Notice of Privacy Policies For the Laurel Eye Clinic

Implemented March 1, 2003

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 the Laurel Eye Clinic, we are committed to treating and using protected health information about you responsibly. This Notice of Health
Information Practices describes the personal information we collect, 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 March 1, 2003 and applies to all protected health information as defined by federal regulations.

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION

Each time you visit the Laurel Eye Clinic, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, 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 the 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: ensure 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.

YOUR HEALTH INFORMATION RIGHTS

Although your health record is the physical property of the Laurel Eye Clinic, the information belongs to you. You have the right to:

• Obtain a paper copy of this notice of information practices upon written request,
  

• Inspect and copy your heath record as provided for in 45 CFR 164.524,
  

• Amend your health record as provided in 45 CFR 164.528,
  

• Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528,
  

• Request communications of your health information by alternative means or at alternative locations,
  

• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522, and
  

• Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

OUR RESPONSIBILITIES

The Laurel Eye Clinic is required to:

• Maintain the privacy of your health information,
  

• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
  

• Abide by the terms of this notice,
  

• Notify you if we are unable to agree to a requested restriction, and
  

• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us, or if you agree, we will email the revised notice to you.

We will not disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions or would like additional information you may contact the practice’s Privacy Officer, Jolynn Dobson Cook, RN, COE, Administrator at (814) 849-8344 or 1-800-494-2020. If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, DC 20201

EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS

The Laurel Eye Clinic will request and expect your co-payment or any balance due at the time of your visit, unless you provide written documentation to the contrary. At your request your account information and/or balances may also be discussed at our front desk. For example: we may call your name aloud in our practice to summon you, send you a postcard reminding you that you should call and schedule an exam, leave a message for you to call our office on your answering machine or voice mail, send you information via regular mail or e-mail informing you of new treatment or procedures that may be of interest to you or may be recommended for your visual needs. We may from time to time send you information on new products or promotions for our retail items (frames, sunglasses, contact lenses, health screenings and open house events, etc.).

We will use your health information for treatment.

For example: Information obtained by a nurse, technician, optometrist, ophthalmologist, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We will also provide your referring doctor and/or primary care physician with copies of various reports that should assist him or her in treating you.

We will use your health information for payment.

For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health care information for regular health operations.

For example: Members of the Laurel Eye Clinic staff, the chart review team, or members of a quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we will provide.

Business associates: There are some services provided in our organization through contacts with business associates. An example would be anesthesia services in the Laurel Laser & Surgery Center. When services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general conditions.

Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Research: We may disclose 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 health information.

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or placement.

Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with the laws relating to workers compensation or other similar programs established by law.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling diseases, injury, or disability.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.