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OPHTHALMIC
ASSOCIATES, aPC This Policy is
also downloadable in PDF format by clicking
here. NOTICE OF
PRIVACY INFORMATION PRACTICES THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS
INFORMATION. THIS NOTICE APPLIES TO ALL OF
THE RECORDS OF YOUR CARE GENERATED BY
OPHTHALMIC ASSOCIATES, WHETHER MADE BY
OPHTHALMIC ASSOCIATES OR AN ASSOCIATED
FACILITY. PLEASE REVIEW IT
CAREFULLY. A.
PURPOSE OF THE NOTICE. Ophthalmic
Associates (Practice) is committed to preserving
the privacy and confidentiality of your health
information which is created and/or maintained at
our clinic. State and federal laws and regulations
require us to implement policies and procedures to
safeguard the privacy of your health information.
This Notice will provide you with information
regarding our privacy practices and applies to all
of your health information created and/or
maintained at our clinic, including any information
that we receive from other health care providers or
facilities. The Notice describes the ways in which
we may use or disclose your health information and
also describes your rights and our obligations
concerning such uses or disclosures. The Practice
provides this Notice to comply with the Privacy
Regulations issued by the Department of Health and
Human Services in accordance with the Health
Insurance Portability and Accountability Act of
1996 (HIPAA). We will abide by
the terms of this Notice, including any future
revisions that we may make to the Notice as
required or authorized by law. We reserve the right
to change this Notice and to make the revised or
changed Notice effective for health information we
already have about you as well as any information
we receive in the future. We will post a copy of
the current Notice, which will identify its
effective date, in our clinic and on our website at
akeyedoc.com. The privacy
practices described in this Notice will be followed
by: The individuals
identified above will share your health information
with each other for purposes of treatment, payment
and health care operations, as further described in
the Notice. We are required
by law to: B.
USES AND DISCLOSURES OF HEALTH INFORMATION
FOR TREATMENT, PAYMENT AND HEALTH CARE
OPERATIONS. 1. The Use and
Disclosure of Medical Information for Treatment,
Payment and Health Care Operations. By law we
are allowed to use and disclose your medical
information for most purposes related to your
medical ("Treatment"), the payment for your medical
treatment ("Payment"), and our health care
operations or the operations of other covered
entities to whom we disclose your medical
information ("Operations"). a.
Treatment means the provision, coordination or
management of health care and related services by
or involving one or more health care providers,
such as the coordination of consultations and
referrals. For example, we can share most medical
information regarding your health condition with
another provider as part of a consultation. We may
also contact you to remind you to make or that you
already made an appointment; to notify you
regarding treatment alternatives or other
health-related benefits and services that may be of
interest to you. Please note that
by law, certain medical information, such as
psychotherapy notes, generally may not be used or
shared even when it is related to your treatment,
unless we obtain an Authorization from you to use
or release that information. b. Payment
means activities related to obtaining reimbursement
from insurers or other payers for services provided
to you. Payment can also cover activities to
determine your eligibility for services with your
insurer, coordination of benefits with other
insurers, billing, claims management, collection,
medical necessity review activities, and disclosure
to consumer reporting agencies. For examples, we
can disclose to your health plan medical
information that is required by the plan to
determine whether the services we have provided to
you are medically necessary. We can also disclose
to your health plan a list of the services that you
obtained from us so that we can be paid by the
health plan for providing the services to you.
c.
Operations cover a range of activities that are
necessary for the business of health care
providers, payors or clearinghouses (i.e., entities
performing certain billing or payment functions).
They may be performed by our employees or, in some
cases, by third-party contractors. These operations
include: quality assessment and improvement
activities, peer review; credentialing and
licensing; training programs; legal and financial
services; business planning and development,
management activities related to privacy practices;
customer services, internal grievances; creating
de-identified information for data aggregation or
other purposes; certain marketing activities; and
due diligence activities. For example, we evaluate
practitioner performance to ensure that they meet
our quality standards. Engaging counsel to defend
us in a legal action is another activity that is
considered health care operations. C.
AUTHORIZATIONS FOR OTHER USES AND
DISCLOSURES OF YOUR MEDICAL
INFORMATION 1. Unless
a use or disclosure is permitted for treatment,
payment or operations purposes under Section B of
this Notice, or is permitted or required under this
Notice, we must obtain a signed Authorization from
you to use or disclose your medical information. We
may also require an Authorization when using or
disclosing certain highly protected information,
such as substance abuse information. An
Authorization is a written permission that
specifically identifies the information that we
will use or disclose, and when and how we will use
or disclose it. You may revoke an Authorization at
any time except to the extent that we have already
used or disclosed your information in reliance on
your Authorization. D.
USES AND DISCLOSURES OF HEALTH INFORMATION
IN SPECIAL SITUATIONS We may use or
disclose your health information in certain special
situations as described below. For these
situations, you have the right to limit these uses
and disclosures as provided for in this Notice.
