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 law’s primary goals are to make it easier for people to maintain health insurance, protect the confidentiality and security of healthcare information, and help the healthcare industry manage administrative costs.
Our goal is to take appropriate steps to safeguard any medical or other personal information 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 to us
- Provide notice of our legal duties and privacy practices
- Abide by the terms of our Notice of Privacy Practices currently
WHO WILL FOLLOW THIS NOTICE
- This notice describes the practices of our employees, staff, and 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 healthcare 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
Additionally, we will collect specific medical information about you and maintain a record of your care. 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 may also 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 various purposes. All types of uses and disclosures of data are described below, but not every use or disclosure in a category is listed.
Required Disclosures. Upon request, we must disclose health information about you to the Secretary of Health and Human Services to determine our compliance with HIPAA and to you, per your right to access and 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 your health information to bill for our services and collect payment from you or your insurance company. For example, we may need to provide the payer with details about your current medical condition so that they will pay us for the eye examinations or other services that we have provided to you. We may also need to inform your payer of the treatment you will receive 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 consultants to review our practices, evaluate our operations, and provide guidance on how to improve our services. 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 several public policy reasons why we may disclose information about you, which are outlined 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 Centers for Disease Control and Prevention, the Food and Drug Administration, the Occupational Safety and Health Administration, and the Environmental Protection Agency, among others.
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 determining compliance.
We may disclose your health information as required by law, including in response to a warrant, subpoena, or other court or administrative hearing body order, or to assist law enforcement in identifying or locating 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. If you are an organ donor, we may release your health information to organ procurement organizations, transplant centers, and eye or tissue banks.
We may release your health information to workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses, regardless of fault.
Health information about you may also 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 research purposes.
If you are an active-duty member of the Armed Forces, we may release health information about you for necessary activities as directed by military command authorities. We may also 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, as well as for the provision of protective services to the President of the United States and other officials, or foreign heads of state.
Our Business Associates. We sometimes collaborate with external individuals and businesses that help us operate our business effectively. We may disclose your health information to these business associates so they can perform the tasks for which we have hired them. Our business associates must agree to 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, we may use and disclose this information without your consent.
Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an upcoming appointment or to encourage you to schedule one.
Treatment Alternatives. We may use and disclose your personal health information to tell you about or recommend possible treatment options, alternatives, or health-related services that may interest you.
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 authorization, 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 request restrictions on how we use and disclose your health information for treatment, payment, and healthcare operations 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 we provide you with communications containing your protected health information in an alternative format or at an alternative location. 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 request copies of this information, we may charge a fee for copying and mailing.
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 the 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 authorize us to make, and uses and disclosures before April 14, 2003, among others. If you request this information from us more than once every twelve months, we may charge a fee. You have the right to a copy of this notice on paper. You may request a copy from us at any time.
To exercise any of your rights, please get in touch with us in writing at:
Neal Nirenberg, MD
5620 East Broadway Road
Mesa, AZ 85206
When requesting an amendment, you must state a reason for making the request.
CHANGES TO THIS NOTICE
We reserve the right to modify 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 Secretary of the Department of Health and Human Services
You also may contact Neal Nirenberg, MD, at 480-981-6111
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:
Neal Nirenberg, MD, at 480-981-6111.
This notice is effective as of February 20, 2003.
