Privacy Statement
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) 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.
WHO WILL FOLLOW THIS NOTICE
This notice describes the practices of our employees and staff as well as our business partners. These individual may share medical information with each other for the treatment, payment and health care operation purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal and we are committed to protecting your medical information. We will gather medical information about you and will create a record of the care provided to you.
HOW WE MAY USE AND DISCLOSE MEDICAL
INFORMATION ABOUT YOU
FOR TREATMENT:
We may use medical information about you in your treatment. We may disclose medical information about you to doctors and staff who are involved in your care while at the practice. We will make our best efforts to keep your health information as private as possible.
FOR PAYMENT:
We may use and disclose medical 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 your health plan information about treatment you received at the practice so your health plan will pay us or reimburse you for treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
FOR HEALTH CARE OPERATIONS:
We may use and disclose information about you for the general operation of our practice. For example, we sometimes arrange for auditors to review our practices, evaluate our procedures and to tell us how to impove our services. Or we may use and disclose your health information to review the quality of the services provided to you.
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 medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
INDIVIDUALS INVOLVED IN YOUR CARE OR
PAYMENT FOR YOUR CARE:
We may release medical information, with your consent, about you to a friend or family member who is involved in your medical care or who helps pay for your medical care.
AS REQUIRED BY LAW:
We will disclose medical information about you when required to do so by federal, state or local law.
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY:
We may use and disclose medical information about you to prevent a serious threat to your health and safety or the public health and safety or the health and safety of another person. Any disclosure, however, would only be to someone able to help prevent such a threat.
SPECIAL SITUATIONS
ORGAN AND TISSUE DONATION:
If you are an organ donor, we may release medical information to organizations that handle organ procurement to facilitate organ or tissue donation and transportation.
MILITARY AND VETERANS:
If you are a member of the armed forces, we may release medical information about you as required by military authorities. We may use and disclose to components of the Department of Veterans Affairs medical information about you to determine whether you are eligible for certain benefits.
WORKERS’ COMPENSATION:
We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
HEALTH OVERSIGHT ACTIVITIES:
We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
LAWSUITS:
If you are involved in a lawsuit, we may disclose medical information about you in response to a court order. We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS:
We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
INMATES:
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.
YOUR RIGHTS REGARDING MEDICAL
INFORMATION ABOUT YOU
RIGHT TO INSPECT AND COPY:
You have the right to inspect and copy medical information that may be used to make decisions about your care. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request.
RIGHT TO AMEND:
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing. In addition, you must provide a reason that supports your request. We may deny your request if you ask us to amend information that was not created by us, is not part of the medical information kept by us, is not part of the information which you would be permitted to inspect and copy, or is accurate and complete.
RIGHT TO AN ACCOUNTING OF DISCLOSURES:
You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you outside the treatment, payment, operational purposes and without an authorization.
RIGHT TO REQUEST RESTRICTIONS:
You have the right to request a restriction or limitation on the medical information we use or disclose about you. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment of your care, such as a family member or friend. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS:
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will accommodate all reasonable requests. Your requests must specify how or where you wish to be contacted.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint with the practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the practice, contact the Privacy Officer of Ophthalmology Consultants of Fort Wayne, P.C. All complaints must be submitted in writing.
OTHER USES OF MEDICAL INFORMATION:
Other uses and disclosures of medical information not covered by this notice will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.