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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. You have the right to obtain a
paper copy of this Notice upon request.
Patient Health Information
Under federal law, your patient health information is protected
and confidential. Patient health information includes information
about your symptoms, test results, diagnosis, treatment,
and related medical information. Your health information
also includes payment, billing and insurance information.
How We Use Your Patient Health
Information
We use health information about you for treatment, to obtain
payment, and for health care operations, including administrative
purposes and evaluation of the quality of care that you
receive. Under some circumstances, we may be required to
use or disclose the information even without your permission.
Examples of Treatment, Payment,
and Health Care Operations
-
Treatment:
We will use and disclose your health information to provide
you with medical treatment or services. For example, nurses,
physicians, and other members of your treatment team will
record information in your record and use it to determine
the most appropriate course of care. We may also disclose
the information to other health care providers who are
participating in your treatment, to pharmacists who are
filling your prescriptions, and to family members who
are helping with your care.
-
Payment:
We will use and disclose your health information for payment
purposes. For example, we may need to obtain authorization
from your insurance company before providing certain types
of treatment. We will submit bills and maintain records
of payments from your health plan.
-
Health Care Operations:
We will use and disclose your health information to conduct
our standard internal operations, including proper administration
of records, evaluation of the quality of treatment, and
to assess the care and outcomes of your case and others
like it.
Special Uses
We may use your information to contact you with appointment
reminders. We may also contact you to provide information
about treatment alternatives or other health-related benefits
and services that may be of interest to you.
Other Uses and Disclosures
We may use or disclose identifiable health information about
you for other reasons, even without your consent. Subject
to certain requirements, we are permitted to give out health
information without your permission for the following purposes:
-
Required by Law:
We may be required by law to report gunshot wounds, suspected
abuse or neglect, or similar injuries and events.
-
Public Health Activities:
As required by law, we may disclose vital statistics,
diseases, information related to recalls of dangerous
products, and similar information to public health authorities.
-
Health Oversight:
We may be required to disclose information to assist in
investigations and audits, eligibility for government
programs, and similar activities.
-
Judicial and Administrative
Proceedings: We may disclose information in response
to an appropriate subpoena or court order.
-
Law Enforcement
Purposes: Subject to certain restrictions, we
may disclose information required by law
enforcement officials.
-
Deaths:
We may report information regarding deaths to coroners,
medical examiners, funeral directors, and organ donation
agencies.
-
Serious Threat to
Health or Safety: We may use and disclose information
when necessary to prevent a serious threat to your health
and safety or the health and safety of the public or another
person.
-
Military and Special
Government Functions: If you are a member of
the armed forces, we may release information as required
by military command authorities. We may also disclose
information to correctional institutions or for national
security purposes.
-
Research:
We may use or disclose information for approved medical
research.
-
Workers Compensation:
We may release information about you for workers compensation
or similar programs
providing benefits for workrelated injuries or illness.
In any other situation, we will ask for your written authorization
before using or disclosing any identifiable health information
about you. If you choose to sign an authorization to disclose
information, you can later revoke that authorization to
stop any future uses and disclosures.
Individual Rights
You have the following rights with regard to your health
information. Please contact the person listed below to obtain
the appropriate form for exercising these rights.
-
Request Restrictions:
You may request restrictions on certain uses and disclosures
of your health information. We are not required to agree
to such restrictions, but if we do agree, we must abide
by those restrictions.
-
Confidential Communications:
You may ask us to communicate with you confidentially
by, for example, sending
notices to a special address or not using postcards to
remind you of appointments.
-
Inspect and Obtain
Copies: In most cases, you have the right to
look at or get a copy of your health information. There
may be a small charge for the copies.
-
Amend Information:
If you believe that information in your record is incorrect,
or if important information is missing, you have the right
to request that we correct the existing information or
add the missing information.
-
Accounting of Disclosures:
You may request a list of instances where we have disclosed
health information about you for reasons other than treatment,
payment, or health care operations.
Our Legal Duty
We are required by law to protect and maintain the privacy
of your health information, to provide this notice about
our legal duties and privacy practices regarding protected
health information, and to abide by the terms of the notice
currently in effect.
Changes in Privacy Practices
We may change our policies at any time. You can also request
a copy of our notice at any time. For more information,
contact the person listed below.
Complaints
If you are concerned that we have violated your privacy
rights, or if you disagree with a decision we made about
your records, you may contact the person listed below. You
also may send a written complaint to the U.S. Department
of Health and Human Services. The person listed below will
provide you with the appropriate address upon request. You
will not be penalized in any way for filing a complaint.
Contact Person
If you have any questions, requests, or complaints, please
contact:
Visionary Eyecare Center, PLLC
Eric Stamper, Optometrist and Owner
100 Country Club Drive, Suite 106
Hendersonville, Tennessee 37075
Phone: 615-824-4246
Effective
Date
The effective date of this notice is 3/1/08. |
