NOTICE OF HEALTH INFORMATION 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.The Practice is required to maintain the privacy of your health information and to provide you with a notice of its legal duties and privacy practices. We will not use or disclose your health information except as described in this Notice. This Notice applies to all of the medical records generated by the Practice, as well as records we receive from other providers.

Use & Disclosure of Protected Health Information in Treatment, Payment & Healthcare Operations

Treatment:  The Practice may use and disclose your protected health information in the course of providing or managing your healthcare as well as any related services.  For the purpose of treatment, the Practice may coordinate your healthcare with a third party.  For example, the Practice may disclose your protected health information to a pharmacy to fulfill a prescription for medication, to a radiology facility to order and X-ray, or to another physician who is assisting in your healthcare.  In addition, the Practice may disclose protected health information to other healthcare providers related to the treatment provided by those other providers.

Payment:  When needed, the Practice will use or disclose your protected health information to obtain payment for its services.  Such uses or disclosures may include disclosures to your health insurer to get approval for a recommended procedure or to determine whether you are eligible for benefits or whether a particular service is covered under your health plan.  When obtaining payment for your healthcare, the Practice may also disclose your protected health information to your insurance company to demonstrate the medical necessity of the care or for utilization review when required to do so by your insurance company.  Finally, the Practice may also disclose your protected health information to another provider where that provider is involved in your care and requires the information to obtain payment.

Operations:  The Practice may use or disclose your protected health information when needed for the PracticeЌs healthcare operations for the purposes of management or administration of the Practice and of offering quality healthcare services.  Healthcare operations may include: (1) quality evaluations and improvement activities; (2) employee review activities and training programs; (3) accreditation, certification, licensing, or credentialing activities; (4) reviews and audits such as compliance reviews, medical reviews, legal services, and maintaining compliance programs; and (5) business management and general administrative activities.  For instance, the Practice may use, as needed, protected health information of patients to review their treatment course when making quality assessments regarding ophthalmologic care or treatment.  In addition, the Practice may disclose your protected health information to another provider of health plan for their healthcare operations.

Other Uses and Disclosures:  As part of treatment, payment, and healthcare operations, the Practice may also use or disclose your protected health information to: (1) remind you of an appointment; (2) inform you of potential treatment alternatives or options; or (3) inform you of health-related benefits or services that may be of interest to you.

 

Uses & Disclosures to Which You May Object

Family/Friends:  The Practice may disclose your health information 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 health 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.  If you have any objection to the use and disclosure of your health information in this manner, please tell us.

Uses & Disclosures That are Required or Permitted Without Your Authorization

Research:  Under certain circumstances, the Practice may use and disclose your health information to approved clinical research studies.  While most clinical research studies require specific patient consent, there are some instances where a retrospective record review with no patient contact may be conducted by such researchers.  For example, the research project may involve comparing the health and recovery of patients who received one medication for their medical condition to those who received a different medication for that same condition.

Regulatory Agencies:  The Practice may disclose your health information to government and certain private health oversight agencies, e.g., the Department of Public Health and Environment, the Joint Commission on Accreditation of Healthcare Organizations or the Board of Medical Examiners, for activities authorized by law, including, but not limited to, licensure, certification, audits, investigations and inspections.  These activities are necessary to monitor compliance with the requirements of government programs.

Law Enforcement/Litigation:  The Practice may disclose your health information for law enforcement purposes as required by law or in response to a court order.

Public Health:  As required by law, The Practice may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.  For example, The Practice is required to report the existence of a communicable disease, such as acquired immune deficiency syndrome ("AIDS"), to the Department of Public Health and Environment to protect the health and well-being of the general public.

Worker's Compensation:  The Practice may release health information about you for workers' compensation or similar programs.  These programs provide benefits for work-related injuries or illnesses.

Military/Veterans:  The Practice may disclose your health information as required by military command authorities, if you are a member of the armed forces.

Organ Procurement Organizations:  To the extent allowed by law, the Practice may disclose your health information to organ procurement organizations and other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.

As Otherwise Required By Law:  The Practice will disclose your health information in any situation in which such disclosure is required by law (e.g., child abuse, domestic abuse).

Uses and Disclosures Requiring Your Authorization:Other than the circumstances described above, the Practice will not disclose your PHI unless you provide written authorization.  You may revoke your authorization in writing at any time except to the extent that the Practice has already taken action in reliance upon the authorization.

Your Rights Related to Your Health Information:  Although all records concerning your treatment obtained at The Practice are the property of The Practice, you have the following rights concerning your health information:

Right to Confidential Communications:  You have the right to receive confidential communications of your health information by alternative means or at alternative locations.  For example, you may request that The Practice only contact you at work or by mail.

Right to Inspect and Copy:  You generally have the right to inspect and copy your health information, except as restricted by your physician or by law.

Right to Amend:  You have the right to request an amendment or correction to your health information.  If we agree that an amendment or correction is appropriate, we will ensure that the amendment or correction is attached to your medical record.

Right to an Accounting:  You have the right to obtain a statement of the disclosures that have been made of your health information other than by your authorization, other than to you and other than for the purpose of treatment, payment or routine operational purposes.

Right to Request Restrictions:  You have the right to request restrictions on certain uses and disclosures of your health information.  If we are able to agree to your request, we will abide by the restrictions.

Right to Receive a Copy of this Notice:  You have the right to receive a paper copy of this Notice, upon request, if this Notice has been provided to you electronically.

Right to Revoke Authorization:  You have the right to revoke your authorization to use or disclose your health information, except to the extent that action has already been taken in reliance on your authorization.

FOR MORE INFORMATION REGARDING EXCERSIZING THESE RIGHTS: If you have questions or would like more information regarding any of the rights listed above, please contact the Compliance Officer at (303) 398-7303.

IF YOU BELIEVE YOUR RIGHTS HAVE BEEN VIOLATED: You may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services.  To file a complaint with the Practice, please contact the Compliance Officer at (303) 398-7303.  All complaints must be submitted in writing.  There will be no retaliation for filing a complaint.

CHANGES TO THIS NOTICE:  The Practice will abide by the terms of the Notice currently in effect.  The Practice reserves the right to change the terms of this Notice at any time.  Any new notice provisions will be effective for all protected health information that it maintains.  The Practice will mail any revised Notice to the address indicated on the Registration Form or such other address you may provide to us from time to time.

NOTICE EFFECTIVE DATE:  This Notice is effective for all health information created on or after April 14, 2003.