1. Appointment
Reminders. We may use or disclose your health
information for purposes of contacting you to
remind you of a health care appointment. 2.
Prescriptions. We may disclose your health
information for purposes of releasing to your
optician or pharmacist prescriptions for
eyeglasses, contact lens, and ocular related
medications as prescribed by the practice doctors.
3. Family
Members and Friends. We may disclose your
health information to individuals, such as family
members and friends, who are involved in your care
or who help pay for your care. We may make such
disclosures when: (a) we have your verbal agreement
to do so; (b) we make such disclosures and you do
not object; or (c) we can infer from the
circumstances that you would not object to such
disclosures. For example, if your spouse comes into
the exam room with you, we will assume that you
agree to our disclosure of your information while
your spouse is present in the room. We also may
disclose your health information to family members
or friends in instances when you are unable to
agree or object to such disclosures, provided that
we feel it is in your best interests to make such
disclosures and the disclosures relate to that
family member or friend's involvement in your care.
For example, if you present to our clinic with an
emergency medical condition, we may share
information with the family member or friend that
comes with you to our clinic. We also may share
your health information with a family member or
friend who calls us to request a prescription
refill for you. 4. For
Disaster Relief. We may use or disclose a
limited amount of your health information to an
entity that assists in disaster relief
efforts E.
OTHER PERMITTED OR REQUIRED USES AND
DISCLOSURES OF HEALTH
INFORMATION. There are certain
instances in which we may be required or permitted
by law to use or disclose your health information
without your permission. These instances are as
follows: 1. As required
by law. We may disclose your health information
when required by federal, state, or local law to do
so. For example, we are required by the Department
of Health and Human Services (HHS) to disclose your
health information in order to allow HHS to
evaluate whether we are in compliance with the
federal privacy regulations. 2. To Business
Associates. We may use or disclose your medical
information to our business associates who perform
functions on our behalf if we first receive
satisfactory assurance that the business associate
will safeguard your information. 3. Public
Health Activities. We may be asked or required
by law to divulge medical information to a public
health authority under the following
circumstances: 4. Health
Oversight Activities. We may disclose your
health information to a health oversight agency
that is authorized by law to conduct health
oversight activities, including audits,
investigations, inspections, disciplinary
proceedings, or licensure and certification
surveys. These activities are necessary for the
government to monitor the persons or organizations
that provide health care to individuals and to
ensure compliance with applicable state and federal
laws and regulations. 5. To Report
Victims of Abuse, Neglect or Domestic Violence.
If we believe that you are a victim of abuse,
negligence or domestic violence, we may report this
information to a governmental authority, social
service or protective services agency if we believe
the disclosure is necessary to prevent harm to you
or another individual, if you cannot agree, or if
the disclosure is required by law. If we make such
a disclosure, you will be notified promptly unless
notification to you would place you at serious risk
of harm or is otherwise not in your best
interest. 6. Judicial or
administrative proceedings. We may disclose
your health information to courts or administrative
agencies charged with the authority to hear and
resolve lawsuits or disputes. We may disclose your
health information pursuant to a court order, a
subpoena, a discovery request, or other lawful
process issued by a judge or other person involved
in the dispute, but only if efforts have been made
to (i) notify you of the request for disclosure or
(ii) obtain an order protecting your health
information. 7. Worker's
Compensation. We may disclose your health
information to worker's compensation programs when
your health condition arises out of a work-related
illness or injury. 8. Law
Enforcement Official. We may disclose your
health information in response to a request
received from a law enforcement official to report
criminal activity or to respond to a subpoena,
court order, warrant, summons, or similar
process. 9. Coroners,
Medical Examiners, or Funeral Directors. We may
disclose your health information to a coroner or
medical examiner for the purpose of identifying a
deceased individual or to determine the cause of
death. We also may disclose your health information
to a funeral director for the purpose of carrying
out his/her necessary activities. 10. Organ
Procurement Organizations or Tissue Banks. If
you are an organ donor, we may disclose your health
information to organizations that handle organ
procurement, transplantation, or tissue banking for
the purpose of facilitating organ or tissue
donation or transplantation. 11.
Research. We may use or disclose your health
information for research purposes under certain
limited circumstances. Because all research
projects are subject to a special approval process,
we will not use or disclose your health information
for research purposes until the particular research
project for which your health information may be
used or disclosed has been approved through this
special approval process. However, we may use or
disclose your health information to individuals
preparing to conduct the research project in order
to assist them in identifying patients with
specific health care needs who may qualify to
participate in the research project. Any use or
disclosure of your health information which is done
for the purpose of identifying qualified
participants will be conducted onsite at our
facility. In most instances, we will ask for your
specific permission to use or disclose your health
information if the researcher will have access to
your name, address or other identifying
information. 12. To Avert a
Serious Threat to Health or Safety. We may use
or disclose your health information when necessary
to prevent a serious threat to the health or safety
of you or other individuals. 13. Military
and Veterans. If you are a member of the armed
forces, we may use or disclose your health
information as required by military command
authorities. 14. National
Security and Intelligence Activities. We may
use or disclose your health information to
authorized federal officials for purposes of
intelligence, counterintelligence, and other
national security activities, as authorized by
law. 15.
