| NOTICE OF PRIVACY PRACTICES
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.
Our goal is to take appropriate steps to attempt to safeguard
any medical or other personal information that is provided
to us. The Privacy Rule under the Health Insurance Portability
and Accountability Act of 1996 ("HIPAA") requires
us to: (i) maintain the privacy of medical information
provided to us; {ii) provide notice of our legal duties
and privacy practices; and (iii) abide by the terms of
our Notice of Privacy Practices currently in effect.
INFORMATION COLLECTED ABOUT YOU
In the ordinary course of receiving treatment and health
care services from us, you will be providing us with personal
information such as:
- Your name, address, and phone number.
- Information relating to your medical history.
- Your insurance information and coverage.
- Information concerning your doctor, nurse or other medical
providers.
In addition, we will gather certain medical information
about you and will create a record of the care provided
to you. Some information also may be provided to us by other
individuals or organizations that are part of your "circle
of care"- such as the referring physician, your other
doctors, your health plan, and close friends or family members.
HOW MAY WE USE AND DISCLOSE INFORMATION ABOUT YOU
We may use and disclose personal and identifiable health
information about you for a variety of purposes. All of
the types of uses and disclosures of information are described
below, but not every use or disclosure in a category is
listed.>
Required Disclosures. We are required to disclose
health information about you to the Secretary of Health
and Human Services, upon request, to determine our compliance
with HIPAA and to you, in accordance with your right to
access and right to receive an accounting of disclosures,
as described below.
For Treatment. We may use health information about
you in your treatment. For example, we may use your medical
history, such as any presence or absence of diabetes, to
assess the health of your eyes.
For Payment. We may use and disclose health information
about you to bill for our services and to collect payment
from you or your insurance company. For example, we may
need to give a payer information about your current medical
condition so that it will pay us for the eye examinations
or other services that we have furnished you. We may also
need to inform your payer of the treatment you are going
to receive in order to obtain prior approval or to determine
whether the service is covered.>
For Health Care Operations. We may use and disclose
information about you for the general operation of our business.
For example, we sometimes arrange for auditors or other
consultants to review our practices, evaluate our operations,
and tell us how to improve our services. Or, for example,
we may use and disclose<
your health information to review the quality of services
provided to you.
Public Policy Uses and Disclosures. There are a
number of public policy reasons why we may disclose information
about you which are described below.
We may disclose health information about you when we are
required to do so by federal, state, or local law.
We may disclose protected health information about you
in connection with certain public health reporting activities.
For instance, we may disclose such information to a public
health authority authorized to collect or receive PHI for
the purpose of preventing or controlling disease, injury
or disability, or at the direction of a public health authority,
to an official of a foreign government agency that is acting
in collaboration with a public health authority. Public
health authorities include state health departments, the
Center for Disease Control, the Food and Drug Administration,
the Occupational Safety and Health Administration and the
Environmental Protection Agency, to name a few.
We are also permitted to disclose protected health information
to a public health authority or other government authority
authorized by law to receive reports of child abuse or neglect.
Additionally we may disclose protected health information
to a person subject to the Food and Drug Administration's
power for the following activities: to report adverse events,
product defects or problems, or biological product deviations;
to track products; to enable product recalls, repairs or
replacements; or to conduct post marketing surveillance.
We may also disclose a patient's health information to a
person who may have been exposed to a communicable disease
or to an employer to conduct an evaluation relating to medical
surveillance of the workplace or to evaluate whether an
individual has a work-related illness or injury.
We may disclose a patient's health information where we
reasonably believe a patient is a victim of abuse, neglect
or domestic violence and the patient authorizes the disclosure
or it is required or authorized by law.
We may disclose health information about you in connection
with certain health oversight activities of licensing and
other health oversight agencies, which are authorized by
law. Health oversight activities include audit, investigation,
inspection, licensure or disciplinary actions, and civil,
criminal, or administrative proceedings or actions or any
other activity necessary for the oversight of 1) the health
care system, 2) governmental benefit programs for which
health information is relevant to determining
beneficiary eligibility, 3) entities subject to governmental
regulatory programs for which health information is necessary
for determining compliance with program standards, or 4)
entities subject to civil rights laws for which health information
is necessary for determining compliance.>
We may disclose your health information as required by
law, including in response to a warrant, subpoena, or other
order of a court or administrative hearing body or to assist
law enforcement identify or locate a suspect, fugitive,
material witness or missing person. Disclosures for law
enforcement purposes also permit us to make disclosures
about victims of crimes and the death of an individual,
among others.
We may release a patient's health information (1) to a
coroner or medical examiner to identify a deceased person
or determine the cause of death and (2) to funeral directors.
We also may release your health information to organ procurement
organizations, transplant centers, and eye or tissue banks,
if you are an organ donor.
We may release your health information to workers' compensation
or similar programs, which provide benefits for work-related
injuries or illnesses without regard to fault.
