|
Notice of
Privacy Practices
Middlesex
Eye Physicians, P.C.
400 Saybrook Road
Middletown, Connecticut, 06457
Diane Rosenbower
Privacy Official
860/347-7466
Effective Date:
April 1, 2003
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.
We understand
the importance of privacy, and are committed to maintaining the
confidentiality of your medical information. We make a record of the
medical care we provide, and may receive such records from others. We
use these records to provide or enable other health care providers to
provide quality medical care, to obtain payment for services provided
to you as allowed by your health plan and to enable us to meet our
professional and legal obligations to operate this medical practice
properly. We are required by law to maintain the privacy of protected
health information and to provide individuals with notice of our legal
duties and privacy practices with respect to protected health
information. This notice describes how we may use and disclose your
medical information. It also describes your rights and our legal
obligations with respect to your medical information. If you have any
questions about this Notice, please contact our Privacy Officer listed
above.
A. How
this Medical Practice May Use or Disclose Your Health Information
The law permits us
to use or disclose your health information for the following purposes:
1.
Treatment. We may use medical information about you to provide
your medical care. We disclose medical information to our employees
and others who are involved in providing the care you need. For
example, we may share your medical information with other physicians
or other health care providers who will provide services, which we do
not provide. We may also share this information with a pharmacist
who needs it to dispense a prescription to you, a laboratory that
performs a test or an optical shop or contact lens company who
provides you with glasses or contact lenses.
2.
Payment. We may use and disclose medical information about you
to obtain payment for the services we provide. For example, we may
give your health plan the information it requires before it will pay
us. We may also disclose information to other health care providers
to assist them in obtaining payment for services they have provided to
you.
3.
Health Care Operations. We may use and disclose medical
information about you to operate this medical practice. For example,
we may use and disclose this information to review and improve the
quality of care we provide, or the competence and qualifications of
our professional staff. We may also use and disclose this
information to request that your health plan authorize services or
referrals. We may also use and disclose this information as necessary
for medical reviews, legal services and audits, including fraud and
abuse detection and compliance programs and business planning and
management. We may also share your information with other health care
providers, a health care clearinghouse or health plans that have a
relationship with you. This information may help them with their
quality assessment and improvement activities, their efforts to
improve health or reduce health care costs, their review of
compliance, qualifications and performance of health care
professionals, their training programs, their accreditation,
certification or licensing activities, or their health care fraud and
abuse detection and compliance efforts.
4.
Business Associates. We may share your medical information with
our "business associates", such as our billing service that performs
administrative services for us. We have a written contract with each
of these business associates that contains terms requiring them to
protect the confidentiality of your medical information.
5.
Appointment Reminders. We may use and disclose medical
information to contact and remind you about appointments. If you are
not home, we may leave this information with the person answering the
phone or on your answering machine. We may mail cards to your home.
6. Sign
in sheet. We may ask you to sign in when you arrive at our
office. We may also call out your name when we are ready to see you.
7.
Notification and communication with family. We may disclose your
health information to a family member or a close friend or other
person you identify where relevant to that person’s involvement in
your care or payment for your care. We may disclose your health
information to notify or assist in notifying a family member, your
personal representative or another person responsible for your care
about your location, your general condition or in the event of your
death. In the event of a disaster, we may disclose information to a
relief organization so that they may coordinate these notification
efforts. If you are able and available to agree or object, we will
give you the opportunity to object prior to making these disclosures,
although we may disclose this information in a disaster even over your
objection if we believe it is necessary to respond to the emergency
circumstances. If you are unable or unavailable to agree or object,
our health professionals will use their best judgment in communicating
with your family and others.
8.
Marketing. We may contact you to give you information about
product or services related to your treatment, case management or care
coordination, or to direct or recommend other treatments or
health-related benefits and services that may be of interest to you or
to provide you with small gifts. We may also encourage you to
purchase a product or service when we see you. We will not use or
disclose your medical information for marketing purposes without your
written authorization.
9.
Required by law. As required by law, we will use and disclose
your health information, but we will limit our use or disclosure to
the relevant requirements of the law. When the law requires us to
report abuse, neglect or domestic violence, or respond to judicial or
administrative proceedings, or to law enforcement officials, we will
further comply with the requirement set forth below concerning those
activities.
10.
Public health. We may, and are sometimes required by law to
disclose your health information to public health authorities for
purposes related to: preventing or controlling disease, injury or
disability; reporting child, elder or dependent adult abuse or
neglect; reporting domestic violence; reporting to the Food and Drug
Administration problems with products and reactions to medications;
and reporting disease or infection exposure. When we report suspected
elder or dependent adult abuse or domestic violence, we will inform
you or your personal representative promptly unless in our best
professional judgment, we believe the notification would place you at
risk of serious harm or would require informing a personal
representative we believe is responsible for the abuse or harm.
11.
Health oversight activities. We may, and are sometimes required
by law to disclose your health information to health oversight
agencies during the course of audits, investigations, inspections,
licensure and other proceedings.
12.
Judicial and administrative proceedings. We may, and are
sometimes required by law, to disclose your health information in the
course of any administrative or judicial proceeding to the extent
expressly authorized by a court or administrative order. We may also
disclose information about you in response to a subpoena, discovery
request or other lawful process if reasonable efforts have been made
to notify you of the request and you have not objected, or if your
objections have been resolved by a court or administrative order.
13. Law
enforcement. We may, and are sometimes required by law, to
disclose your health information to a law enforcement official for
purposes such as identifying of locating a suspect, fugitive, material
witness or missing person, complying with a court order, warrant,
grand jury subpoena and other law enforcement purposes.
