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.
Our goal is to take appropriate steps to attempt to
safeguard any medical or other personal information that is provided to
us. The Privacy Rule under the Health Insurance Portability and
Accountability Act of 1996 ("HIPAA") requires us to: (i) maintain
the privacy of medical information provided to us; (ii) provide notice
of our legal duties and privacy practices; and (iii) abide by the terms
of our Notice of Privacy Practices currently in effect.
WHO WILL FOLLOW THIS NOTICE
| This notice describes the practices
of our employees and staff as well as physicians at Ohio Valley Eye
Physicians and Surgeons, PLLC and Physicians Outpatient Surgery Center,
Ltd. This notice applies to each of these individuals, entities, sites
and all office locations. In addition, these individuals, entities,
sites and locations may share medical information with each other
for treatment, payment and health care operation purposes described
in this notice. |
INFORMATION COLLECTED ABOUT YOU
In the ordinary course of receiving treatment and health
care services from us, you will be providing us with personal information
such as:
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Your name, address, and phone number.
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Information relating to your medical
history. |
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Your insurance information and coverage.
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Information concerning your doctor,
nurse or other medical providers. |
In addition, we will gather certain medical information about you and
will create a record of the care provided to you. Some information
also may be provided to us by other individuals or organizations that
are part of your "circle of care"- such as the referring physician, your
other doctors, your health plan, and close friends or family members.
We
may use and disclose personal and identifiable health information about
you for a variety of purposes. All of the types of uses and disclosures
of information are described below, but not every use or disclosure in
a category is listed.
Required Disclosures. We are required
to disclose health information about you to the Secretary of Health and
Human Services, upon request, to determine our compliance with HIPAA and
to you, in accordance with your right to access and right to receive an
accounting of disclosures, as described below.
For Treatment. We may use health information about
you in your treatment. For example, we may use your medical history,
such as any presence or absence of diabetes, to assess the health of your
eyes.
For Payment. We may use and disclose health information
about you to bill for our services and to collect payment from you or
your insurance company. For example, we may need to give a payer
information about your current medical condition so that it will pay us
for the eye examinations or other services that we have furnished you.
We may also need to inform your payer of the treatment you are going to
receive in order to obtain prior approval or to determine whether the
service is covered.
For Health Care Operations. We may use and disclose
information about you for the general operation of our business.
For example, we sometimes arrange for auditors or other consultants to
review our practices, evaluate our operations, and tell us how to improve
our services. Or, for example, we may use and disclose your health
information to review the quality of services provided to you.
Public Policy Uses and Disclosures. There are a number
of public policy reasons why we may disclose information about you which
are described below.
We may disclose health information about you when we are required
to do so by federal, state, or local law.
We may disclose protected health information about you in connection
with certain public health reporting activities.
We may disclose protected health information about you in connection with
certain public health reporting activities. For instance, we may
disclose such information to a public health authority authorized to collect
or receive PHI for the purpose of preventing or controlling disease, injury
or disability, or at the direction of a public health authority, to an
official of a foreign government agency that is acting in collaboration
with a public health authority. Public health authorities
include state health departments, the Center for Disease Control, the
Food and Drug Administration, the Occupational Safety and Health Administration
and the Environmental Protection Agency, to name a few.
We are also permitted to disclose protected health information to a public
health authority or other government authority authorized by law to receive
reports of child abuse or neglect. Additionally we may disclose
protected health information to a person subject to the Food and Drug
Administration's power for the following activities: to report adverse
events, product defects or problems, or biological product deviations;
to track products; to enable product recalls, repairs or replacements;
or to conduct post marketing surveillance. We may also disclose
a patient's health information to a person who may have been exposed to
a communicable disease or to an employer to conduct an evaluation relating
to medical surveillance of the workplace or to evaluate whether an individual
has a work-related illness or injury.
We may disclose a patient's health information where we reasonably believe
a patient is a victim of abuse, neglect or domestic violence and the patient
authorizes the disclosure or it is required or authorized by law.
We may disclose health information about you in connection with certain
health oversight activities of licensing and other health oversight agencies
which are authorized by law. Health oversight activities include audit,
investigation, inspection, licensure or disciplinary actions, and civil,
criminal, or administrative proceedings or actions or any other activity
necessary for the oversight of 1) the health care system, 2) governmental
benefit programs for which health information is relevant to determining
beneficiary eligibility, 3) entities subject to governmental regulatory
programs for which health information is necessary for determining compliance
with program standards, or 4) entities subject to civil rights laws for
which health information is necessary for determining compliance.
We may disclose your health information as required by law, including
in response to a warrant, subpoena, or other order of a court or administrative
hearing body or to assist law enforcement identify or locate a suspect,
fugitive, material witness or missing person. Disclosures for law
enforcement purposes also permit use to make disclosures about victims
of crimes and the death of an individual, among others.
We may release a patient's health information (1) to a coroner or medical
examiner to identify a deceased person or determine the cause of death
and (2) to funeral directors. We also may release your health information
to organ procurement organizations, transplant centers, and eye or tissue
banks, if you are an organ donor.
We may release your health information to workers' compensation or similar
programs, which provide benefits for work-related injuries or illnesses
without regard to fault.
Health information about you also may be disclosed when necessary to prevent
a serious threat to your health and safety or the health and safety of
others.
We may use or disclose certain health information about your condition
and treatment for research purposes where an Institutional Review Board
or a similar body referred to as a Privacy Board determines that your
privacy interests will be adequately protected in the study. We
may also use and disclose your health information to prepare or analyze
a research protocol and for other research purposes.
