Privacy Policy
| Effective: | January 11, 2005 (EXAMPLE ONLY) |
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This notice describes
How Medical Information about you may be used and disclosed
& How you can get access to this information
PLEASE REVIEW IT CAREFULLY
OUR PROMISE TO OUR PATIENTS!
The optometric practice of Gary L Morgan, OD, PC (Eye Tech Eye Associates aka "ETEA") is required by a federal regulation, known as the HIPAA Privacy Rule, to maintain the privacy of your health information, and to provide you with notice of its legal duties and privacy practices. ETEA will not use or disclose your health information except as described in this Notice.
This is not meant to alarm you! Quite the opposite! It is our desire to communicate to you that ETEA is taking the new federal laws (HIPAA - Health Insurance Portability and Accountability Act, which was written to protect the confidentiality of your health information) seriously. We do not ever want you to delay treatment because you are afraid your personal health history might be unnecessarily made available to others outside of our office.
The most significant variable that has motivated the federal government to legally enforce the importance of the privacy of health information is the rapid evolution of computer technology and its use in healthcare. The government has appropriately sought to standardize and protect the privacy of the electronic exchange of your health information. This has challenged us to review not only how your health information is used within our computers but also with the Internet, phone, faxes, copy machines, and charts. We believe this has been an important exercise for us because it has disciplined us to put in writing the policies and procedures we use to ensure the protection your health information everywhere it is used.
The associates at ETEA want you to know about these policies and procedures which we developed to make sure your health information will not be shared with anyone who does not require it. ETEA is subject to state and federal law regarding the confidentiality of your health information and in keeping with these laws; we want you to understand our procedures and your rights as our valuable patient.
ETEA is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information created and obtained in providing optometric and vision services to you. The health information about you is documented in a medical record and on a computer. Such information may include documenting your symptoms, medical history, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.
Examples of uses of your health information for treatment purposes are:
An ETEA provider, technician or assistant obtains treatment information about you and records it in a health record. During the course of your treatment, the provider determines the need to consult with another specialist in the area. Your provider will share the information with such specialist and obtain his/her input.
Example of use of your health information for payment purposes:
On your behalf and as a courtesy to you, ETEA submits requests for payment to your health insurance company. The health insurance company (or other business associate helping us obtain payment) requests health information from us regarding medical care given. ETEA will provide information to them about you and the care given, which may include copies or excerpts of your medical record which are necessary for payment of your account. For example, a bill sent to your health insurance company may include information that identifies your diagnosis, and the procedures and supplies used. ETEA may do this with insurance forms filed for you in the mail or sent electronically. We will only work with companies with a similar commitment to the security of your health information.
Example of use of your health information for health care operations:
Your health information may be used during performance evaluations of our staff. Some of our best teaching opportunities use clinical situations experienced by patients receiving care at our office. ETEA may obtain services from our insurers or other business associates (an individual or entity under contract with us to perform or assist us in a function or activity that necessitates the use or disclosure of health information) such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical transcription, medical review, legal services, and insurance. ETEA will share health information about you with our insurers or other business associates as necessary to obtain these services. Be assured that ETEA requires that our insurers and other business associates protect the confidentiality of your health information.
Additional Health Care Operations:
Because the providers at ETEA believe regular care is very important to your general health, we will remind you of a scheduled appointment or that it is time for you to contact us and make an appointment. We may contact you to follow up on your care and inform you of treatment options or services that may be of interest to you or your family. These communications are an important part of our philosophy of partnering with our patients to be sure they receive the best preventive and curative care modern medicine can provide. They may include postcards, folding postcards, letters, telephone reminders or electronic reminders such as e-mail (unless you tell us that you do not want to receive these reminders).
ETEA Responsibilities
ETEA is required to:
- Maintain the privacy of your health information as required by law.
- Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you.
- Abide by the terms of this Notice.
- Notify you if we cannot accommodate a requested restriction or request.
- Accommodate your reasonable requests regarding methods to communicate health information with you.
ETEA reserves the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If ETEA information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our "Notice of Privacy Practices", by visiting our office and picking up a copy, or by visiting our website (eyetecheyeassociates.com) and downloading a copy.
To Request Information or File a Complaint
If you have questions, if you would like additional information, want to report a problem regarding the handing of your information, or if you believe your privacy rights have been violated and wish to file a written complaint with our office, please contact this office and ask to speak with the Privacy Officer. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services.
We cannot, and will not, require you to waive your rights under the Privacy Rule, including the right to file a complaint with the Secretary of Health and Human Services (HHS), as a condition of receiving
treatment from ETEA. We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Other Disclosures and Uses ETEA Can Make
Without Your Written Authorization
Notification and Communication with Family, Friends and/or Caregiver:
Unless you object, ETEA may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative or other person responsible for your care, about your location, and about your general condition, in an emergency, or at your death. We may share your information with those you tell us will be helping you with your home hygiene, treatment, medications, or payment. We will be sure to ask your permission first. In the case of an emergency, where you are unable to tell us what you want, we will use our very best judgment when sharing your health information only when it will be important to those participating in providing your care.
