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.
WHO WILL FOLLOW THIS NOTICE
We may use your medical information for treatment, payment, or healthcare operations. All employees, including the physicians of OPHTHALMOLOGY OF MONTCLAIR, follow these privacy practices.
ABOUT THIS NOTICE
This notice will tell you about the ways we may use and disclose medical information about you. We also describe your rights and our obligations regarding the use and disclosure of medical information.
We are required by law to:
-make sure that medical information that identifies you is kept private.
-give you this notice of our legal duties and privacy practice with respect to your medical information
-follow the terms of the notice that is currently in effect
-notify individuals, either known or reasonably believed to be affected, following a breach of unsecured Protected health information.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
FOR TREATMENT: We may use medical information about you to provide you with medical treatment services. We may disclose medical information about you to doctors, nurses, technicians, or other practice or facility personnel who are involved in your care. Different department of the practice or facility also may share medical information about you in order to coordinate the different services you may need, such as prescriptions, lab work and imaging services. We also may disclose medical information about you to people outside the practice who may be involved in your medical care.
FOR PAYMENT: We may use and disclose medical information about you so that we may bill for treatment and service you receive and collect payment from you, an insurance company, or another party as permitted by law.
FOR APPOINTMENT REMINDERS: We may use and disclose medical information to contact you to remind you that you have and appointment for treatment or medical care.
TO 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 also give information to someone who helps pay for your care. 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.
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.
SPECIAL SITUATIONS
SPECIAL PRIVACY PROTECTIONS: HIV related information, alcohol and substance abuse information, mental health information and genetic information will be protected as required by law.
ORGAN AND TISSUE DONATION: If you are an organ or tissue donor, we ma release medical information bout you to organization that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank.
MILITARY AND VETERANS: If you are a member of the armed forces of the US or another country, 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.
PUBLIC HEALTH RISKS: We may disclose to authorized public health or government officials, medical information about you for public health activities ie. To prevent or control disease, injury or disability or to report disease or injury to report child abuse or neglect, to report reactions to medications, to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease, to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
HEALTH OVERSIGHT ACTIVITIES: We may disclose medical information about you to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order, subpoena, warrant, summons or similar process.
LAW ENFORCEMENT: We may release medical information about you if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process.
TO A SCHOOL: We may disclose information to a school who is a student or prospective student of the school if the covered entity obtains and documents the agreement to the disclosure.
YOUR RIGHTS REGARDNG MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
RIGHT TO INSPECT AND COPY: You have the right to inspect and copy medical information that may be used to make decisions about your care. ie medical and billing records. This right does not include psychotherapy notes, information compiled for use in a legal proceeding or certain information maintained by laboratories. You must submit your request in writing. We may deny your request to inspect and copy in certain limited circumstances. You may request in writing that the denial be reviewed. A licensed healthcare professional will conduct the review. We will comply with the outcome of the review.
RIGHT TO AMEND: If you think that medical information we have about you is incorrect, you may ask us to amend the information. This request must be submitted in writing. In addition, you must give a reason that supports your request. We may deny this if your information is accurate and complete, and you will be provided with a written notice of action.
RIGHT TO ACCOUNTING OF DISCLOSURES: You have the right to request an “accounting of disclosures”. This is a list of certain disclosures we made of medical information about you. We are not required to account for any disclosures you specifically requested or for disclosures related to treatment, payment, or healthcare operation or made pursuant to an authorization signed by you. You must submit your request in writing. Your request must state a time period, which may not be longer than six years. We may charge you for our reasonable retrieval costs.
RIGHT TO REQUEST RESTRICTIONS: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. Additionally, you can request restrictions on medical information disclosed to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the information pertains solely to a health care item or service for which you, or person other than the health plan on your behalf, has paid us in full.
WE ARE NOT REQUIRED TO AGREE TO YOUR REQUEST: If we agree to your request, we will comply with your request unless the information is needed to provide you emergency treatment. You may terminate the restriction at any time. We are not able to terminate or refuse your request for restrictions to disclosures to health plans if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law. And the information pertains solely to a health care item or service for which you, or person other than the health plan on your behalf, has paid us in full.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must submit a written request. We will attempt to accommodate reasonable requests.
RIGHT TO A PAPER COPY OF THIS NOTICE: You have the right to a paper copy of this notice at your first treatment encounter at this office. You may get an additional copy of this notice at any time when requested.
CHANGES TO THIS NOTICE: We reserve the right to change this Notice. We reserve the right to make the revised notice effective for medical information about you we already have as well as information we receive in the future. We will post a copy of the current notice at the office which will show the effective date. In addition, each time your register at the practice, we will provide available copies of the current notice. This will also be posted on the website.
OTHER USES OF MEDICAL INFORMATION: Other uses and disclosures of medical information not described in this notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. However, we may continue to use or disclose that information to the extent we have relied on your authorization. You also understand that we are unable to take back any disclosure we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.
