NOTICE OF PRIVACY PRACTICES
FOR WESTFIELD EYE CENTER

 

  

EFFECTIVE DATE: MARCH 01st, 2003

 

 

 

 

 

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THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

 

Introduction

 

At Westfield Eye Center, we are committed to treating and using protected health information about you responsibly.  This  Notice of Health Information Practices describes the type of information we gather about you, and how and when we use or disclose that information.  It also describes your rights as they relate to your protected health information.  This Notice is effective as of March 1st, 2003, and applies to all protected health information as defined by federal and state regulations.

 

Understanding Your Health Record/Information

 

Each time you visit Westfield Eye Center, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment.  This information, often referred to as your health or medical record, serves as a:

 

·         Basis for planning your care and treatment,

·         Means of communication among the many health professionals who contribute to your care                  

·         Legal document describing the care you received

·         Means by which you or a third-party payer can verify that services billed were actually provided

·         A tool in educating health professionals

·         A source of data for medical research  

·         A source of information for public health officials charged with improving the health of this state and   

       nation

·         A source of data for our planning and marketing 

·         A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

   

Understanding what is in your record and how your health information is used helps you to:  insure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

 

How We May Use and Disclose Medical Information About You

 

The following categories describe different ways that we may use and disclose medical information.

 

For Treatment.  We may use medical information about you to provide you with medical treatment or services.

 

We may disclose medical information about you to doctors, nurses, technicians, training doctors, or other health care professionals who are involved in taking care of you.  Different health care professionals also may share medical information  about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays.

 

For Payment.  We may use and disclose medical information about you  so that the treatment or services you receive may be billed  to and payment may be collected from you, an insurance company or a third party.  We may also use and disclose medical information about you to obtain prior approval or to determine whether your insurance will cover the treatment, or to undertake other tasks related to seeking payment for services provided.

For Health Care Operations Purposes.  This is necessary to make sure that all of our patients receive quality care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you, or to otherwise manage and operate more effectively.  We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

 

Appointment Reminders.  We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.

 

Treatment Alternatives.  We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

 

Health-Related Benefits and Services.  We may use and disclose medical information to tell you about health related benefits that may be of interest to you.

 

 Individuals Involved in Your Care or Payment for Your Care.  We may release medical information about you to a friend or family member who is involved in your medical care.  We may give information to someone who helps pay for your care.  If you are in the hospital, we may also  tell your family or friends your condition and that you are in a hospital.  In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

                                                                                                

 Research.   Under certain circumstances, we may use and disclose medical information about you for research purposes.

 

As Required By Law.  We will disclose medical information about you when required to do so by federal, state or local law.

 

To Avert a Serious Threat to Health or Safety.  We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would only be to someone able to help prevent the threat.

 

Fundraising Activities.  We may use medical information about you in an effort to raise money for a purpose of potential benefit to you.  For example, if you have a particular medical problem and an entity is conducting fundraising for research in that area of medical science, we may write you for solicitation of funds for that entity.  We expect this to occur rarely.  If you do not want us to contact you for fundraising efforts, you must notify our Privacy Officer in writing at the address below.

 

Where Nevada law and HIPAA regulations conflict, we will abide by the more stringent provision protecting your personal health information.

 

SPECIAL SITUATIONS REQUIRING RELEASE OF INFORMATION

 

Organ and Tissue Donation.  If you are an organ donor, we may release medical information to organizations that handle organ procurement, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

 

Military and Veterans.  If you are a member of the armed forces, we may release medical information

about you as required by military command authorities.

 

Workers Compensation.  We may release medical information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

 

Public Health Risks.  We may disclose medical information about you for public health activities.  These activities generally include the following:

·         to prevent or control disease, injury or disability

·         to report births and deaths

·         to report child abuse or neglect

·         to report reactions to medications or problems with products

·         to notify people of recalls of products they may be using

·         to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading

       a disease or condition

·         to notify the appropriate government authority if we believe a patient has been the victim of abuse,  

       neglect or domestic violence.

   

Health Oversight Activities.  We may disclose medical information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the overall health care system, the conduct of government programs, and compliance with civil rights laws.

 

Lawsuits and Disputes.  We may disclose medical information about you in response to a subpoena, discovery request, or other lawful order from a court.

 

Law Enforcement.  We may release medical information if asked to do so by a law enforcement official as part of law enforcement activities; in investigations of criminal conduct or of victims of crime; in response to court orders; in emergency circumstances; or when required to do so by law.

 

Coroners, Medical Examiners and Funeral Directors.  We may release medical information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

 

Protective Services for the President, National Security and Intelligence Activities.  We may release medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations, or for intelligence, counterintelligence, and other national security activities authorized by law.

 

Inmates and in the Custody of Law Enforcement.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.  This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others, or (3) for the safety and security of the correctional institution.

 

Your Rights Regarding Medical Information About You

 

Although your health record is the physical property of Westfield Eye Center, the information belongs to you.  You have the right to

 

·         Right to inspect and copy your health record as provided for in 45 CFR 164.524

 

·         Right to Amend your health record as long as the information is kept.  To request and amendment it must be in writing and submitted to our Privacy Officer.  In addition, you must provide a reason that supports your request.  It will be denied if request is not in writing.  In addition, we may deny your request if you ask us to amend information that: 

1.       Was not created by us, unless the person or entity that created the information is no longer available

       to make the amendment;

2.       Is not part of the medical information kept by the provider

3.       Is not part of the information which you would be permitted to inspect and copy;         

4.       Is accurate and complete

 

·         Right to an Accounting of Disclosures.  To request this list you must submit in writing to our privacy officer.  The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the cost of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

·         Right to Request Restrictions.  You have the right to restrict or limit the information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  We are not required to agree with your request.  If we do agree, we will comply unless the information is needed to provide you emergency treatment.  Your request must be in writing to our Privacy Officer.  In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclose or both; and (3) to whom you want the limits to apply.

·         Right to Request Confidential Communications.  Examples:  you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Privacy Officer.  Your request must specify how or where you wish to be contacted.  If complying with your request entails additional expense over our usual means of communication, we may ask that you reimburse us or those expenses.

·         Right to a Paper Copy of This Notice.  You have the right to a paper 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.  To obtain a paper copy of this notice, please request one from our Privacy Officer.

                                                                       

CHANGES TO THIS NOTICE

We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for medical information we receive in the future.  We will always post a copy of the current notice in the following location: on the counter at the front check entrance and the bulletin board in the front main patient waiting room. 

 

For More Information or Reporting Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.  To file a complaint with us, contact our Privacy Officer at the address and phone number below.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

 

 

                                                 

 

OTHER USES OF MEDICAL INFORMATION

 

 

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization.  If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing at any time.  If you revoke your permission, we will thereafter no longer use or disclose medical information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made under you authorization.  We are required to retain our records of the care that we provided to you for six years.

 

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