HIPAA - Health Insurance Portability & Accountability Act.
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. HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs.
goal is to take appropriate steps to attempt to safeguard any medical
or other personal information that is provided to us. The Privacy Rule
under the Health Insurance Portability and Accountability Act of 1996
("HIPAA") requires us to:
- Maintain the privacy of medical information provided
- Provide notice of our legal duties and privacy practices
- Abide by the terms of our Notice of Privacy Practices
WHO WILL FOLLOW THIS NOTICE
This notice describes the practices of our employees and staff as well as our
business partners. This notice applies to each of these individuals, entities,
sites and locations.
In addition, these individuals, entities, sites and locations may share medical
information with each other for treatment, payment and health care operation
purposes described in this notice.
INFORMATION COLLECTED ABOUT YOU
In the ordinary 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
In addition, we will gather certain medical information
about you and will create a record of the care provided to you. 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 also may provide some information to us.
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, but not every use or disclosure in a category
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 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.
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.
Public Policy Uses and Disclosures. There are a number of public policy
reasons why we may disclose information about you, which are described below.
We may disclose health information about you when we are required to do so
by federal, state, or local law.
We may disclose protected health information about you in connection with
certain public health reporting activities.
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 a 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
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.
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.
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
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 us to make disclosures about victims of crimes and the death of
an individual, among others.
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.
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 a 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
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
a 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
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 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
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
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. 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
If you believe that information in your records is 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. You have the right
to a copy of this notice in paper form. You may ask us for a copy at any time.
To exercise any of your rights, please contact us in writing at:
Neal Nirenberg, MD
5620 East Broadway Road
Mesa, AZ 85206
When making a request for amendment, you must state a reason for making the
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.
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
You also may contact:
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:
This notice is effective as of February 20, 2003.
The eye specialists of East Valley Ophthalmology perform advanced
technology diagnostic testing and treatment, as well as taking
the time necessary to provide each patient with information needed
to fully understand their condition and to achieve their best possible
If you would like further information, please call our office at:
East Valley Ophthalmology
Eye Doctors - Mesa, Arizona
If you or a family member
or friend have not had a recent routine eye examination, have a specific eye condition that needs addressing, or are looking for
an eye specialist or professional eye consultant please take a moment to Request an Appointment.