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.
We understand that your health information is personal to you, and we are
committed to protecting the information about you. This Notice of Privacy
Practices (or "Notice") describes how we will use and disclose protected
information and data that we receive or create related to your health care.
Our Duties
We are required by law to maintain the privacy of your health information,
and to give you this Notice describing our legal duties and privacy
practices. We are also required to follow the terms of the Notice currently
in effect.
How We May Use And Disclose Health Information About You
We will not use or disclose your health information without your
authorization, except in the following situations:
Treatment: We will use and disclose your health information while
providing, coordinating or managing your health care. For example,
information obtained by a nurse, physician, or other member of your
healthcare team will be recorded in your record and used to determine the
course of treatment that should work best for you. Your physician will put
in your record his or her expectations of the members of your healthcare
team. Members of your healthcare team will then record the actions they took
and their observations. In that way, the physician will know how you are
responding to treatment. We may also provide other healthcare providers with
your information to assist him or her in treating you.
Payment: We will use and disclose your medical information to obtain
or provide compensation or reimbursement for providing your health care. For
example, we may send a bill to you or your health plan. The information on
or accompanying the bill may include information that identifies you, as
well as your diagnosis, procedures, and supplies used. As another example,
we may disclose information about you to your health plan so that the health
plan may determine your eligibility for payment for certain benefits.
Health Care Operations: We will use and disclose your health
information to deal with certain administrative aspects of your health care,
and to manage our business more efficiently. For example, members of our
medical staff may use information in your health record to assess the
quality of care and outcomes in your case and others like it. This
information will then be used in an effort to improve the quality and
effectiveness of the healthcare and services we provide.
Business Associates: There are some services provided in our
organization through contracts with business associates. We may disclose
your health information to our business associate so they can perform the
job we've asked them to do. However, we require the business associate to
take precautions to protect your health information.
Facility Directory: Unless you notify us that you object, we will use
your name, location in the facility, general condition, [and religious
affiliation] for directory purposes. This information may be provided to
members of the clergy and, except for religious affiliation, to other people
who ask for you by name.
Notification of Family: We may use or disclose information to notify
or assist in notifying a family member, personal representative, or other
person responsible for your care of your location and general condition.
Communication with Family: We may disclose to a family member, other
relative, close personal friend or any other person you identify, health
information relevant to that person's involvement in your care.
Research: Consistent with applicable law we may disclose information
to researchers when their research has been approved by an institutional
review board that has reviewed the research proposal and established
protocols to ensure the privacy of your health information.
Funeral Director, Coroner, and Medical Examiner: Consistent with
applicable law we may disclose health information to funeral directors,
coroners, and medical examiners to help them carry out their duties.
Organ Procurement Organizations: Consistent with applicable law, we may
disclose health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of organs
for the purpose of tissue donation and transplant.
Food and Drug Administration (FDA): We may disclose to the FDA health
information relative to adverse events, product defects, or post marketing
surveillance information to enable product recalls, repairs, or replacement.
Public Health: As required by law, we may disclose your health
information to public health or legal authorities charged with preventing or
controlling disease, injury, or disability, including child abuse and
neglect.
Victims of Abuse, Neglect or Domestic Violence: We may disclose your
health information to appropriate governmental agencies, such as adult
protective or social services agencies, if we reasonably believe you are a
victim of abuse, neglect, or domestic violence.
Health Oversight: In order to oversee the health care system,
government benefits programs, entities subject to governmental regulation
and civil rights laws for which health information is necessary to determine
compliance, we may disclose your health information for oversight activities
authorized by law, such as audits and civil, administrative, or criminal
investigations.
Court Proceeding: We may disclose your health information in response
to requests made during judicial and administrative proceedings, such as
court orders or subpoenas.
Law Enforcement: Under certain circumstances, we may disclose your
health information to law enforcement officials. These circumstances include
reporting required by certain laws (such as the reporting of certain types
of wounds), pursuant to certain subpoenas or court orders, reporting limited
information concerning identification and location at the request of a law
enforcement official, reports regarding suspected victims of crimes at the
request of a law enforcement official, reporting death, crimes on our
premises, and crimes in emergencies.