Disaster Relief:
ETEA may use and disclose your health information to assist in disaster relief efforts.
Employers:
ETEA may release health information about you to your employer if we provide health care services to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work related illness or injury. In such circumstances, ETEA will give you written notice of such release of information to your employer. Any other disclosures to your employer will be made only if you execute an authorization for the release of that information to your employer.
Deceased Persons:
ETEA may disclose your health information to funeral directors, medical examiners, or coroners consistent with applicable law to allow them to carry out their duties. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary for them to carry out their duties.
Organ Procurement Organizations:
Consistent with applicable law, ETEA may disclose your health
information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Appointment Reminders, Marketing and Treatment Alternatives:
ETEA may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you. We may also encourage you to purchase a product or service when we see you. We will not disclose your health information without your written authorization.
Food and Drug Administration (FDA):
ETEA may disclose to the FDA your health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
Workers' Compensation:
If you are seeking compensation through Workers' Compensation, ETEA may disclose your health information to the extent necessary to comply with laws relating to Workers' Compensation.
Public Health:
As required by law, ETEA may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reactions to medications or problems with products; to notify people of recalls; to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.
Abuse, Neglect & Domestic Violence:
ETEA may disclose your health information to public authorities as allowed by law to report abuse, neglect, or domestic violence. ETEA will make this disclosure only when we are compelled by our ethical judgment, when we believe we are specifically required or authorized by law or with the patient's agreement.
Sign-in Sheet:
ETEA may use and disclose your health information by having you sign in when you arrive at our office. An ETEA associate may call out your name when your appointment commences.
Inmates:
It you are an inmate of a correctional institution or under the custody of a law enforcement officer, ETEA may disclose to the institution or law enforcement official health information necessary for your health and the health and safety of other individuals.
Law Enforcement:
ETEA may disclose your health information for law enforcement purposes as required by law, such as when required by a court order; for identification of a victim of a crime if certain protective requirements are met; to report a crime on our premises; to report crime in emergencies; and other appropriate situations permitted by law.
Health Oversight:
ETEA may disclose your health information to appropriate health oversight agencies or for health oversight activities.
Judicial / Administrative Proceedings:
ETEA may disclose your health information in the course of any judicial or administrative proceeding as allowed or required by law or as directed by a proper court order or in response to a subpoena, with your authorization, discovery request or other lawful process if certain specific requirements are met.
Serious Threat:
To avert a serious threat to health or safety, ETEA may disclose your health information consistent with applicable laws to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
For Specialized Governmental Functions:
We may disclose your health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purpose, or to public assistance program personnel.
Website:
If ETEA maintains a website for public view that provides information about the ETEA office, this Notice will be on the website.
Research:
Advancing medical knowledge often involves learning from the careful study of the medical histories of prior patients. Formal review and study of health histories as a part of a research study will happen only under the ethical guidance, requirements and approval and of an Institutional Review Board. ETEA may disclose your health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Fund Raising:
ETEA may contact you as part of a fund raising effort. If you do not want to receive these materials notify our Privacy Officer.
Public Health and National Security
ETEA may be required to disclose to federal officials or military authorities health information necessary to complete an investigation related to public health or to national security. Health information could be important when the government believes that the public safety could benefit when the information could lead to the control or prevention of an epidemic or the understanding of new side effects of a drug treatment or medical device.
0ther Uses:
Other than is stated above or where federal, state or local law requires us, ETEA will not disclose your health information other than with your written authorization. You may revoke that authorization in writing at any time.
Your Health Information Rights and Responsibilities
This new law is careful to describe that you have the following rights related to your health information. The health and billing records ETEA maintains are the physical property of ETEA. However, the information in it belongs to you. You have a right to:
- Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office - we are not required to grant the request but we will comply with any request granted.
- Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office.
- Request that you be allowed to inspect and copy your ETEA medical record and billing record. You may exercise this right by delivering the request in writing to our office using the form ETEA provides to you upon request. ETEA may charge you a reasonable fee to duplicate and assemble your copy.
- Appeal a denial of access to your protected health information except in certain circumstances.
- Request that your medical record be amended to correct incomplete or incorrect information by delivering a written request, including a reason to support it, to our office using the form we provide to you upon request. Your request may be denied if the health information record in question was not created by our office, is not part of our records or if the records containing your health information are determined to be accurate and complete.
- File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information.
- Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not include uses and disclosures of information for treatment, payment, or health care operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; or to family members or friends or uses relevant to that person's involvement in your care or in payment for such care; or uses or disclosures to notify family or others responsible for your care of your location, condition, or your death; we may charge a cost-based fee for more than one accounting in a 12-month period.
- Request that confidential communication of your health information be made by alternative means, or at an alternative location by delivering the request in writing to our office using the form we provide to you upon request. You have the right to request that we communicate with you in a certain way. You may request that we only communicate your health information privately with no other family members present or through mailed communications that are sealed. ETEA will make every effort to honor your reasonable requests for confidential communications.
- Revoke authorizations that you made previously to use or disclose information (except to the extent information or action has commenced) by delivering a written revocation to our office.
If you want to exercise any of the above rights, please contact ETEA in person or in writing during normal business hours. Our Privacy Officer will provide you with assistance on the steps to take to exercise your rights.
You have the right to review this Notice before signing the acknowledgment authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes. ETEA encourages you to express any concerns you may have regarding the privacy of your information. If you have concerns or complaints, please notify us in writing.
ETEA is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of our Privacy Practices. We are required to practice the policies and procedures described in this notice but we do reserve the right to change the terms of our Notice. If we change our privacy practices we will be sure all of our patients receive a copy of the revised Notice.
This ABRIDGED notice describes:
How Medical Information about you may be used and disclosed
& How you can get access to this information
If you prefer to review the entire notice, please tell us! The UNABRIDGED version is available at the concierge desk. PLEASE REVIEW CAREFULLY.
OUR PROMISE TO OUR PATIENTS!
The optometric practice of Gary L Morgan, OD, PC dba Eye Tech Eye Associates (aka "ETEA") is required by a federal regulation, known as the HIPAA Privacy Rule, to maintain the privacy of your health information, and to provide you with notice of its legal duties and privacy practices. ETEA will not use or disclose your health information except as described in this Abridged and the Unabridged Notice. ETEA is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. An ETEA provider, technician or assistant obtains treatment information about you and records it in a health record. During the course of your treatment, the provider determines the need to consult with another specialist in the area. Your provider will share the information with such specialist and obtain his/her input. ETEA reserves the right to amend, change, or eliminate provisions in our privacy.
ETEA is required to:
- Maintain the privacy of your health information as required by law.
- Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you.
- Abide by the terms of this Notice.
- Notify you if we cannot accommodate a requested restriction or request.
- Accommodate your reasonable requests regarding methods to communicate health information with you.
The unabridged and complete policy informs you of the following actions:
- To request information or file a complaint
- Other disclosures and uses ETEA can make without your written authorization
- Examples of uses of your health information for treatment purposes
- Example of use of your health information for payment purposes
- Example of use of your health information for health care operations
•· Additional health care operations
Your Health Information Rights and Responsibilities
This new law is careful to describe that you have the following rights related to your health information. The health and billing records ETEA maintains are the physical property of ETEA. However, the information in it belongs to you. Please see the back of this page for a list of your rights.
You have the right to:
- Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office - we are not required to grant the request but we will comply with any request granted.
- Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office.
- Request that you be allowed to inspect and copy your ETEA medical record and billing record. You may exercise this right by delivering the request in writing to our office using the form ETEA provides to you upon request. ETEA may charge you a reasonable fee to duplicate and assemble your copy.
- Appeal a denial of access to your protected health information except in certain circumstances.
- Request that your medical record be amended to correct incomplete or incorrect information by delivering a written request, including a reason to support it, to our office using the form we provide to you upon request. Your request may be denied if the health information record in question was not created by our office, is not part of our records or if the records containing your health information are determined to be accurate and complete.
- File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information.
- Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not include uses and disclosures of information for treatment, payment, or health care operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; or to family members or friends or uses relevant to that person's involvement in your care or in payment for such care; or uses or disclosures to notify family or others responsible for your care of your location, condition, or your death; we may charge a cost-based fee for more than one accounting in a 12-month period.
- Request that confidential communication of your health information be made by alternative means, or at an alternative location by delivering the request in writing to our office using the form we provide to you upon request. You have the right to request that we communicate with you in a certain way, for instance with no family member present or through mailed communications that are sealed. ETEA will make every effort to honor your reasonable requests for confidential communications.
- Revoke authorizations that you made previously to use or disclose information (except to the extent information or action has commenced) by delivering a written revocation to our office.
If you want to exercise any of the above rights, please contact ETEA in writing during normal business hours. Our Privacy Officer will provide you with assistance on the steps to take to exercise your rights. You have the right to review this Notice before signing the acknowledgment authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes. ETEA encourages you to express any concerns you may have regarding the privacy of your information. If you have concerns or complaints, please notify us in writing.
| Privacy Contact Officer: | Sarah J Nelson, Executive Director |
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