Health information about you also may be disclosed when
necessary to prevent a serious threat to your health and
safety or the health and safety of others.>
We may use or disclose certain health information about
your condition and treatment for research purposes where
an Institutional Review Board or a similar body referred
to as a Privacy Board determines that your privacy interests
will be adequately protected in the study. We may also use
and disclose your health information to prepare or analyze
a research protocol and for other research purposes.
If you are a member of the Armed Forces, we may release
health information about you for activities deemed necessary
by military command authorities. We also may release health
information about foreign military personnel to their appropriate
foreign military authority.>
We may disclose your protected health information for legal
or administrative proceedings that involve you. We may release
such information upon order of a court or administrative
tribunal. We may also release protected health information
in the absence of such an order and in response to a discovery
or other lawful request, if efforts have been made to notify
you or secure a protective order.
If you are an inmate, we may release protected health information
about you to a correctional institution where you are incarcerated
or to law enforcement officials in certain situations such
as where the information is necessary for your treatment,
health or safety , or the health or safety of others.
Finally, we may disclose protected health information for
national security and intelligence activities and for the
provision of protective services to the President of the
United States and other officials or foreign heads of state.
Our Business Associates. We sometimes work with
outside individuals and businesses that help us operate
our business successfully. We may disclose your health information
to these business associates so that they can perform the
tasks that we hire them to do. Our business associates must
promise that they will respect the confidentiality of your
personal and identifiable health information.
Disclosures to Persons Assisting in Your Care or Payment
for Your Care. We may disclose information to individuals
involved in your care or in the payment for your care.
This includes people and organizations that are part of
your "circle of care" --such as your spouse,
your other doctors, or an aide who may be providing services
to you. We may also use and disclose health information
about a patient for disaster relief efforts and to notify
persons responsible for a patient's care about a patient's
location, general condition or death. Generally, we will
obtain your verbal agreement before using or disclosing
health information in this way. However, under certain
circumstances, such as in an emergency situation, we may
make these uses and disclosures without your agreement.
Appointment Reminders. We may use and disclose medical
information to contact you as a reminder that you have an
appointment or that you should schedule an appointment.
Treatment Alternatives. We may use and disclose
your personal health information in order to tell you about
or recommend possible treatment options, alternatives or
health-related services that may be of interest to you.
Marketing. We may use your protected health information
to contact you by mail to advise you of programs, activities,
new treatment options, etc. being offered here at our facility.
OTHER USES AND DISCLOSURES OF PERSONAL INFORMATION
We are required to obtain written authorization from you
for any other uses and disclosures of medical information
other than those described above. If you provide us with
such permission, you may revoke that permission, in writing,
at any time. If you revoke your permission, we will no longer
use or disclose personal information about you for the reasons
covered by your written authorization, except to the extent
we have already relied on your original permission.
INDIVIDUAL RIGHTS
You have the right to ask for restrictions on the ways we
use and disclose your health information for treatment,
payment and health care operation purposes. You may also
request that we limit our disclosures to persons assisting
your care or payment for your care. We will consider your
request, but we are not required to accept it.
You have the right to request that you receive communications
containing your protected health information from us by
alternative means or at alternative locations. For example,
you may ask that we only contact you at home or by mail.
Except under certain circumstances, you have the right
to inspect and copy medical, billing and other records used
to make decisions about you. If you ask for copies of this
information, we may charge you a fee for copying and mailing.
If you believe that information in your records is incorrect
or incomplete, you have the right to ask us to correct the
existing information or add missing information. Under certain
circumstances, we may deny your request, such as when the
information is accurate and complete.
You have a right to receive a list of certain instances
when we have used or disclosed your medical information.
We are not required to include in the list uses and disclosures
for your treatment, payment for services furnished to you,
our health care operations, disclosures to you, disclosures
you give us authorization to make and uses and disclosures
before April 14, 2003, among others. If you ask for this
information from us more than once every twelve months,
we may charge you a fee.
You have the right to a copy of this notice in paper form.
You may ask us for a copy at any time.
To exercise any of your rights, please contact us in writing.
When making a request for amendment, you must state a reason
for making the request.
CHANGES TO THIS NOTICE
We reserve the right to make changes to this notice at
any time. We reserve the right to make the revised notice
effective for personal health information we have about
you as well as any information we receive in the future.
In the event there is a material change to this notice,
the revised notice will be posted. In addition, you may
request a copy of the revised notice at any time.
COMPLAINTS/COMMENTS
If you have any complaints concerning our privacy practices,
you may contact the Secretary of the Department of Health
and Human Services, at 200 Independence Avenue, S.W., Room
509F, HHH Building, Washington, D.C. 20201 (e-mail: ocrmail@hhs.gov).
You also may contact us at Eye Health Vision Center, 51
State Road, North Dartmouth, MA 02747, Attn: George Picard
(Privacy Officer), 508-992-2882.
YOU WILL NOT BE RETALIATED AGAINST OR PENALIZED BY US FOR
FILING A COMPLAINT. |