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Valley Eye Specialists provides this Notice to comply with the
Privacy Regulations issued by the Department of Health and Human
Services in accordance with the Health Insurance Portability and
Accountability Act of 1996 (HIPPA).
We understand that your medical information is personal to you
and we are committed to protecting the information about you. As
our patient, we create paper and electronic medical records about
your health, our care for you, and the services and/or items we
provide to you as our patient. We need this record to provide for
your care and to comply with certain legal requirements.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU
The following categories describe different ways that we use and
disclose protected health information that we have and share with
others. Each category of uses or disclosures provides a general
explanation and provides some examples of uses. Not every use or
disclosure in a category is either listed or actually in place.
The explanation is provided for your general information only.
a. Medical Treatment. We use previously given medical
information about you to provide you with current or prospective
medical treatment or services. Therefore we may, and most likely
will disclose medical information about you to doctors, nurses,
technicians, medical students, or hospital personnel who are involved
in taking care of you. For example, a doctor to whom we refer you
for ongoing or further care may need your medical record. We may
also discuss your medical information with you to recommend possible
treatment options or alternatives that may be of interest to you.
We also may disclose medical information about you to people outside
the Practice who may be involved in your medical care after you
leave the practice; this may include your family members, or other
personal representatives authorized by you or by a legal mandate
(a guardian or other person who has been named to handle your medical
decisions, should you become incompetent).
b. Payment. We may use and disclose medical information
about you for services and procedures so that they may be billed
and collected from your insurance company, or any other third party.
For example, we may need to give your health care information, about
treatment you received at Valley Eye Specialists to obtain payment
or reimbursement for the care. We may also tell your health plan
and\or referring physician about a treatment you are going to receive
to obtain prior approval or to determine whether your plan will
cover the treatment, to facilitate payment of a referring physician,
or the like.
c. Health Care Operations. We may use and disclose
medical information about you so that we can run our Practice more
efficiently and make sure that all of our patients receive quality
care. These uses may include reviewing our treatment and services
to evaluate the performance of our staff, deciding what additional
services to offer and where, deciding what services are not needed,
and whether certain new treatments are effective. We may also disclose
information to other medical personnel for review and learning purposes.
We may combine the medical information we have with medical information
from other practices to compare how we are doing and see where we
can make improvements in the care and services we offer. We may
remove information that identifies you from this set of medical
information so others may use it to study health care and health
care delivery without learning who the specific patients are.
d. Appointment and Patient Recall Reminders. We
may ask that you sign in writing at the Receptionists’ Desk,
a “Sign In’ log on the day of your appointment with
the practice. We may use and disclose medical information to contact
you as a reminder that you have an appointment for medical care
with Valley Eye Specialists or that you are due to receive periodic
care from Valley Eye Specialists. This contact may be by phone,
in writing, e-mail, or otherwise and may involve the leaving an
e-mail message, a message on an answering machine, or otherwise
which could (potentially) be received or intercepted by others.
e. Emergency Situations. In addition, we may disclose
medical information about you to an organization assisting in a
disaster relief effort or in an emergency situation so that your
family can be notified about your condition, status and location.
f. Required by Law. We will disclose medical information
about you when required to do so by federal, state or local law.
g. To Avert a Serious Threat to Health or Safety.
We may use and disclose medical information about you when necessary
to prevent a serious threat either to your specified health and
safety or the health and safety of the public or another person.
Any disclosure, however, would only be to someone able to help prevent
the threat.
h. 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.
i. Public Health Risks. Law or public policy may
require us to disclose medical information about you for public
health activities. The activities generally include the following:
1. to prevent or control disease, injury or disability.
2. to report child abuse or neglect.
3. to report reactions to medications or problems with products.
4. to notify people of recalls of products they may be using.
5. to notify a person who may have been exposed to a disease or
may be at risk for contracting or spreading a disease or condition.
6. to notify the appropriate government authority if we believe
a patient has been the victim of abuse, neglect or domestic violence.
j. Investigation and Government Activities. We
may disclose medical information to a local, state or federal agency
for activities authorized by law. These oversight activities include,
for example, audits, investigations, inspections, and licensure.
These activities are necessary for the payor, the government and
other regulatory agencies to monitor the health care systems, government
programs, and compliance with civil rights laws.
k. Lawsuits and Disputes. If you are involved
in a lawsuit or a dispute, we may disclose medical information about
you in response to a court or administrative order. This is especially
true if you make your health an issue. We may also disclose medical
information about you in response to a subpoena, discovery request,
or other lawful process by someone else involved in a dispute. We
shall attempt in these cases to tell you about the request so that
you may obtain an order protecting the information requested if
you so desire. We may also use such information to defend ourselves
or any member of our practice in any actual or threatened action.
l. Law Enforcement. We may release
medical information if asked to do so by a law enforcement official:
1. In response to a court order, subpoena, warrant, summons or similar
process;
2. to identify or locate a suspect, fugitive, material witness or
missing person;
3. about the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person’s agreement
4. about a death we believe may be the result of criminal conduct;
5. about criminal conduct at the practice; and
6. in emergency circumstances to report a crime; the location of
the crime or victims; or the identity, description or location of
the person who committed the crime.
m. Inmates. If you are an inmate
of a correctional institution or under the custody of the law enforcement
official, we may release medical information about you to the correctional
institution or law enforcement official. This release would be necessary
for the institution to provide you with health care, to protect
your health and safety or the health and safety of others; or for
the safety and security of the correctional institution.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We reserve
the right to make the revised or changed notice effective for medical
information we already have about you as well as any information
we may receive from you in the future. We will post a copy of the
current notice in the Practice. The notice will contain on the first
page, in the top right hand corner, the date of the last revision
and effective date. In addition, each time you visit the practice
for treatment or health care services you may request a copy of
the current notice in effect.
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 our office manager, who will direct you on
how to file an office complaint. All complaints must be submitted
in writing, and all complaints shall be investigated, without repercussion
to you.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by
this notice or the laws that apply to us will be made only with
your written permission, unless those uses can be reasonably inferred
from the intended uses above. If you have provided us with your
permission to use or disclose medical information about you, you
may revoke that permission, in writing, at any time. If you revoke
your permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization.
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.
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