If you are a member of the Armed Forces, we may release health information
about you for activities deemed necessary by military command authorities.
We also may release health information about foreign military personnel
to their appropriate foreign military authority.
We may disclose your protected health information for legal or administrative
proceedings that involve you. We may release such information upon
order of a court or administrative tribunal. We may also release
protected health information in the absence of such an order and in response
to a discovery or other lawful request, if efforts have been made to notify
you or secure a protective order.
If you are an inmate, we may release protected health information about
you to a correctional institution where you are incarcerated or to law
enforcement officials in certain situations such as where the information
is necessary for your treatment, health or safety, or the health or safety
of others.
Finally, we may disclose protected health information for national security
and intelligence activities and for the provision of protective services
to the President of the United States and other officials or foreign heads
of state.
Our Business Associates. We sometimes
work with outside individuals and businesses that help us operate our
business successfully. We may disclose your health information to
these business associates so that they can perform the tasks that we hire
them to do. Our business associates must promise that they will
respect the confidentiality of your personal and identifiable health information.
Disclosures to Persons Assisting in Your Care or
Payment for Your Care. We may disclose information to individuals
involved in your care or in the payment for your care. This includes
people and organizations that are part of your "circle of care"
-- such as your spouse, your other doctors, or an aide who may be providing
services to you. We may also use and disclose health information
about a patient for disaster relief efforts and to notify persons responsible
for a patient's care about a patient's location, general condition or
death. Generally, we will obtain your verbal agreement before
using or disclosing health information in this way. However, under
certain circumstances, such as in an emergency situation, we may make
these uses and disclosures without your agreement.
Appointment Reminders. We may use and
disclose medical information to contact you as a reminder that you have
an appointment or that you should schedule an appointment. This appointment
reminder may be done as a post card, a letter, a phone call or an automated
(computer generated) phone call appointment reminder.
Treatment Alternatives. We
may use and disclose your personal health information in order to tell
you about or recommend possible treatment options, alternatives or health-related
services that may be of interest to you.
Follow-up contacts. We may contact you after
surgery, or after an office visit, to discuss your progress, discuss test
results and answer questions. We may also contact patients periodically
for internal quality assurance programs.
We are required to obtain written authorization from you for any other
uses and disclosures of medical information other than those described
above. If you provide us with such permission, you may revoke that
permission, in writing, at any time. If you revoke your permission,
we will no longer use or disclose personal information about you for the
reasons covered by your written authorization, except to the extent we
have already relied on your original permission.
INDIVIDUAL RIGHTS
You have the right to ask for restrictions
on the ways we use and disclose your health information for treatment,
payment and health care operation purposes. You may also request
that we limit our disclosures to persons assisting your care or payment
for your care. We will consider your request, but we are not required
to accept it.
You have the right to request that you receive
communications containing your protected health information from us by
alternative means or at alternative locations. For example, you
may ask that we only contact you at home or by mail.
Except under certain circumstances, you have
the right to inspect and copy medical, billing and other records used
to make decisions about you. If you ask for copies of this information,
we may charge you a fee for copying and mailing.
If you believe that information in your records
is incorrect or incomplete, you have the right to ask us to correct the
existing information or add missing information. Under certain circumstances,
we may deny your request, such as when the information is accurate and
complete.
You have a right to receive a list of certain
instances when we have used or disclosed your medical information.
We are not required to include in the list uses and disclosures for your
treatment, payment for services furnished to you, our health care operations,
disclosures to you, disclosures you give us authorization to make and
uses and disclosures before April 14, 2003, among others. If you
ask for this information from us more than once every twelve months, we
may charge you a fee.
You have the right to a copy of this notice
in paper form. You may ask us for a copy at any time.
To exercise any of your rights, please contact
us in writing at:
David S.
George, MD
HIPAA Compliance Officer
The Eye MDs, PLLC
418 Grand Park Drive, Suite
315
Parkersburg, WV 26101
Or
David S.
George, MD
HIPAA Compliance Office
Physicians Outpatient Surgery
Center, Ltd.
1933 Washington Blvd.
Belpre, Ohio 45714
When making a request for amendment, you must
state a reason for making the request.
CHANGES TO THIS NOTICE
We reserve the right to make changes to this notice
at any time. We reserve the right to make the revised notice effective
for personal health information we have about you as well as any information
we receive in the future. In the event there is a material change
to this notice, the revised notice will be posted at our office locations
and on the web site. In addition, you may request a copy of the
revised notice at any time.
COMPLAINTS/COMMENTS
If you have any complaints concerning our privacy practices,
you may contact the Secretary of the Department of Health and Human Services,
at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington,
D.C. 20201 (e-mail: ocrmail@hhs.gov). You also may contact
us at
David S. George, MD
HIPAA Compliance Office
Physicians Outpatient Surgery
Center, Ltd.
1933 Washington Blvd.
Belpre, Ohio 45714
YOU WILL NOT BE RETALIATED AGAINST OR PENALIZED BY
US FOR FILING A COMPLAINT.
To obtain more information concerning this
notice, you may contact our Privacy Officer David S.George, MD at:
David S. George, MD
HIPAA Compliance Officer
The Eye MDs, PLLC
418 Grand Park Drive, Suite
315
Parkersburg, WV 26101
1-800-758-3937 or fax at 304-422-7900
Copyright © 2001 Arent Fox Kintner Plotkin
& Kahn, PLLC. All rights reserved. Modified and revised by David
S. George (with permission) to be specific for OVEPS and POSC.
This notice is effective as of 2/1/2003.
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