NOTICE OF PRIVACY PRACTICES
Effective June 1, 2013
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 respect our legal obligation to keep private health information that identifies you. The law obligates us to give you notice of our legal duties regarding protection of your health information and our privacy practices, and to notify you if a breach involving unsecured health information occurs in spite of our privacy and security practices.
Generally, we can only use your health information in our office or disclose it outside of our office, without your written permission for purposes of treatment, payment or healthcare operations. In most other situations, we will not use or disclose your health information unless you sign a written authorization form. In some limited situations, the law allows or requires us to disclose your health information without written authorization.
Uses or Disclosures of Health Information
Examples of how we use information for treatment purposes:
We may disclose your health information outside of our office for treatment purposes, for example:
Sometimes we may ask for copies of your health information from another professional that you may have seen before.
We may use your health information within our office or disclose your health information outside of our office for payment purposes. Some examples are:
We use and disclose your health information for healthcare operations in a number of ways. Health care operations means those administrative and managerial functions that we have to do in order to run our office. We may use or disclose your health information, for example, for financial or billing audits, for internal quality assurance, for personnel decisions, to enable our doctors to participate in managed care plans, for the defense of legal matters, to develop business plans, and for outside storage of our records.
We may call to remind you of scheduled appointments. We may also call to notify you of other treatments or services available at our office that might help you.
Uses & Disclosures without an Authorization
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never happen at our office at all. Such uses or disclosures are:
We will not make any other uses or disclosures of your health information unless you sign a written authorization form. You do not have to sign such a form. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it.
Your Rights Regarding Your Health Information
The law gives you many rights regarding your health information.
You can ask us to communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing health information to a different address, or by using e-mail to your personal email address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. To request confidential communications, please send a written request to Eye Carumba Optometry at the address, fax or e-mail shown at the beginning of this notice.
You can ask to see or to get photocopies of your health information. You will be able to review your health information during normal business hours at our office within five working days of asking us. You may also request copies of your information, which will be provided to you within 15 days of your request. You may have to pay for photocopies in advance. If you want to review or get photocopies of your health information, send a written request to Eye Carumba Optometry at the address, fax or e-mail shown at the beginning of this notice.
You can ask us to attach an addendum to your health information if you think that it is incorrect or incomplete. We will place your addendum in your record within 60 days from when you ask us. We will send corrected information to persons who we know got the wrong information, and others that you specify. Once your addendum is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law, we can have one 30-day extension of time to consider a request for amendment if we notify you in writing of the extension. If you want to ask us to amend your health information, send a written request, including your reasons for the amendment, to Eye Carumba Optometry at the address, fax or e-mail shown at the beginning of this notice.
Our Notice of Privacy Practices
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time in compliance with and as allowed by law. If we change this notice, the new privacy practices will apply to your health information that we already have, as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office and have copies for you to take.
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to Eye Carumba Optometry at the address, fax or e-mail shown at the beginning of this notice.
For More Information
If you want more information about our privacy practices, call or visit Eye Carumba Optometry at the phone number/address at the beginning of this notice.