Our goal is to have all staff members and associates, in all locations, take the appropriate steps to safeguard any medical and professional information that is provided to us. This notice describes how this information, about you, may be used or disclosed and how you may access this information. Please read this document carefully.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
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. We may disclose health information about you when we are required to do so because:
- Of 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.
- We may use health information about you in your treatment.
- We may use and disclose health information about you to authorize or bill for our services and to collect payment from you or your insurance company.
- We may use and disclose information about you for the general operation of our business.
- Of a federal, state, or local law and certain public health reporting activities.
- Of a public health authority or other government authority authorized by law to receive reports of child abuse or neglect.
- Person may have been exposed to a communicable disease.
- An employer must conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether an individual has a work-related illness or injury.
- 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 believe if is necessary to prevent a serious threat to your health and safety or the health and safety of others.
- 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 need to prepare or analyze a research protocol and for other research purposes.
- Activities deemed necessary by military command authorities.
- To appropriate foreign military authority.
- Of an order of a court or administrative tribunal.
- Of 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.
- You are an inmate, in 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.
- Of 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.
- We need to contact you as a reminder that you about an appointment
- We need to inform you about or recommend possible treatment options, alternatives or health-related services.
- We sometimes work with outside individuals and businesses that help us operate our business successfully. These individuals or businesses must promise that they will respect your confidentiality.
- You have 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".
- We need to share information among office locations of Augusta Eye Associates.
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. In addition, you may request a copy of the revised notice at any time.
INFORMATION COLLECTED ABOUT YOU
In the course of receiving treatment and health care services from us, you will be providing us with personal information such as:
- Your name, address, and phone number.
- Information relating to your medical history.
- Your insurance information and coverage.
- Information concerning your doctor, nurse or other medical providers.
- Other information needed to provide you with medical care and the private and third party billing of that care.
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.
OTHER USES AND DISCLOSURES OF PERSONAL INFORMATION
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.
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. We will consider your request, but we are not required to accept it.
- Request that you receive communications containing your protected health information from us by alternative means or at alternative locations.
- Inspect and to request copies (for a fee) of medical, billing and other records used to make decisions about you.
- 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.
- 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. If you ask for this information from us more than once every twelve months, we may charge you a fee.
- A copy of this notice in paper form. You may ask us for a copy at any time.
- Exercise any of your rights. To do so please contact us in writing to the Compliance Officer, Augusta Eye Associates, 425 South Linden Ave, Waynesboro, Virginia 22980. When making a request for amendment, you must state a reason for making the request.
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: email@example.com). You also may contact our Compliance Officer, at Augusta Eye Associates, 425 South Linden Ave., Waynesboro, Virginia 22980 (1-540-949-6060)
YOU WILL NOT BE RETALIATED AGAINST OR PENALIZED BY US FOR FILING A COMPLAINT.