a Consent and
Here is One Example of Each:
Treatment. We will use your protected health information to provide,
coordinate, or manage your health care and any related services. Your
health information may be used by our physicians and staff members or
disclosed to other health care professionals for the purpose of evaluating
your health, diagnosing medical conditions, and providing treatment.
Payment. Your health information may be used to seek payment from your
health plan, other sources of coverage such as automobile insurer, or
credit card companies that you may use to pay for services.
Healthcare Operations. Your health information may be used as necessary to
support the day-to-day activities and management of The Eye Care Center.
For example, information on the services you received may be used to
support budgeting and financial reporting and activities to evaluate and
promote quality to insure that our practice is meeting state and federal
guidelines and laws designated to protect your health care information.
B. We May Use or Disclose Your Health Information Under the Following
Circumstances without Obtaining Your Prior Consent or Authorization:
For Treatment, Payment or Healthcare
Operations. See above.
When a disclosure is required by federal, state, or local law, judicial or
administrative proceedings, or law enforcement.
To Provide it to You:
For Public Health Purposes. We may use or disclose your Health Information
to provide information to state or federal public health authorities, as
required by law to prevent or control disease, injury or disability; to
report child abuse or neglect; report domestic violence; report to the
Food and Drug Administration problems with products and reactions to
medications; and report disease or infection exposure.
For Health Oversight Activities. We may use or disclose your Health
Information to health agencies during the course of audits,
investigations, inspections, licensure and other proceedings.
To Law Enforcement Personnel. We may use or disclose your Health
Information to a law enforcement official to identify or locate a suspect,
fugitive, material witness or missing person, comply with a court order or
subpoena and other law enforcement purposes.
To Coroners or Funeral Directors. We may use or disclose your Health
Information for purposes of communicating with coroners, medical examiners
and funeral directors.
For Purposes of Organ Donation. We may use or disclose your Health
Information for purposes of communicating to organizations involved in
procuring, banking or transplanting organs and tissues.
In Order to Conduct Research. We may use or disclose your Health
Information in order to conduct research that has been approved by our
Institutional Review Board.
For Public Safety. We my use or disclose your Health Information in order
to prevent or lessen a serious and imminent threat to the health or safety
of a particular person or the general public.
To Aid Specialized Government Functions. If necessary, we may use or
disclose your Health Information for military or national security
purposes.
For Worker’s Compensation. We may use or disclose your Health Information
necessary to comply with worker’s compensation laws.
Appointment Reminders and Health-Related
Benefits or Services. We may use PHI to provide appointment reminders or
give you information about treatment alternatives or other health care
services or benefits we offer.
Change of Ownership. In the event that our practice is sold or merged with
another organization, your Health Information/record will become property
of the new owner.
To Correctional Institutions or Law Enforcement Officials, if you are in
Inmate.
C. Uses and Disclosures Require You to Have the Opportunity to Object.
To Notify and/or Communicate with your Family. Unless you object, we may
use or disclose your PHI in order to notify your family or assist in
notifying your family, your personal representative or another person
responsible for your care about your location, your general condition or
in the event of your death. If you are unable or unavailable to agree or
object, our health professionals will use their best judgment in any
communications with your family and others.
Emergencies. We may use or disclose your PHI in an emergency treatment
situation. If this happens, your physician shall try to obtain your
consent as soon as reasonably practicable after the delivery of treatment.
Third Party Business Associates. We will share your PHI with third party
business associates that perform various activities (e.g. billing,
transcription services) for the practice. Whenever an arrangement between
our office and a business associate involves the use or disclosure of your
protected health information, we will have a written contract that
contains terms that will protect the privacy of your PHI.
Communication Barriers. We may use and disclose your PHI if your physician
or another physician in the practice attempts to obtain consent from you
but is unable to do so due to substantial communication barriers and the
physician determines that you intend to consent to use or disclosure under
the circumstances.
D. For All Other Circumstances, We May Only Use or Disclose Your Health
Information After You have Signed an Authorization. If you authorize us to
use or disclose your Health Information for another purpose, you may
revoke your authorization in writing at any time.
IV. Your Rights.
1. You have the right to request restrictions on the uses and disclosures
of your Health Information. We are not required to comply with your
request.
2. You have the right to receive your Health Information through
confidential means through a reasonable alternative means or at an
alternative location.
3. You have the right to inspect and copy your Health Information. We may
charge you a reasonable cost-based fee to cover copying, postage and/or
preparation of a summary.
4. You have a right to request that we amend your Health Information that
is incorrect or incomplete. We are not required to change your health
information and will provide you with information about our denial and how
you can disagree with the denial.
5. You have a right to receive an accounting of disclosures of your Health
Information made by us, except that we do not have to account for
disclosures made for treatment, payment, health care operations,
information provided to you, notification and communication with family,
certain government functions, appointment reminders and fund raising as
described in section III of this Notice of Privacy Practices.
6. You have a right to a paper copy of this Notice of Privacy Practices.
If you would like to have a more detailed explanation of these rights or
if you would like to exercise one or more of these rights, contact our
Privacy Officer.
V. Complaints. If you think that we may have violated your privacy rights,
or you disagree with a decision we made about access to your PHI, you may
file a complaint with us or the Secretary of Health and Human Services.
You may file a complaint with us by notifying our privacy officer at
561-391-3334 of your complaint. We will not retaliate against you for
filing a complaint.
VI. Electronic Notice
This Notice of Privacy Practices is available on our website and in print.
VII. This notice was published and becomes effective on April 14, 2003.
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