| EYE
ASSOCIATES
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 our practices and those of:
Ø All employees, staff and other Eye Associates personnel;
Ø All fellows, residents, medical students, and other
trainees of, or affiliated with, Eye Associates;
Uses and Disclosures
of Your Health Information
Treatment. Your health information
may be used by our physicians and staff members or disclosed
to other health care professionals for the purpose of evaluating
your health, diagnosing medical conditions, and providing treatment.
For example, your health information may be disclosed to a corrective
lens provider to obtain appropriate corrective lenses for you.
Payment. Your health information
may be used to seek payment from your health plan, other sources
of coverage such as an automobile insurer, or credit card companies
that you may use to pay for services. For example, your health
plan may request and receive information on dates of service,
the services provided, and the medical condition being treated.
Health Care Operations. Your
health information may be used as necessary to support the day-to-day
activities and management Eye Associates. For example, information
on the services you received may be used to support budgeting
and financial reporting, activities to evaluate and promote
quality and to insure that our practice is meeting various legal
requirements.
Law Enforcement. Your health
information may be disclosed to law enforcement agencies, without
your permission, to support government audits and inspections,
to facilitate law enforcement investigations, and to comply
with government mandated reporting.
Public Health Reporting. Your
health information may be disclosed to public health and governmental
agencies as required by law. For example, our practice is required
to report certain communicable diseases to the New Jersey State
Department of Health.
Additional Uses of Information.
Ø Appointment reminders. Your health information will
be used by our staff to call/send you appointment reminders
and notices regarding your optical and contact lens orders.
Ø Information about treatments. Your health information
may be used to send you information on the treatment and management
of your medical condition that you may find to be of interest.
We may also send you information describing other health-related
goods and services that we believe may interest you.
Other uses and disclosures require
your authorization. Disclosures or uses of your health information
for a purpose other than those listed above requires your specific
written authorization. If you change your mind after authorizing
a use or disclosure of your information, you may submit a written
revocation of the authorization. However, your decision to revoke
the authorization will not affect or undo any use or disclosure
of information that occurred before we received the written
revocation.
Your Rights Regarding
Your Medical Information
You have the following rights regarding your protected health
information:
Ø The right to request restrictions on the use and disclosure
of your protected health information. Eye Associates is not
required to agree to a requested restriction. A written request
should be submitted to the contact person named below.
Ø The right to receive confidential communications concerning
your medical condition and treatment.
Ø The right to inspect and copy your protected health
information.
Ø The right to request an amendment or submit corrections
to your protected health information.
Ø The right to receive an accounting of how and to whom
your protected health information has been disclosed.
Ø The right to receive a copy of this notice.
Requests to Inspect Protected
Health Information
We require that requests to inspect or copy protected health
information be submitted in writing. You may obtain a form to
request access to your records from the contact person noted
below or the office manager. If you request a copy, we may charge
a fee.
Eye Associates Duties
We are required by law to maintain the privacy of your protected
health information and to provide you with this notice of privacy
practices. We are also required to abide by the privacy policies
and practices that are outlined in this notice.
This Notice May Be Amended
At Any Time
We may change the terms of this Notice at any time. Any revised
Notice will be effective for all health information that we
maintain. The effective date of a revised Notice will be noted.
A copy of the current Notice in effect will be posted. You may
request a copy of the current Notice at any time.
Comments, Questions and
Complaints
If you would like to submit a comment or complaint about our
privacy practices, or obtain additional information about our
privacy practices, you can do so by sending a letter outlining
your concerns to the person listed below. You will not be penalized
or otherwise retaliated against for filing a complaint.
Gina L. Biagi, Administrator
Eye Associates
2466 E. Chestnut Avenue
Vineland, NJ 08361
856-691-8188
Effective date
This notice is effective on or after April 14, 2003.
|
