| |
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.
|
| |
|
|