14.
Coroners. We may, and are often required by law, to disclose your
health information to coroners in connection with their investigations
of deaths.
15.
Organ or tissue donation. We may disclose your health information
to organizations involved in procuring, banking or transplanting
organs and tissues.
16. To
avert a serious threat to health or safety. We may, and are
sometimes required by law, to disclose your health information to
appropriate persons in order to prevent or lessen a serious and
imminent threat to the health or safety of a particular person or the
general public.
17.
Specialized government functions. We may disclose your health
information for military or national security purposes or to
correctional institutions or law enforcement officers that have you in
their lawful custody.
18.
Worker’s compensation. We may disclose your health information as
necessary to comply with worker’s compensation laws. For example, to
the extent your care is covered by workers' compensation, we will make
periodic reports to your employer about your condition. We are also
required by law to report cases of occupational injury or occupational
illness to the employer or workers' compensation insurer.
19.
Change of Ownership. In the event that this medical practice is
sold or merged with another organization, your health
information/record may be transferred the new owner, although you will
maintain the right to request that copies of your health information
be transferred to another physician or medical group.
B. When
This Medical Practice May Not Use or Disclose Your Health Information
Except as
described in this Notice of Privacy Practices, this medical practice
will not use or disclose health information, which identifies you
without your written authorization. If you do authorize this medical
practice to use or disclose your health information for another
purpose, you may revoke your authorization in writing at any time,
except to the extent that we have already taken action in
reliance on the authorization.
C. Your
Health Information Rights
1.
Right to Request Special Privacy Protections. You have the right
to request restrictions on certain uses and disclosures of your health
information, by submitting a written request specifying what
information you want to limit and what limitations on our use or
disclosure of that information you wish to have imposed. We reserve
the right to accept or reject your request, and will notify you of our
decision.
2.
Right to Request Confidential Communications. You have the right
to request that you receive your health information in a specific way
or at a specific location. For example, you may ask that we send
information to a particular address or to your work address. We will
comply with all reasonable requests submitted in writing which specify
how or where you wish to receive these communications.
3.
Right to Inspect and Copy. You have the right to inspect and copy
your health information, with limited exceptions. To access your
medical information, you must submit a written request detailing what
information you want access to and whether you want to inspect it or
get a copy of it. We will charge a reasonable fee, as allowed by
Connecticut law. We may deny your request under limited
circumstances.
4.
Right to Amend or Supplement. You have a right to request that we
amend your health information that you believe is incorrect or
incomplete. You must make a request to amend in writing, and include
the reasons you believe the information is inaccurate or incomplete.
We are not required to change your health information, and will
provide you with information about this medical practice's denial and
how you can disagree with the denial. We may deny your request if we
do not have the information, if we did not create the information
(unless the person or entity that created the information is no longer
available to make the amendment), if you would not be permitted to
inspect or copy the information at issue, or if the information is
accurate and complete as is.
5.
Right to an Accounting of Disclosures. You have a right to
receive an accounting of disclosures of your health information made
by this medical practice, except that this medical practice does not
have to account for the disclosures provided to you or pursuant to
your written authorization, or as described in paragraphs 1
(treatment), 2 (payment), 3 (health care operations), 7 (notification
and communication with family) and 17 (certain government functions)
of Section A of this Notice of Privacy Practices or disclosures of
data which exclude direct patient identifiers for purposes of research
or public health or disclosures which are incident to a use or
disclosure otherwise permitted or authorized by law, or the
disclosures to a health oversight agency or law enforcement official
to the extent this medical practice has received notice from that
agency or official that providing this accounting would be reasonably
likely to impede their activities and certain other disclosures.
6.
Right to Receive a Notice of Privacy Practices. You have a right
to receive a paper copy of this Notice of Privacy Practices, even if
you have previously requested its receipt by mail.
If you would like
to have a more detailed explanation of these rights or if you would
like to exercise one or more of these rights, contact our Privacy
Officer listed at the top of this Notice of Privacy Practices.
D.
Special Rules Regarding Disclosure of Psychiatric, Substance Abuse and
HIV-Related Information
Under Connecticut
or federal law, additional restrictions may apply to disclosures of
health information that relates to care for psychiatric conditions,
substance abuse or HIV-related testing and treatment. This
information may not be disclosed without your specific written
permission, except as may be specifically required or permitted by
Connecticut or federal law. The following are examples of disclosures
that may be made without your specific written permission:
-
Psychiatric
information.
We may disclose psychiatric information to a mental health program
if needed for your diagnosis or treatment. We may also disclose
very limited psychiatric information for payment purposes.
-
HIV-related
information.
We may disclose HIV-related information for purposes of treatment or
payment.
-
Substance abuse
treatment.
We may disclose information obtained from a substance abuse program
in an emergency.
E.
Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice
of Privacy Practices at any time in the future. Until such amendment
is made, we are required by law to comply with this Notice. After an
amendment is made, the revised Notice of Privacy Protections will
apply to all protected health information that we maintain, regardless
of when it was created or received. We will keep a copy of the
current notice posted in our reception area, and provide you with a
copy upon request. We will also post the current notice on our
website.
F.
Complaints
Complaints about
this Notice of Privacy Practices or how this medical practice handles
your health information should be directed to our Privacy Officer
listed at the top of this Notice of Privacy Practices.
You may also submit a complaint to:
Department of
Health and Human Services
Office of Civil
Rights
Hubert H. Humphrey
Bldg.
200 Independence
Avenue, S.W.
Room 509F HHH
Building
Washington, DC
20201
You will not be
penalized for filing a complaint.
|
