Notice
of Privacy Practices
Effective Date April 14th, 2003
Eger
Eye Group, P.C.
1501 State Avenue Coraopolis, PA 15108
Phone: 412-264-8830 Fax: 412-269-7766 E-mail: yoursight@egereye.com
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 health information
that identifies you private. We are obligated by law
to give you notice of our privacy practices. This
Notice describes how we protect your health information
and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your
health information is for treatment, payment or health
care operations. Examples of how we use or disclose
information for treatment purposes are: setting up
an appointment for you; testing or examining your
eyes; prescribing glasses, contact lenses, or eye
medications and faxing them to be filled; showing
you low vision aids; referring you to another doctor
or clinic for eye care or low vision aids or services;
or getting copies of your health information from
another professional that you may have seen before
us. Examples of how we use or disclose your health
information for payment purposes are: asking you about
your health or vision care plans, or other sources
of payment; preparing and sending bills or claims;
and collecting unpaid amounts (either ourselves or
through a collection agency or attorney). "Health
care operations" mean those administrative and
managerial functions that we have to do in order to
run our office. Examples of how we use or disclose
your health information for health care operations
are: financial or billing audits; internal quality
assurance; personnel decisions; participation in managed
care plans; defense of legal matters; business planning;
and outside storage of our records.
We routinely use your health information inside our
office for these purposes without any special permission.
If we need to disclose your health information outside
of our office for these reasons, we usually will not
ask you for special written permission.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT
PERMISSION
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 come up at our office
at all. Such uses or disclosures are:
-
when a state or federal law mandates that certain
health information be reported for a specific purpose;
-
for public health purposes, such as contagious disease
reporting, investigation or surveillance; and notices
to and from the federal Food and Drug Administration
regarding drugs or medical devices;
-
disclosures to governmental authorities about victims
of suspected abuse, neglect or domestic violence;
-
uses and disclosures for health oversight activities,
such as for the licensing of doctors; for audits
by Medicare or Medicaid; or for investigation of
possible violations of health care laws;
-
disclosures for judicial and administrative proceedings,
such as in response to subpoenas or orders of courts
or administrative agencies;
-
disclosures for law enforcement purposes, such as
to provide information about someone who is or is
suspected to be a victim of a crime; to provide
information about a crime at our office; or to report
a crime that happened somewhere else;
-
disclosure to a medical examiner to identify a dead
person or to determine the cause of death; or to
funeral directors to aid in burial; or to organizations
that handle organ or tissue donations;
-
uses or disclosures for health related research;
-
uses and disclosures to prevent a serious threat
to health or safety;
-
uses or disclosures for specialized government functions,
such as for the protection of the president or high
ranking government officials; for lawful national
intelligence activities; for military purposes;
or for the evaluation and health of members of the
foreign service;
-
disclosures of de-identified information;
-
disclosures relating to worker's compensation programs;
-
disclosures of a "limited data set" for
research, public health, or health care operations;
-
incidental disclosures that are an unavoidable by-product
of permitted uses or disclosures;
-
disclosures to "business associates" who
perform health care operations for us and who commit
to respect the privacy of your health information;
Unless
you object, we will also share relevant information
about your care with your family or friends who are
helping you with your eye care.
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled appointments,
or that it is time to make a routine appointment. We
may also call or write to notify you of other treatments
or services available at our office that might help
you. Unless you tell us otherwise, we will mail you
an appointment reminder on a post card, and/or leave
you a reminder message on your home answering machine
or with someone who answers your phone if you are not
home.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your
health information unless you sign a written "authorization
form." The content of an "authorization form"
is determined by federal law. Sometimes, we may initiate
the authorization process if the use or disclosure is
our idea. Sometimes, you may initiate the process if
it's your idea for us to send your information to someone
else. Typically, in this situation you will give us
a properly completed authorization form, or you can
use one of ours.
If we initiate the process and ask you to sign an authorization
form, you do not have to sign it. If you do not sign
the authorization, we cannot make the use or disclosure.
If you do sign one, you may revoke it at any time unless
we have already acted in reliance upon it. Revocations
must be in writing. Send them to the office named at
the beginning of this Notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding your health
information. You can:
- ask us to restrict our uses and disclosures for purposes
of treatment (except emergency treatment), payment
or health care operations. We do not have to agree
to do this, but if we agree, we must honor the restrictions
that you want. To ask for a restriction, send a written
request to the office contact person at the address
or fax shown at the beginning of this Notice.
- 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 E Mail address.
We will accommodate these requests if they are reasonable,
and if you pay us for any extra cost. If you want
to ask for confidential communications, send a written
request to the office at the address or fax shown
at the beginning of this Notice.
- ask to see or to get photocopies of your health information.
By law, there are a few limited situations in which
we can refuse to permit access or copying. For the
most part, however, you will be able to review or
have a copy of your health information within 30 days
of asking us (or sixty days if the information is
stored off-site). You may have to pay for photocopies
in advance. If we deny your request, we will send
you a written explanation, and instructions about
how to get an impartial review of our denial if one
is legally available. By law, we can have one 30 day
extension of the time for us to give you access or
photocopies if we send you a written notice of the
extension. If you want to review or get photocopies
of your health information, send a written request
to the office at the address or fax shown at the beginning
of this Notice.
- ask us to amend your health information if you think
that it is incorrect or incomplete. If we agree, we
will amend the information within 60 days from when
you ask us. We will send the corrected information
to persons who we know got the wrong information,
and others that you specify. If we do not agree, you
can write a statement of your position, and we will
include it with your health information along with
any rebuttal statement that we may write. Once your
statement of position and/or our rebuttal 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 the office at the address or fax shown at the beginning
of this Notice.
- get a list of the disclosures that we have made of
your health information within the past six years
(or a shorter period if you want). By law, the list
will not include: disclosures for purposes of treatment,
payment or health care operations; disclosures with
your authorization; incidental disclosures; disclosures
required by law; and some other limited disclosures.
You are entitled to one such list per year without
charge. If you want more frequent lists, you will
have to pay for them in advance. We will usually respond
to your request within 60 days of receiving it, but
by law we can have one 30 day extension of time if
we notify you of the extension in writing. If you
want a list, send a written request to the office
at the address or fax shown at the beginning of this
Notice.
- get additional paper copies of this Notice of Privacy
Practices upon request. It does not matter whether
you got one electronically or in paper form already.
If you want additional paper copies, send a written
request to the office at the address or fax 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 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, have copies
available in our office, and post it on our Web site
(www. EgerEye.com).
COMPLAINTS
If you think that we have not properly respected the
privacy of your health information, you are free to
complain to us or 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
the office at the address or fax shown at the beginning
of this Notice. If you prefer, you can discuss your
complaint in person or by phone.
FOR MORE INFORMATION
If you want more information about our privacy practices,
call or visit the office contact person (Kathy) at the
address or phone number shown at the beginning of this
Notice.
|