Inmates: If you are an inmate of a correctional institution or under
the custody of a law enforcement official, we may release health information
about you to the correctional institution or law enforcement official. This
release would be necessary (1) for the institution to provide you with
health care; (2) to protect your health and safety or the health and safety
of others; or (3) for the safety and security of the correctional
institution.
Threats to Public Health or Safety: We may disclose or use health
information when it is our good faith belief, consistent with ethical and
legal standards, that it is necessary to prevent or lessen a serious and
imminent threat or is necessary to identify or apprehend an individual.
Specialized Government Functions: Subject to certain requirements, we
may disclose or use health information for military personnel and veterans,
for national security and intelligence activities, for protective services
for the President and others, for medical suitability determinations for the
Department of State, for correctional institutions and other law enforcement
custodial situations, and for government programs providing public benefits.
Workers Compensation: We may disclose health information when authorized
and necessary to comply with laws relating to workers compensation or other
similar programs.
Other Uses: We may also use and disclose your personal health
information for the following purposes:
- To contact you to remind you of an appointment for treatment;
- To describe or recommend treatment alternatives to you;
- To furnish information about health-related benefits and services that may
be of interest to you; or for certain charitable fundraising purposes.
Prohibition on Other Uses or Disclosures
We may not make any other use or disclosure of your personal health
information without your written authorization. Once given, you may revoke
the authorization by writing to the contact person listed below.
Understandably, we are unable to take back any disclosure we have already
made with your permission.
Individual Rights
You have many rights concerning the confidentiality of your health
information. You have the right:
To request restrictions on the health information we may use and disclose
for treatment, payment, and health care operations. We are not required to
agree to these requests. To request restrictions, please send a written
request to the address below.
To receive confidential communications of health information about you in a
certain manner or at a certain location. For instance, you may request that
we only contact you at work or by mail. To make such a request, you must
write to us at the address below, and tell us how or where you wish to be
contacted.
To inspect or copy your health information. You must submit your request in
writing to the address below. If you request a copy of your health
information we may charge you a fee for the cost of copying, mailing or
other supplies. In certain circumstances we may deny your request to inspect
or copy your health information. If you are denied access to your health
information, you may request that the denial be reviewed. Another licensed
health care professional will then review your request and the denial. The
person conducting the review will not be the person who denied your request.
We will comply with the outcome of the review.
To amend health information. If you feel that health information we have
about you is incorrect or incomplete, you may ask us to amend the
information. To request an amendment, you must write to us at the address
below. You must also give us a reason to support your request. We may deny
your request to amend your health information if it is not in writing or
does not provide a reason to support your request. We may also deny your
request if:
The information was not created by us, unless the person that created the
information is no longer available to make the amendment,
The information is not part of the health information kept by or for us,
Is not part of the information you would be permitted to inspect or copy, or
Is accurate and complete To receive an accounting of disclosures of your
health information. You must submit a request in writing to the address
below. Not all health information is subject to this request. Your request
must state a time period, no longer than 6 years and may not include dates
before April 14, 2003. Your request must state how you would like to receive
the report (paper, electronically).
The first accounting you request within a 12-month period is free. For
additional accountings, we may charge you the cost of providing the
accounting. We will notify you of this cost and you may choose to withdraw
or modify your request before charges are incurred.
To receive a paper copy of this Notice upon request, even if you have agreed
to receive the Notice electronically. You may also obtain a copy of this
notice at our website, www.eyeinstitute2020.com. You must submit a
request for a paper notice in writing to the address below.
All requests to restrict use of your health information for treatment,
payment, and health care operations, to inspect and copy health information,
to amend your health information, or to receive an accounting of disclosures
of health information must be made in writing to the contact person listed
below.
Complaints
If you believe that your privacy rights have been violated, a complaint may
be made to our privacy officer at (321) 722-4443 or the address listed
below. You may also submit a complaint to the Secretary of the Department of
Health and Human Services. We will not retaliate against you for filing a
complaint.
Our contact person for all questions, requests or for further information
related to the privacy of your health information is:
The Eye Institute
1995 West Nasa Boulevard
Melbourne, Fl 32904
Attn: Privacy OfficerChanges to This Notice
We reserve the right to change our privacy practices and to apply the
revised practices to health information about you that we already have. Any
revision to our privacy practices will be described in a revised Notice that
will be posted prominently in our facility.
Notice of Privacy Practices Acknowledgement Effective Date: August 14, 2003 |
