|
|
The Independent Practices of
RALEIGH OPHTHALMOLOGY
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. If you have any questions about this Notice please contact
Privacy Officer for Raleigh Ophthalmology.
This Notice
of Privacy Practices describes how we may use and disclose
your protected health information to carry out treatment, payment
or health care operations and for other purposes that are permitted
or required by law. It also describes your rights to access and control
your protected health information. “Protected Health Information” is
information about you, including demographic information, that may
identify you and that relates to your past, present or future physical
or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices.
We may change the terms of our notice, at any time. The new notice
will be effective for all protected health information that we maintain
at that time. Upon your request, we will provide you with any revised
Notice of Privacy Practices by accessing our web site at www.RaleighOp.com,
calling the office and requesting that a revised copy be sent to
you in the mail, or asking for one at the time of your next appointment.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information: Your protected
health information may be used and disclosed by your physician, our
office staff and others outside of our office that are involved in
your care and treatment for the purpose of providing health care
services to you. Your protected health information may also be used
and disclosed to pay your health care bills and to support the operation
of the physician’s practice.
Following are examples of the types of uses and disclosures of your
protected health care information that the physician’s office
is permitted to make. These examples are not meant to be exhaustive,
but to describe the types of uses and disclosures that may be made
by our office.
Treatment: We will use and disclose your protected health information
to provide, coordinate, or manage your health care and any related
services. This includes the coordination or management of your health
care with a third party that has already obtained your permission
to have access to your protected health information. For example,
we would disclose your protected health information, as necessary,
to a home health agency that provides care to you. We will also disclose
protected health information to other physicians who may be treating
you when we have the necessary permission from you to disclose your
protected health information. For example, your protected health
information may be provided to a physician to whom you have been
referred to ensure that the physician has the necessary information
to diagnose or treat you.
In addition, we may disclose your protected health information from
time-to-time to another physician or health care provider (e.g.,
a specialist or laboratory) who, at the request of your physician,
becomes involved in your care by providing assistance with your health
care diagnosis or treatment to your physician.
We may use your PHI in order to write a prescription for you, or
we may disclose your PHI to a pharmacy when we order a prescription
for you. Additionally, we may disclose your PHI to others who may
assist in your care, such as your spouse, children, or parents, unless
you object.
Payment: Your protected health information will be used, as needed,
to obtain payment for your health care services. This may include
certain activities that your health insurance plan may undertake
before it approves or pays for the health care services we recommend
for you such as; making a determination of eligibility or coverage
for insurance benefits, reviewing services provided to you for medical
necessity, and undertaking utilization review activities. For example,
obtaining approval for a procedure or surgery may require that your
relevant protected health information be disclosed to the health
plan to obtain approval.
Healthcare Operations: We may use or disclose, as-needed, your protected
health information in order to support the business activities of
your physician’s practice. These activities include, but are
not limited to, quality assessment activities, employee review activities,
training of medical students, licensing, marketing and fundraising
activities, and conducting or arranging for other business activities.
For example, we may disclose your protected health information to
medical school students that see patients at our office. In addition,
we may use a sign-in sheet at the registration desk where you will
be asked to sign your name and indicate your physician. We may also
call you by name in the waiting room when your physician is ready
to see you. We may use or disclose your protected health information,
as necessary, to contact you to remind you of your appointment, and
may leave the message on your answering machine or with another member
of your household. We will send out a recall card as a reminder to
make an appointment. We may call you to follow up in regard to your
on going care provided by one of our physicians.
We will share your protected health information with third party “business
associates” that perform various activities (e.g., billing,
transcription services) for the practice. Whenever an arrangement
between our office and a business associate involves the use or disclosure
of your protected health information, we will have a written contract
that contains terms that will protect the privacy of your protected
health information.
We may use or disclose your protected health information, as necessary,
to provide you with information about treatment alternatives or other
health-related benefits and services that may be of interest to you.
We may also use and disclose your protected health information for
other marketing activities. For example, your name and address may
be used to send you a newsletter about our practice and the services
we offer. We may also send you information about products or services
that we believe may be beneficial to you. You may contact our Privacy
Contact to request that these materials not be sent to you.
We may use or disclose your demographic information and the dates
that you received treatment from your physician, as necessary, in
order to contact you for fundraising activities supported by our
office. If you do not want to receive these materials, please contact
our Privacy Contact and request that these fundraising materials
not be sent to you.
