 |
| 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. |
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| How
We May Use and Disclose Information About You |
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| 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, but not
every use of disclosure in a category is listed. |
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|
Required
Disclosures. We are required
to disclose health information about you to the Secretary of
Health and Human Services, upon 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. |
|
| For
Treatment. We may use health information about you in
your treatment. For example, we may use your medical history,
such as any presence or absence of diabetes, to assess the health
of your eyes. |
|
| For
Payment. We may use and disclose health information about
you to bill for our services and to collect payment from you
or your insurance company. For example, we may need to give
a payer information about your current medical condition, so
that it will pay us for the eye examinations or other services
that we have furnished you. We may also need to inform your
payer of the treatment you are going to receive in order to
obtain prior approval or to determine whether the service is
covered. |
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| For
Health Care Operations. We may use and disclose information
about you for the general operation of our business. For example,
we sometimes arrange for auditors or other consultants to review
our practices, evaluate our operations, and tell us how to improve
our services. Or, for example, we may use and disclose your
health information to review the quality of services provided
to you. |
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| Public
Policy Uses and Disclosures. There are a number of public
policy reasons why we may disclose information about you which
are described below. |
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| We
may disclose health information about you when we are required
to do so by federal, state, or local law. |
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| We
may disclose protected health information about you in connection
with certain public health reporting activities. |
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| We
may disclose protected health information about you in connection
with certain public health reporting activities. For instance,
we may disclose such information to a public health authority
authorized to collect or receive PHI for the purpose of preventing
or controlling disease, injury or disability, or at the direction
of a public health authority, to an official of a foreign government
agency that is acting in collaboration with public health authority.
Public health authorities include state health departments,
the Center for Disease Control, the Food and Drug Administration,
the Occupational Safety and Health Administration and the Environmental
Protection Agency, to name a few. |
|
| We
are also permitted to disclose protected health information
to a public health authority or other government authority authorized
by law to receive reports of child abuse or neglect. Additionally
we may disclose protected health information to a person subject
to the Food and Drug Administration’s power for the following
activities: to report adverse events, product defects or problems,
or biological product deviations; to track products; to enable
product recalls, repairs or replacements; or to conduct post
marketing surveillance. We may also disclose a patient’s
health information to a person who may have been exposed to
a communicable disease or to an employer to conduct an evaluation
relating to medical surveillance of the workplace or to evaluate
whether an individual has a work-related illness or injury. |
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| We
may disclose a patient's health information where 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. |
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| We
may disclose health information about you in connection with
certain health oversight activities of licensing and other health
oversight agencies which are authorized by law. Health oversight
activities include audit, investigation, inspection, licensure
or disciplinary actions, and civil, criminal, or administrative
proceedings or actions or any other activity necessary for the
oversight of 1) the health care system, 2) governmental benefit
programs for which health information is relevant to determining
beneficiary eligibility, 3) entities subject to governmental
regulatory programs for which health information is necessary
for determining compliance with program standards, or 4) entities
subject to civil rights laws for which health information is
necessary for determining compliance. |
|
| We
may disclose your health information as required by law, including
in response to a warrant, subpoena, or other order of a court
or administrative hearing body or to assist law enforcement
identify or locate a suspect, fugitive, material witness or
missing person. Disclosures for law enforcement purposes also
permit use to make disclosures about victims of crimes and the
death of an individual, among others. |
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| We
may release a patient's health information (1) to a coroner
or medical examiner to identify a deceased person or determine
the cause of death and (2) to funeral directors. We also may
release your health information to organ procurement organizations,
transplant centers, and eye or tissue banks, if you are an organ
donor. |
|
| We
may release your health information to workers’ compensation
or similar programs, which provide benefits for work-related
injuries or illnesses without regard to fault. |
|
| Health
information about you also may be disclosed when necessary to
prevent a serious threat to your health and safety or the health
and safety of others. |
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| We
may use or disclose certain health information about your condition
and treatment for research purposes where an Institutional Review
Board or a similar body referred to as Privacy Board determines
that your privacy interests will be adequately protected in
the study. We may also use and disclose your health information
to prepare or analyze a research protocol and for other research
purposes. |
|
| If
you are a member of the Armed Forces, we may release health
information about you for activities deemed necessary by military
command authorities. We also may release health information
about foreign military personnel to their appropriate foreign
military authority. |
|
| We
may disclose your protected health information for legal or
administrative proceedings that involve you. We may release
such information upon order of court or administrative tribunal.
