Morganton Eye
Physicians, PA
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.
If You Have Any
Questions about This Notice Please Contact: Privacy Officer at 828-433-1000
“Protected
health information” (PHI) is information about you that may identify you and
that relates to your physical health. We understand that your health information
is personal and we are committed to protecting any medical or personal
information that is provided to us. This Notice of Privacy Practices (Notice)
describes how we may use your information as well as your rights to access and
control your protected health information.
In
the ordinary course of receiving treatment and health care services from us, you
will provide us with personal information such as:
§
Your
name, address, telephone number, social security number
§
Information
relating to your medical history
§
Your
insurance information and coverage
§
Information
concerning your family doctor or other medical providers
We
will create a record of the care we provide to you. In addition, other health
care providers may supply us with information about you.
We
are required by law to maintain the privacy of your health information, and to
give you this Notice describing our legal duties and privacy practices. We are
required to follow the terms of the Notice currently in effect.
HOW
WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
We will not use or disclose your health information without your authorization, except in the following situations:
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.
Treatment
We
will use and disclose your protected health information to provide, coordinate,
or manage your health care and any related services. For example, we would
disclose your protected health information, as necessary, to a home health
agency that provides care to you. We will also disclose protected health
information to other physicians who may be treating you. Your protected health
information may be provided to a physician to whom you have been referred to
ensure that the physician has the necessary information to diagnose or treat
you. In addition, we may disclose your protected health information from
time-to-time to another physician or health care provider (e.g., a specialist or
laboratory) who, at the request of your physician, becomes involved in your care
by providing assistance with your health care diagnosis or treatment to your
physician.
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 your insurance payer information about your current medical condition so
we may get reimbursed for services we have provided 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 by your plan.
Healthcare
Operations
§
We may
use or disclose information about you for the general operations of our
business. For example, we sometimes arrange for auditors or other consultants to
review our practices, evaluate our operations, and advise us how to improve our
services. We may also use or disclose your health information to review the
quality of services provided to you.
§
Your
health information may also be disclosed for staff and student training at our
office. We may also call you by name in the waiting room when your physician is
ready to see you. We may use or disclose your protected health information, as
necessary, to contact you to remind you of your appointment. This may include
leaving a message on your answering machine or with a relative as well as
sending a reminder card in the mail.
§
We may
use your protected health information, as necessary, to provide you with
information about our products, services, treatment alternatives or other
health-related benefits that may be of interest to you. We may also use your
name and address to send you a newsletter about the products and services we
offer. We may send you information about products or services that we believe
may be beneficial to you. You may
request not to receive marketing and advertisement materials by contacting our
privacy officer.
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. Public health authorities include, but are not limited to, state and local health departments, the CDC, the FDA, the EPA, and OSHA.
§
We may
disclose PHI to a person subject to the FDA’s power to report adverse events,
product defects or problems, or biological product deviations, to track
products, to enable recalls, repairs, or replacements.
§
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 or the workplace or to evaluate whether an
individual has a work-related injury or illness.
§
We may
disclose PHI when we reasonably believe a patient is a victim of abuse, neglect
or domestic violence to the governmental entity or agency authorized to receive
such information. We are also permitted to disclose PHI to agencies authorized
by law to receive reports of child abuse or neglect.
§
We may
disclose PHI to a health oversight agency for activities authorized by law, such
as audits, investigations, and inspections. Oversight agencies seeking this
information include government agencies that oversee the health care system,
government benefit programs, other government regulatory programs and civil
rights laws.
§
We may
also disclose PHI, 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. We are permitted to make disclosures about victims of crimes to
authorized law enforcement agencies.
§
We may
release a patient’s health information to a coroner or medical examiner to
identify a deceased person or determine the cause of death. We may also release
health information to organ procurement organizations, transplant centers, or
eye banks, if you are an organ donor.
§
We may
release PHI to workers’ compensation or similar programs, which provide
benefits for work-related injuries or illness without regard to fault.
§
PHI may
be disclosed when necessary to prevent a serious threat to a patient’s health
or safety.