Uses and Disclosures of Protected Health Information Based upon Your
Written Authorization
Other uses and disclosures of your protected health information will
be made only with your written authorization, unless otherwise permitted
or required by law as described below. You may revoke this authorization,
at any time, in writing, except to the extent that your physician
or the physician’s practice has taken an action in reliance
on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made
With Your Authorization or Opportunity to Object
We may use and disclose your protected health information in the
following instances. You have the opportunity to agree or object
to the use or disclosure of all or part of your protected health
information. If you are not present or able to agree or object to
the use or disclosure of the protected health information, then your
physician may, using professional judgement, determine whether the
disclosure is in your best interest. In this case, only the protected
health information that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare: Unless you object, we may disclose
to a member of your family, a relative, a close friend or any other
person you identify, your protected health information that directly
relates to that person’s involvement in your health care. If
you are unable to agree or object to such a disclosure, we may disclose
such information as necessary if we determine that it is in your
best interest based on our professional judgment. We may use or disclose
protected health information to notify or assist in notifying a family
member, personal representative or any other person that is responsible
for your care of your location, general condition or death. Finally,
we may use or disclose your protected health information to an authorized
public or private entity to assist in disaster relief efforts and
to coordinate uses and disclosures to family or other individuals
involved in your health care.
Other Permitted and Required Uses and Disclosures That May Be Made
Without Your Authorization or Opportunity to Object
We may use or disclose your protected health information in the following
situations without your authorization. These situations include:
Required By Law: We may use or disclose your protected health information
to the extent that the use or disclosure is required by law. The
use or disclosure will be made in compliance with the law and will
be limited to the relevant requirements of the law. You will be notified,
as required by law, of any such uses or disclosures.
Public Health: We may disclose your protected health information
for public health activities and purposes to a public health authority
that is permitted by law to collect or receive the information. The
disclosure will be made for the purpose of controlling disease, injury
or disability. We may also disclose your protected health information,
if directed by the public health authority, to a foreign government
agency that is collaborating with the public health authority.
Communicable Diseases: We may disclose your protected health information,
if authorized by law, to a person who may have been exposed to a
communicable disease or may otherwise be at risk of contracting or
spreading the disease or condition.
Health Oversight: We may disclose protected health information to
a health oversight agency for activities authorized by law, such
as audits, investigations, and inspections. Oversight agencies seeking
this information include government agencies that oversee the health
care system, government benefit programs, other government regulatory
programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information
to a public health authority that is authorized by law to receive
reports of child abuse or neglect. In addition, we may disclose your
protected health information if we believe that you have been a victim
of abuse, neglect or domestic violence to the governmental entity
or agency authorized to receive such information. In this case, the
disclosure will be made consistent with the requirements of applicable
federal and state laws.
Food and Drug Administration: We may disclose your protected health
information to a person or company required by the Food and Drug
Administration to report adverse events, product defects or problems,
biologic product deviations, track products; to enable product recalls;
to make repairs or replacements, or to conduct post marketing surveillance,
as required.
Legal Proceedings: We may disclose protected health information in
the course of any judicial or administrative proceeding, in response
to an order of a court or administrative tribunal (to the extent
such disclosure is expressly authorized), in certain conditions in
response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information,
so long as applicable legal requirements are met, for law enforcement
purposes. These law enforcement purposes include (1) legal processes
and otherwise required by law, (2) limited information requests for
identification and location purposes, (3) pertaining to victims of
a crime, (4) suspicion that death has occurred as a result of criminal
conduct, (5) in the event that a crime occurs on the premises of
the practice, and (6) medical emergency (not on the Practice’s
premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose
protected health information to a coroner or medical examiner for
identification purposes, determining cause of death or for the coroner
or medical examiner to perform other duties authorized by law. We
may also disclose protected health information to a funeral director,
as authorized by law, in order to permit the funeral director to
carry out their duties. We may disclose such information in reasonable
anticipation of death. Protected health information may be used and
disclosed for cadaveric organ, eye or tissue donation purposes.
Research: We may disclose your protected health information to researchers
when their research has been approved by an institutional review
board that has reviewed the research proposal and established protocols
to ensure the privacy of your protected health information.
