Health Insurance Portability and Accountability Act
Your Privacy and rights explained

hipaa

HIPAA NOTICE OF PRIVACY PRACTICES

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), this document is designed to tell you how we may, under federal law, use or disclose your Health Information

Effective Date of this Notice: April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal law and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. We realize that these laws are complicated, but we must provide you with the following important information:

  • How we may use and disclose your IIHI
  • Your privacy rights in your IIHI
  • Our obligations concerning the use and disclosure of your IIHI

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Tammy Romero
HIPAA Compliance/Privacy Officer
(210) 366-1199 Extension 2109

C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI)
IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your IIHI.
1. Treatment
Our practice may use your IIHI to treat you. For example, we might use your IIHI in order to write a prescription for you, or we might disclose your IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice including, but not limited to, our Doctors, Doctors Assistants and Billing staff in our office may access your information for purposes of providing your care.

2. Payment
Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. For example our billing office may access your information and send relevant parts to your insurance company to allow us to be paid for services we render to you. Also, we may use your IIHI to bill you directly for service and items.

3. Health Care Operations
Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may need to use your IIHI to evaluate the quality of care you received from use; send information to our attorneys or accountants; or to conduct cost-management and business planning activities for our practice.

4. Appointment Reminders
Our practice may use and disclose your IIHI to contact you to provide appointment reminders or to give information about other treatments or health-related benefits and services that may be of interest to you.

5. Change of Ownership
Our practice may use and disclose your IIHI in the event that our practice is sold or merged with another organization, and your Health Information/record may then become the property of the new owner.

D. WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION IN CERTAIN CIRCUMSTANCES WITHOUT OBTAINING YOUR PRIOR CONSENT OR AUTHORIZATION

1. To Provide It To You
2. To Notify And /Or Communicate With Your Family
Unless you tell us you object, we may use or disclose your Health Information in order to notify your family or assist in notifying your family, your personal representative or another person responsible for your care, about your location, your general condition or in the event of your death. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in any communications with your family and others.

E. USE AND DISCLOSURE OF YOUR HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your individually identifiable health information:
1. Public Health Purposes
Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:

  • Preventing or controlling disease, injury or disability
  • Reporting child abuse or neglect
  • Reporting domestic violence
  • Reporting to the Food and Drug Administration reactions to drugs or problems with products or devices
  • Reporting disease or infection exposure

2. Health Oversight Activities
Our practice may disclose your IIHI to health oversight agencies for activities authorized by law: during the course of audits, investigations, inspections, licensee and other proceedings.

3. Lawsuits and Similar Proceedings
Our practice may use and disclose your IIHI in response to subpoenas or for judicial and administrative proceedings. However, in general, we will attempt to ensure that you have been made aware of the use or disclosure of your Health Information prior to providing it to another person

4. Law Enforcement
Our practice may release IIHI if asked to do so by a law enforcement official:
To identify/locate a suspect, material witness, fugitive or missing person
In response to a warrant, summons, court order, subpoena or similar legal process

5. Deceased Patients
Our practice may release IHII to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs

6. Organ and Tissue Donation

Our practice may release your IHII to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

7. Research
Our practice may release your IHII in order to conduct research that has been approved by our Institutional Review Board.

8. Public Safety
Our practice may release your IHII when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the general public.

9. National Security
Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

10. Worker’s Compensation
Our practice may release your IIHI for worker’s compensation and similar programs, which are necessary to comply with worker’s compensation laws.

11. Inmates
Our practice may disclose your IHII to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.

F. FOR ALL OTHER CIRCUMSTANCES, WE MAY ONLY USE OR DISCLOSE

YOUR HEALTH INFORMATION AFTER YOU HAVE SIGNED AN AUTHORIZATION.

If you authorize us to use or disclose your Health Information for another purpose, you may revoke your authorization in writing at any time.

G. YOUR RIGHTS REGARDING YOUR IIHI

You have the following rights regarding the IIHI that we maintain about you:

1. Confidential Communications
You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. Our practice will accommodate reasonable requests. In order to request a confidential communication, you must make a written request to Tammy Romero the practice’s HIPAA Compliance/Privacy Officer; POBOX 160308, San Antonio, Texas 78280 for more information she can be reached at (210) 366-1199 Extension 2109.

2. Requesting Restrictions

You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment or health care operations. We are not required to agree to your request.

3. Inspection and Copies
You have the right to inspect and obtain a copy of your Health Information. You must submit your request in writing to Tammy Romero the Practice’s Administrator; for more information she can be reached at (210) 366-1199 Extension 2109. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.

4. Amendment
You have the right to ask us to amend your Health Information if you believe the information is incorrect or incomplete. We are not required to change your health information. However, we will provide you with information about our denial and how you can disagree with said denial.

5. Accounting of Disclosures
All of our patients have the right to request an accounting of disclosures of their Health Information made by us, except that we do not have to account for disclosures:

  • Authorized by patients
  • Made for treatment, payment, or health care operations
  • Information provided to patients
  • Notification and communication with family
  • Certain government functions
  • Appointment reminders

6. Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact Tammy Romero the Practice’s HIPAA Administrator at (210) 366-1199 Extension 2109.

H. Our Duties
We are required by law to maintain the privacy of your Health Information and to provide you with a copy of this Notice.
We reserve the right to amend this Notice at any time in the future and to make the new Notice provisions applicable to all of your Health Information even if it was created prior to the change in the Notice. If such amendment is made, we will immediately display the revised Notice at our office and provide you with a copy of the amended Notice. We will also provide you with a copy, at any time, upon request.

I. Complaints to the Government
You may make complaints to the Secretary of the Department of Health and Human Services (DHHS), if you believe your rights have been violated.
We promise not to retaliate against you for any complaint you make to the government about our privacy practices.

J. Contact Information
You may contact us about our privacy practices by calling the Practice’s Privacy Officer Tammy Romero at (210) 366-1199 Extension 2109; Or you may contact The US Department of Health & Human Service at:
200 Independence Avenue, SW Washington, DC 20201 Telephone: 1-877-696-6775

K. Electronic Notice
This Notice of Privacy Practices is also available on our web page at www.eyetx.net

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