§
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 may also
release health information about foreign military personnel to their appropriate
foreign military authority.
§
We may
disclose PHI in the course of any judicial or administrative proceeding, in
response to an order of a court or administrative tribunal (to the extent such
disclosure is expressly authorized), in certain conditions in response to a
subpoena, discovery request or other lawful process.
§
We may
release health information to a correctional institution where a patient is
incarcerated or to law enforcement officials in certain situations such as where
the information is necessary for the patient’s treatment, health or safety, or
the health or safety of others.
§
We may
disclose PHI 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.
We
work with outside individuals and businesses that help us operate our business
successfully. Such business associates, for example, may include billing
agencies. We may disclose PHI to these business associates so that they can
perform the tasks that we hire them to do. Our business associates must sign a
written contract to respect the confidentiality of your personal and
identifiable health information.
Others
Involved in Your Healthcare
Unless
you object, we may disclose your PHI to a relative, friend, or any person you
identify as directly involved in your health care. If you are unable to agree or
object to such a disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional judgment.
We may use or disclose PHI to notify or assist in notifying a family member,
personal representative or any other person that is responsible for your care of
your location, general condition or death. We may also use or disclose your PHI
to an authorized public or private entity to assist in disaster relief efforts
and to coordinate uses and disclosures to family or other individuals involved
in your health care.
We
may use or disclose your protected health information 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. If your
physician or another physician in the practice is required by law to treat you
and the physician has attempted to obtain your consent but is unable to obtain
your consent, he or she may still use or disclose your protected health
information to treat you.
YOUR
RIGHTS
§
You may
ask us not to use or disclose any part of your protected health information for
the purposes of treatment, payment or healthcare operations. You may also
request that any part of your protected health information not be disclosed to
family members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. Your request must
state the specific restriction requested and to whom you want the restriction to
apply. We will consider your request, but we are not required to accept it. If
your physician believes it is in your best interest to permit use and disclosure
of your protected health information, your protected health information will not
be restricted.
§ You have the right to request to receive communications containing your protected health information by alternative means or at an alternative location. For example, you may ask that we only contact you at home or by mail. We will accommodate any reasonable requests that are made in writing to our Privacy Officer.
§
You have the right to inspect and copy medical, billing, and other
records used to make decisions about you. When permitted by law, we may deny an
individual’s request to inspect and copy PHI. Depending on the circumstances,
you may have a right to have this decision reviewed. We may charge you a
cost-based fee for copying and mailing.
§ If you believe that information in your records is incorrect or incomplete, you have the right to ask your doctor to correct the existing information or add missing information. This means you may request an amendment of your health information. The request must be in writing and include the reason for making the request. We have a request form available upon request. In certain cases, we may deny your request. If we deny your request, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement. We will provide you with a copy of any such rebuttal.
§ You have the right to receive a list of instances when we have used or disclosed your medical information. We are not required to include disclosures used for your treatment, to collect payment for services furnished to you, our healthcare operations, disclosures we have made to you, to family members or friends involved in your care. You have the right to receive specific information regarding disclosures occurring after April 14, 2003. If you ask for this information more than once every twelve months, we may charge you a fee.
Questions, complaints, or requests for further information to: Privacy Officer
335 East Parker Road Morganton, NC 28655
828-433-1000
email:
privacyofficer@morgantoneye.com
COMPLAINTS
We
will not retaliate against you for filing a complaint. If
you believe that your privacy rights have been violated, we have a form you may
submit a complaint to our privacy officer or you may call (828)
433-1000. You may also submit a complaint to:
The Secretary of Health and Human
Services
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. Upon request, we will provide you with a revised Notice of Privacy Practices. You may request a revised copy by calling our office and requesting that a copy be sent to you in the mail, asking for one at the time of your next appointment, or by accessing our website www.morgantoneye.com
You
have the right to obtain a paper copy of this notice from us. You may ask us for
a copy at any time.
This
notice was published and becomes effective on
April 14, 2003.