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.
This Notice describes the privacy practices of Union Eye Works, LLC and all business associates with whom we may share your protected health and medical information. We provide the Notice of Privacy Practices to every patient who whom we have a direct treatment relationship after the November 27th, 2012 effective date. This Notice is also available to any member of the public and is posted within our reception area. Every effort will be made to obtain a signed Receipt of Notice of Privacy Practices from each patient that will be kept on file. If the patient refuses to sign the form, it will be noted that the Notice was given but the patient refused to or could not sign the receipt.
We understand that your protected health information is confidential and we are committed to maintaining its privacy. Federal law requires that we provide you with this Notice of our legal duties and privacy practices with respect to your protected health information. We are required to abide by the terms of this Notice when we use or disclose your protected health information.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
We may use and disclose protected health information about you without your prior authorization for the following reasons:
Treatment Purposes: For example, to diagnose and treat your illness, activities related to providing services to the patient. In addition, we may contact you to provide appointment reminders. We may also disclose your protected health information to other providers involved in your treatment.
Payment Purposes. Such as the submission of claims and sending billing information to Medicare, Medicaid, your health insurer, HMO, or other company or program that will pay for your health care and any additional information requested by the insurance company so they can determine if they should pay the claim. If you are receiving treatment for a work-related injury, state law requires us to provide information to parties involved in the authorization and management of your claim.
Health Care Operations: For example, we may also disclose protected health information to other health care providers when such protected health information is required for them to treat you, receive payment for services they render to you, or conduct certain health care operations, such as quality assessment and improvement activities, and peer review.
Disclosure to Family, Close Friends and Other Caregivers: In an emergency situation, we may disclose protected health information about you to those involved in a patient's care when the patient approves or, when the patient is not present or not able to approve, when such disclosure is deemed appropriate in the professional judgment of the practice. When the patient is not present, we determine whether the law requires the disclosure of the patient's protected health information and if so, disclose only the information directly relevant to the person's involvement with the patient's health care. We do not disclose protected health information to a suspected abuser, if, in its professional judgment, there is reason to believe that such a disclosure could cause the patient serious harm. Further, we use and disclose information as required by law.
Other Disclosures Required by Law: We may also use or disclose protected health information about you without your prior authorization, subject to certain requirements and as required by law, for several other reasons to include: public health activities for the purpose of preventing or controlling diseases; abuse and neglect, to a governmental authority if we reasonably believe you are a victim of abuse, neglect or domestic violence or to avert a serious threat to health or safety; health oversight activities or inspections, to a health oversight agency that oversees the health care system; judicial, administrative and law enforcement purposes in response to a subpoena or a request by a law enforcement officer; workers' compensation purposes and your health and safety. We may also disclose your protected health information as appropriate to provide treatment in emergency situations. In those instances where we have not previously provided our Notice of Privacy Practices to a patient who receives direct treatment in an emergency situation, we provide the Notice as soon as practicable following the provision of emergency treatment.
We may contact individuals through telephone and mail with appointment reminders and may utilize facsimile transmissions for specific authorizations and prescription refills through pharmacies.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
For any purpose other than the ones described above, we will only use or disclose your protected health information when you give us your written authorization. For instance, we will obtain your written authorization before we can send your protected health information to your employer or health plan sponsor, for underwriting and related purposes or life insurance company or to the attorney representing the other party in litigation in which you are involved.
Highly Confidential Information. Federal and state law requires special privacy protections for highly confidential information about you. Highly Confidential Information consists of protected health information related to: psychotherapy notes; mental health and developmental disabilities services; alcohol and drug abuse services; HIV/AIDS testing, diagnosis or treatment; venereal disease(s); genetic testing; child abuse and neglect; domestic abuse of an adult with a disability; or sexual assault. In order for us to disclose your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your written authorization.
This Notice describes the privacy practices of Union Eye Works, LLC and all business associates with whom we may share your protected health and medical information. We provide the Notice of Privacy Practices to every patient who whom we have a direct treatment relationship after the November 27th, 2012 effective date. This Notice is also available to any member of the public and is posted within our reception area. Every effort will be made to obtain a signed Receipt of Notice of Privacy Practices from each patient that will be kept on file. If the patient refuses to sign the form, it will be noted that the Notice was given but the patient refused to or could not sign the receipt.
We understand that your protected health information is confidential and we are committed to maintaining its privacy. Federal law requires that we provide you with this Notice of our legal duties and privacy practices with respect to your protected health information. We are required to abide by the terms of this Notice when we use or disclose your protected health information.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
We may use and disclose protected health information about you without your prior authorization for the following reasons:
Treatment Purposes: For example, to diagnose and treat your illness, activities related to providing services to the patient. In addition, we may contact you to provide appointment reminders. We may also disclose your protected health information to other providers involved in your treatment.
Payment Purposes. Such as the submission of claims and sending billing information to Medicare, Medicaid, your health insurer, HMO, or other company or program that will pay for your health care and any additional information requested by the insurance company so they can determine if they should pay the claim. If you are receiving treatment for a work-related injury, state law requires us to provide information to parties involved in the authorization and management of your claim.
Health Care Operations: For example, we may also disclose protected health information to other health care providers when such protected health information is required for them to treat you, receive payment for services they render to you, or conduct certain health care operations, such as quality assessment and improvement activities, and peer review.
Disclosure to Family, Close Friends and Other Caregivers: In an emergency situation, we may disclose protected health information about you to those involved in a patient's care when the patient approves or, when the patient is not present or not able to approve, when such disclosure is deemed appropriate in the professional judgment of the practice. When the patient is not present, we determine whether the law requires the disclosure of the patient's protected health information and if so, disclose only the information directly relevant to the person's involvement with the patient's health care. We do not disclose protected health information to a suspected abuser, if, in its professional judgment, there is reason to believe that such a disclosure could cause the patient serious harm. Further, we use and disclose information as required by law.
Other Disclosures Required by Law: We may also use or disclose protected health information about you without your prior authorization, subject to certain requirements and as required by law, for several other reasons to include: public health activities for the purpose of preventing or controlling diseases; abuse and neglect, to a governmental authority if we reasonably believe you are a victim of abuse, neglect or domestic violence or to avert a serious threat to health or safety; health oversight activities or inspections, to a health oversight agency that oversees the health care system; judicial, administrative and law enforcement purposes in response to a subpoena or a request by a law enforcement officer; workers' compensation purposes and your health and safety. We may also disclose your protected health information as appropriate to provide treatment in emergency situations. In those instances where we have not previously provided our Notice of Privacy Practices to a patient who receives direct treatment in an emergency situation, we provide the Notice as soon as practicable following the provision of emergency treatment.
We may contact individuals through telephone and mail with appointment reminders and may utilize facsimile transmissions for specific authorizations and prescription refills through pharmacies.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
For any purpose other than the ones described above, we will only use or disclose your protected health information when you give us your written authorization. For instance, we will obtain your written authorization before we can send your protected health information to your employer or health plan sponsor, for underwriting and related purposes or life insurance company or to the attorney representing the other party in litigation in which you are involved.
Highly Confidential Information. Federal and state law requires special privacy protections for highly confidential information about you. Highly Confidential Information consists of protected health information related to: psychotherapy notes; mental health and developmental disabilities services; alcohol and drug abuse services; HIV/AIDS testing, diagnosis or treatment; venereal disease(s); genetic testing; child abuse and neglect; domestic abuse of an adult with a disability; or sexual assault. In order for us to disclose your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your written authorization.