Criminal Activity: Consistent with applicable federal and state laws,
we may disclose your protected health information, if we believe
that the use or disclosure is necessary to prevent or lessen a serious
and imminent threat to the health or safety of a person or the public.
We may also disclose protected health information if it is necessary
for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions
apply, we may use or disclose protected health information of individuals
who are Armed Forces personnel (1) for activities deemed necessary
by appropriate military command authorities; (2) for the purpose
of a determination by the Department of Veterans Affairs of your
eligibility for benefits, or (3) to foreign military authority if
you are a member of that foreign military services. We may also disclose
your protected health information to authorized federal officials
for conducting national security and intelligence activities, including
for the provision of protective services to the President or others
legally authorized.
Workers’ Compensation: Your protected health information may
be disclosed by us as authorized to comply with workers’ compensation
laws and other similar legally-established programs.
Inmates: We may use or disclose your protected health information
if you are an inmate of a correctional facility and your physician
created or received your protected health information in the course
of providing care to you.
Required Uses and Disclosures: Under the law, we must make disclosures
to you and when required by the Secretary of the Department of Health
and Human Services to investigate or determine our compliance with
the requirements of Section 164.500 et. seq.
2. Your Rights
Following is a statement of your rights with respect to your protected
health information and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your protected health
information. This means you may inspect and obtain a copy of protected health
information about you that is contained in a designated record set
for as long as we maintain the protected health information. A “designated
record set” contains medical and billing records and any other
records that your physician and the practice uses for making decisions
about you.
Under federal law, however, you may not inspect or copy the following
records; psychotherapy notes; information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative
action or proceeding, and protected health information that is subject
to law that prohibits access to protected health information. Depending
on the circumstances, a decision to deny access may be reviewable.
In some circumstances, you may have a right to have this decision
reviewed. Please contact our Privacy Contact if you have questions
about access to your medical record.
You have the right to request a restriction of your protected
health information. This means you may ask us not to use or disclose any
part of your protected health information for the purposes of treatment,
payment or healthcare operations. You may also request that any part
of your protected health information not be disclosed to family members
or friends who may be involved in your care or for notification purposes
as described in this Notice of Privacy Practices. Your request must
state the specific restriction requested and to whom you want the
restriction to apply.
Your physician is not required to agree to a restriction that you
may request. If physician believes it is in your best interest to
permit use and disclosure of your protected health information, your
protected health information will not be restricted. If your physician
does agree to the requested restriction, we may not use or disclose
your protected health information in violation of that restriction
unless it is needed to provide emergency treatment. With this in
mind, please discuss any restriction you wish to request with your
physician. You may request a restriction by submitting a written
request to our Privacy Contact.
You have the right to request to receive confidential communications
from us by alternative means or at an alternative location. We will
accommodate reasonable requests. We may also condition this accommodation
by asking you for information as to how payment will be handled or
specification of an alternative address or other method of contact.
We will not request an explanation from you as to the basis for the
request. Please make this request in writing to our Privacy Contact.
You may have the right to have your physician amend your
protected health information. This means you may request an amendment of protected
health information about you in a designated record set for as long
as we maintain this information. In certain cases, we may deny your
request for an amendment. If we deny your request for amendment,
you have the right to file a statement of disagreement with us and
we may prepare a rebuttal to your statement and will provide you
with a copy of any such rebuttal. Please contact our Privacy Contact
to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information. This
right applies to disclosures for purposes other than treatment, payment
or healthcare operations as described in this Notice of Privacy Practices.
It excludes disclosures we may have made to you, as a result of an
authorization signed by you, to family members or friends involved
in your care, or for notification purposes. You have the right to
receive specific information regarding these disclosures that occurred
after April 14, 2003. You may request a shorter timeframe. The right
to receive this information is subject to certain exceptions, restrictions
and limitations.
You have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice electronically.
3. Complaints
You may complain to us or to the Secretary of Health and Human Services
if you believe your privacy rights have been violated by us. You
may file a complaint with us by notifying our privacy contact of
your complaint. We will not retaliate against you for filing a complaint.
You may contact our Privacy Contact at (919)782-5400 or www.RaleighOp.com
for further information about the complaint process.
This notice was published and becomes effective on August
6, 2008.
Acknowledgement of
Receipt Of Notice of Privacy Practices |
|
 |
|
