NOTICE OF PRIVACY PRACTICES FOR OPTOMETRIC ASSOCIATES
Effective Date: October 2014
Authorized by: Jonathan D. Andrews, O.D., F.A.A.O.
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.
OUR COMMITMENT TO YOUR PRIVACY
At Optometric Associates, your privacy is a top priority. We are required by law to maintain the privacy and security of your Protected Health Information (PHI). This notice explains our legal duties and your rights concerning your PHI.
HOW WE PROTECT YOUR INFORMATION
We take measures to safeguard your PHI by:
- Using secure systems to store and transmit data.
- Limiting access to only those employees who need it to perform their duties.
- Training our staff on privacy practices.
WE ARE REQUIRED BY LAW TO:
- Maintain the privacy of your PHI
- Provide you with this notice of our legal duties and privacy practices
- Notify you of a breach of unsecured PHI
- Follow the terms of the Notice in effect
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Federal law allows us to use or disclose your PHI without your permission for the following purposes:
Treatment:
- To provide, coordinate, or manage your eye care and related health care services
- Disclosing your PHI to doctors, nurses, technicians, student trainees, and other providers who participate in your care
- Coordinating services you need such as prescriptions, lab work, imaging
Payment:
- To bill and collect payment for services provided to you.
- Determining eligibility for health care services and pre-certifying benefits
- Coordinating benefits with insurance payers
- Billing and collecting for health care services and materials provided
- Facilitating payment to another provider who has participated in your care
- Provision of a bill to a family member or other designated as responsible for payment of services rendered to you
- Providing consumer reporting agencies with credit information
- Providing information to a collection agency or our attorney for purposes of securing payment of a delinquent account
- Disclosing information in a legal action for purposes of securing payment of a delinquent account
Healthcare Operations:
- To improve the quality of care we provide.
- Accrediting, certifying, licensing or credentialing health care providers
- Reviewing competence or qualifications of health care professionals
- Developing, maintaining and supporting computer systems
- Managing, budgeting and planning activities and reports
- Allowing your health insurer access to your medical record for a medical necessity or quality review audit
- Conducting other medical review, legal services, and auditing functions
- Business planning and development activities, such as conducting cost management and planning related analysis
- Sharing information with entities interested in or actively purchasing the practice
For employees and family members, we may share limited information for treatment, payment or health care operations as described in this Notice unless you request a restriction as set forth in this Notice.
Additional uses and disclosures for which authorization or opportunity to agree or object is not required by HIPAA:
- As Required by Law: We will disclose PHI about you when required to do so by federal, state, or local law; such as public health risks, disease control, report of communicable diseases, report of medical device safety issues and adverse effects, vital events such as births and deaths.
- Victims of Abuse, Neglect, or Domestic Violence: We may disclose your PHI with government agencies authorized by law to receive reports of suspected child or elder abuse, neglect, or domestic violence if we believe that you have been a victim.
- Research: Research is one of the many missions of Optometric Associates. All research projects are subject to a special approval process before we use or disclose PHI. We may contact you about research studies you may qualify for so that you can decide if you want to participate. If you qualify, then you will be asked to sign a separate consent form to participate in the project that includes an authorization for use and possible disclosure of your information outside the network of Optometric Associates. To support approved medical research projects, subject to strict privacy safeguards.
- Health Oversight Activities: We may disclose your PHI with a health oversight agency for activities permitted by law. For example, these activities may include audits, investigations, inspections, or licensure. Health care oversight agencies include government agencies that oversee the health care system, government benefit programs, and agencies that enforce civil rights laws.
- Judicial and Administrative Proceedings: We may disclose your PHI in the course of an administrative or judicial proceeding, such as in response to a court order or subpoena as permitted by federal and state law.
- Law Enforcement: We may disclose your PHI to a law enforcement official if required or permitted by law for reasons such as reporting crimes occurring at Optometric Associates or providing routine reporting to all enforcement agencies.
