SPRING RIDGE FAMILY EYECARE 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.
The Health Insurance Portability & Accountability Act of 1996
("HIPAA") is a federal program that requires that all
medical records and other individually identifiable health information
used or disclosed by us in any form, whether electronically, on
paper, or orally, are kept properly confidential. This Act gives
you, the patient, significant new rights to understand and control
how your health information is used. "HIPAA" provides
penalties for covered entities that misuse personal health information.
As required by "HIPAA", we have prepared this explanation
of how we are required to maintain the privacy of your health information
and how we may use and disclose your health information.
We may use and disclose your medical records only for each of the
following purposes: treatment, payment and health care operations.
Treatment means providing, coordinating, or managing healthcare
and related services by one or more healthcare providers. An example
of would be a comprehensive eye exam.
Payment means such activities as obtaining reimbursement for services,
confirming coverage, billing or collection activities, and utilization
review. An example of this would be sending a bill for your visit
to your insurance company for payment.
Health care operations include the business aspects of running
our practice, such as conducting quality assessment and improvement
activities, auditing functions, cost-management analysis, and customer
service. An example would be an internal quality assessment review.
We may also create and distribute de-identified health information
by removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information
about treatment alternatives or other health-related benefits and
services that may be of interest to you.
Any other uses and disclosures will be made only with your written
authorization. You may revoke such authorization in writing and
we are required to honor and abide by that written request, except
to the extent that we have already taken actions relying on your
authorization.
You have the following rights with respect to your protected health
information, which you can exercise by presenting a written request
to the Privacy Officer:
- The right to request restrictions on certain uses and disclosures
of protected health information, including those related to disclosures
to family members, other relatives, close personal friends, or
any other person identified by you. We are, however, not required
to agree to a requested restriction. If we do agree to a restriction,
we must abide by it unless you agree in writing to remove it.
- The right to reasonable requests to receive confidential communications
of protected health information from us by alternative means or
at alternative locations.
- The right to Inspect and copy your protected health information.
- The right to amend your protected health information.
- The right to receive an accounting of disclosures of protected
health information,
- The right to obtain a paper copy of this notice from us upon
request.
We are required by law to maintain the privacy of your protected
health information and to provide you with notice of our legal duties
and privacy practices with respect to protected health information.
This notice is effective as of April 15, 2003 and we are required
to abide by the terms of the Notice of Privacy Practices currently
in effect. We reserve the right to change the terms of our Notice
of Privacy Practices and to make the new notice provisions effective
for all protected health information that we maintain. We will post
and you may request a written copy of a revised Notice of Privacy
Practices from this office.
You have recourse if you feel that your privacy protections have
been violated. You have the right to file written complaint with
our office, or with the Department of Health & Human Services,
Office of Civil Rights, about violations of the provisions of this
notice or the policies and procedures of our office. We will not
retaliate against you for filing a complaint.
Please contact us for more information:
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Service
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775
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