Inmates. If you are an inmate of a correctional
institution or under the custody of a law
enforcement official, we may use or disclose your
health information to the correctional institution
or to the law enforcement official as may be
necessary (i) for the institution to provide you
with health care; (ii) to protect the health or
safety of you or another person; or (iii) for the
safety and security of the correctional
institution. 16. Other
Permitted Disclosures. We may disclose your
medical information as required or permitted by the
privacy regulations promulgated pursuant to the
Health Insurance Portability and Accountability
Act, as amended and interpreted from time to
time. F.
USES AND DISCLOSURES PURSUANT TO YOUR
WRITTEN AUTHORIZATION. Except for the
purposes identified above in Sections B through D,
we will not use or disclose your health information
for any other purposes unless we have your specific
written authorization. You have the right to revoke
a written authorization at any time as long as you
do so in writing. If you revoke your authorization,
we will no longer use or disclose your health
information for the purposes identified in the
authorization, except to the extent that we have
already taken some action in reliance upon your
authorization. G.
YOUR RIGHTS REGARDING YOUR HEALTH
INFORMATION. You have the
following rights regarding your health information.
You may exercise each of these rights, in writing,
by providing us with a completed form that you can
obtain from Phyllis Knight. We may charge you for
the cost(s) associated with providing you with the
requested information. Additional information
regarding how to exercise your rights, and the
associated costs, can be obtained from Phyllis
Knight. 1. Right to
Inspect and Copy. You have the right to inspect
and copy health information that may be used to
make decisions about your care. Normally, we will
provide access within 30 days of your request. We
may deny your request to inspect and copy your
health information in certain limited
circumstances. If you are denied access to your
health information, you may request that the denial
be reviewed. 2. Right to
Amend. You have the right to request an
amendment of your health information that is
maintained by or for our clinic and is used to make
health care decisions about you. We may deny your
request if it is not properly submitted or does not
include a reason to support your request. We will
generally amend your information within 60 days of
your request, and will notify you when we have
amended your information. We may also deny your
request if the information sought to be amended:
(a) was not created by us, unless the person or
entity that created the information is no longer
available to make the amendment; (b) is not part of
the information that is kept by or for our clinic;
(c) is not part of the information which you are
permitted to inspect and copy; or (d) is accurate
and complete. 3. Right to an
Accounting of Disclosures. You have the right
to request an accounting of the disclosures of your
health information made by us. We will generally
provide you with your accounting within 60 days of
your request. This accounting will not include
disclosures of health information that we made for
purposes of treatment, payment or health care
operations or pursuant to a written authorization
that you have signed. 4. Right to
Request Restrictions. You have the right to
request a restriction or limitation on the health
information we use or disclose about you for
treatment, payment, or health care operations. You
also have the right to request a limit on the
health information we disclose about you to
someone, such as a family member or friend, who is
involved in your care or in the payment of your
care. For example, you could ask that we not use or
disclose information regarding a particular
treatment that you received. We are not required to
agree to your request. If we do agree, that
agreement must be in writing and signed by you and
us. 5. Right to
Request Confidential Communications. You have
the right to request that we communicate with you
about your health care in a certain way or at a
certain location. For example, you can ask that we
only contact you at work or by mail. 6. Right to a
Paper Copy of this Notice. You have the right
to receive a paper copy of this Notice. You may ask
us to give you a copy of this Notice at any time.
Even if you have agreed to receive this Notice
electronically, you are still entitled to a paper
copy of this Notice. H.
QUESTIONS OR COMPLAINTS. If you have any
questions regarding this Notice or wish to receive
additional information about our privacy practices,
please contact our Privacy Officer &endash; Phyllis
Knight. If you believe your privacy rights have
been violated, you may file a complaint with our
clinic or with the Secretary of the Department of
Health and Human Services (HHS). To file a
complaint with our clinic, contact our Privacy
Officer at 542 West Second Avenue, Anchorage,
Alaska 99501. All complaints must be submitted in
writing. You will not be penalized for filing a
complaint. I.
OUR DUTIES. We are required
by law to maintain the privacy of your medical
information and to provide you with this Notice of
our legal duties and privacy practices with respect
to your medical information. We are required
by law to abide by the terms of this
Notice. We reserve the
right to revise this Notice and will revise the
Notice if we materially change any use, disclosure,
individual right or legal duty or other privacy
practice stated in this Notice. If we revise a
Notice, copies will be available by asking Phyllis
Knight or any staff member. We reserve the right to
change our privacy practices retroactively with
respect to information that we created or received
prior to issuing a revised Notice. Contact
Officer: Phyllis Knight Effective
Date: 04/11/03 Address: Telephone:
907 276-1617 |