We may also release protected health information in 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. |
|
| If
you are an inmate, we may release protected health information
about you to 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. |
|
| Finally,
we may disclose protected health information for 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. |
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|
| Our
Business Associates. We sometimes work with outside individuals
and businesses that help us operate our business successfully.
We may disclose your health information to these business associates
so that they can perform the tasks that we hire them to do.
Our business associates must promise that they will respect
the confidentiality of your personal and identifiable health
information. |
|
| Disclosures
to Persons Assisting in Your Care or Payment for Your Care.
We may disclose information to 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" - such
as your spouse, your other doctors, or an aide who may be providing
services to you. We may also use and disclose health information
about a patient for disaster relief efforts and to notify persons
responsible for a patient's care about a patient's location,
general condition or death. Generally, we will obtain your verbal
agreement before using or disclosing health information in this
way. However, under certain circumstances, such as in an emergency
situation, we may make these uses and disclosures without your
agreement. |
|
| Appointment
Reminders. We may use and disclose medical information
to contact you, via postal service or telephone communication,
as a reminder that you have an appointment or that you should
schedule an appointment. |
|
| Treatment
Alternatives. We may use and disclose your personal health
information in order to tell you about or recommend possible
treatment options, alternatives or health- related services
that may be of interest to you. This may be communicated by
telephone or messaging. |
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| 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. |
|
| Individual
Rights |
|
| You
have the right to ask for restrictions of the ways we use and
disclose your health information for treatment, payment and
health care operation purposes. You may also request that we
limit our disclosures to persons assisting your care or payment
for your care. We will consider your request, but we are not
required to accept it. |
|
| You
have the right to request that you receive communications containing
your protected health information from us by alternative means
or at alternative locations. For example, you may ask that we
only contact you at home or by mail. |
|
| Except
under certain circumstances, you have the right to inspect and
copy medical, billing and other records used to make decisions
about you. If you ask for copies of this information, we may
charge you a fee for copying and mailing. |
|
| If
you believe that information in your records in incorrect or
incomplete, you have the right to 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. |
|
| You
have a right to 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, among others. If you ask for this information from
us more than once every twelve months, we may charge you a fee. |
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| You
have the right to a copy of this notice in paper form. You may
ask us for a copy at any time. |
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| You
may also obtain a copy of this form from our web site: |
|
www.corneacolorado.com |
|
To
exercise any of your rights, please contact us in writing at:
8381
SouthPark Lane
Littleton,
Colorado 80120
Attention:
Privacy Officer
When making a request for amendment, you must state a reason
for making the request. |
| |
| 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. |
|
| Complaints/Comments |
|
If
you have any complaints concerning our privacy practices, you
may contact:
Secretary
of the Department of Health and Human Services
200
Independence Avenue, S.W.
Room
509F, HHH Building
Washington,
D.C. 20201
e-mail:
ocrmail@hhs.gov
You also may contact us:
Corneal
Consultants of Colorado, P.C.
8381
SouthPark Lane
Littleton,
Colorado 80120
Attention:
Privacy Officer |
|
| YOU
WILL NOT BE RETALIATED AGAINST OR PENALIZED BY US FOR FILING
A COMPLAINT. |
|
| To
obtain more information concerning this notice, you may contact
our Privacy Officer at 8381 SouthPark Lane, Littleton, Colorado
80120 or call 303-730-0404. |
|
This
notice is effective as of April 2003.
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This
notice describes the practices of our employees and staff. 