- Deceased Person’s PHI: We may disclose PHI to a funeral director as necessary so they may carry out their duties. We may also disclose your PHI to a coroner or medical examiner for identification purposes, determining cause of death, or performing other duties authorized by law.
- Organ and Tissue Donation: We may disclose your PHI to organizations that handle organ, tissue, and eye procurement to facilitate organ, tissue and eye donation and transplantation.
- To Avert a Serious Threat to Health or Safety: We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, the public’s health and safety, or another person’s health and safety.
- Specialized Government Functions: We may disclose your PHI to authorized federal officials for national security and intelligence, military, or veterans’ activities required by law, medical suitability determinations from the Department of State, correctional institutions and other law enforcement custodial situations.
- Workers’ Compensation: We may disclose your PHI to Workers’ Compensation, as required by workers’ compensation laws or other similar programs. These programs provide benefits for work-related injuries or illnesses.
- Disaster Relief Efforts. We may use or disclose your PHI to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating with such entity in the notification of your family member, personal representative or another person responsible for your care.
- Inspection and Copying: You have a right to obtain a copy of your protected health information that we maintain. This right is subject to limitations and we may impose charge for the labor and supplies involved in providing copies. However, we reserve the right to disclose only medically necessary information within reason for certain circumstances.
You have the following rights regarding your PHI:
Right to Request Restrictions You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or healthcare operations. We are required to honor your request to restrict disclosures of PHI to a health plan where you have paid out of pocket in full for the health care item or service you have received. Otherwise, although we will consider your request, we are not required to agree to or abide by your request. You must make your request for any restrictions or limitations in writing to Optometric Associates, ATTN Privacy Officer, 117 W Main St, and New Holland, PA 17557. In your request, you must tell us: what PHI you want to limit; whether you want to limit our use, disclosure, or both; and to whom you ant the limits to apply.
Right to Amend: If you feel your information is incorrect or incomplete, you may request an amendment. Submit your request to Optometric Associates, ATTN Privacy Officer, 117 W Main St, and New Holland, PA 17557. Your request must be made in writing and include a reason that supports your request. We may deny your request if you ask us to change PHI that was not created by us, is not part of our records, is not part of the PHI you would be permitted access of, or that we believe is accurate and complete.
Right to an Accounting of Disclosures: You can ask for a list of instances where we’ve disclosed your PHI, excluding disclosures for treatment, payment, and healthcare operations. You must make your request for any restrictions or limitations in writing to Optometric Associates, ATTN Privacy Officer, 117 W Main St, and New Holland, PA 17557. Your request must tell us the calendar dates you want to see; the time period may include up to six years of information prior to the date of the request.
Right to Confidential Communications: You can request that we communicate with you in a confidential manner. You have the right to request that we communicate with you about your PHI in a certain way or at a certain location. You must make your request for any restrictions or limitations in writing to Optometric Associates, ATTN Privacy Officer, 117 W Main St, and New Holland, PA 17557. We will accommodate reasonable requests. Your request must specify how or where you wish to be contacted.
Right to Review and Copy: You have the right to review and obtain a copy of your PHI that may be used to make decisions about your care. You must make your request for any restrictions or limitations in writing to Optometric Associates, ATTN Privacy Officer, 117 W Main St, and New Holland, PA 17557. If you request a copy of the PHI, then we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. Under very limited situations, you may not be allowed to review or obtain a copy of parts of your health information. For example, our health care provider may decide for clear treatment reasons that sharing your PHI with you will likely have an adverse effect on you. If your request is denied, you will be notified of this decision in writing and you may appeal this in writing to the Optometric Associates HIPAA Office.
Right to a Copy of This Notice: You can request a paper or electronic copy of this notice at any time.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. The updated notice will apply to all PHI we maintain and will be available in our office and on our website.
QUESTIONS OR COMPLAINTS
If you have questions about this notice or believe your privacy rights have been violated, you may contact:
Privacy Officer
Optometric Associates
117 W Main St
New Holland, PA 17557
You may also file a complaint with the U.S. Department of Health and Human Services. Filing a complaint will not affect the care you receive.