NOTICE OF PRIVACY PRACTICES FOR OPHTHALMOLOGY ASSOCIATES OF YORK, LLP
Effective date: 9/19/2013
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
If you have any questions regarding this notice, you may contact our privacy officer at:
Ophthalmology Associates of York, LLP, Attention: Privacy Officer
1945 Queenswood Drive, York, PA 17403
Ophthalmology Associates of York, LLP is required by the federal privacy rule to maintain the privacy of health information that is protected by the rule, and to provide you with notice of our legal duties and privacy practices with respect to your protected health care information. We are required to abide by the terms of the notice currently in effect.
Generally speaking, your protected health information is any information that relates to your past, present or future physical or mental health or condition, the provision of health care to you, or payment for health care provided to you, and individually identifies you or reasonably can be used to identify you.
Your medical and billing records at our practice are examples of information that usually will be regarded as your protected health information.
A. Treatment, payment, and health care operations
This section describes how we may use and disclose your protected health information for treatment, payment, and health care operations purposes. The descriptions include examples. Not every possible use or disclosure for treatment, payment, and health care operations purposes will be listed.
We may use and disclose your protected health information for our treatment purposes as well as the treatment purposes of other health care providers. Treatment includes the provision, coordination, or management of health care services to you by one or more health care providers. Some examples of treatment uses and disclosures include:
During an office visit, practice physicians and other staff involved your care may review your medical record and share and discuss your medical information with each other.
We may share and discuss your medical information with an outside physician to whom we have referred you for care.:
We may share and discuss your medical information with an outside laboratory, radiology center, or other health care facility where we have referred you for testing.
We may share and discuss your medical information with a hospital or other health care facility where we are admitting or treating you.
We may use a patient sign-in sheet in the waiting area which is accessible to all patients.
We may page patients in the waiting room when it is time for them to go to an examining room. We may contact you by mail or telephone to provide appointment reminders.
We may use and disclose your protected health information for our payment purposes as well as the payment purposes of other health care providers and health plans. Payment uses and disclosures include activities conducted to obtain payment for the care provided to you or so that you can obtain reimbursement for that care, for example, from your health insurer. Some examples of payment uses and disclosures include:
Sharing information with your health insurer to determine whether you are eligible for coverage or whether proposed treatment is a covered service.
Submission of a claim form to your health insurer.
Sharing your demographic information with other health care providers who seek this information to obtain payment for health care services provided to you.
Mailing you bills in envelopes with our practice name and return address.
Provision of a bill to a family member or other person designated as responsible for payment for services rendered to you.
Providing medical records and other documentation to your health insurer to support the medical necessity of a health service.
Providing information to a collection agency or our attorney for purposes of securing payment of a delinquent account.
Disclosing information in a legal action for purposes of securing payment of a delinquent account.
We may use and disclose your protected health information for our health care operation purposes as well as certain health care operation purposes of other health care providers and health plans. Some examples of health care operation purposes include:
Quality assessment and improvement activities.
Conducting training programs for medical and other students.
Accreditation, certification, licensing, and credentialing activities.
Health care fraud and abuse detection and compliance programs.
Conducting other medical review, legal services, and auditing functions.
Other business management and general administrative activities, such as compliance with the federal privacy rule and resolution of patient grievances.
B. Uses and disclosures for other purposes
We may use and disclose your protected health information for other purposes. This section generally describes those purposes by category. Each category includes one or more examples.
We may disclose your protected health information to someone involved in your care or payment for your care, such as a spouse, a family member, or close friend. For example, if you have surgery, we may discuss your physical limitations with a family member assisting in your post-operative care.
We may use and disclose your protected health information to notify, or to assist in the notification of, a family member, a personal representative, or another person responsible for your care, regarding a your location, general condition, or-death. For example, if you are hospitalized, we may notify a family member of the hospital and your general condition
We may use and disclose protected health information when required by federal, state, or local law. For example, we may disclose protected health information to comply with mandatory reporting requirements involving child abuse, disease prevention and control, medical device-related deaths and serious injuries, and driving impairments.
We may use and disclose protected health information for public health activities, including:
Public health reporting, for example, communicable disease reports.
FDA-related reports and disclosures, for example, adverse event reports.
OSHA requirements for workplace surveillance and injury reports.
We may use and disclose protected health information for purposes of reporting abuse, neglect or domestic violence in addition to child abuse., for example, reports of elder abuse to the Department of Aging or abuse of a nursing home patient to the Department of Public Welfare.
We may use and disclose protected health information for purposes of health oversight activities authorized by law. These activities could include audits, inspections, investigations, licensure actions, and legal proceedings. For example, we may comply with a Drug Enforcement Agency inspection.
We may use and disclose protected health information disclosures in judicial and administrative proceedings in response to a court order or subpoena, discovery request or other lawful process. For example, we may comply with a court order to testify in a case at which your medical condition is at issue.
We may use and disclose protected health information for certain law enforcement purposes including to: Comply with legal process, for example, a search warrant.
Respond to a request for information about a crime victim.
Provide information regarding a crime on the premises.
Report a crime in an emergency.
We may use and 'disclose protected health information for purposes of providing information as necessary to carry out their duties.
For purposes of facilitating organ, eye and tissue donation and transplantation, we may use protected health information
We may use and disclose protected health information for purposes involving a threat to public safety, including protection of a third party from harm and identification and apprehension of a criminal
We may use and disclose protected health information for purposes involving specialized government functions including: National security and intelligence.
Correctional institutions and other law enforcement custodial situations.
We may use and disclose protected health information as authorized by and to the extent necessary to comply with laws relating to workers' compensation or similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault. For example, this would include submitting a claim for payment to your employer's workers' compensation carrier if we treat you for a work injury.
Certain functions of the practice are performed by a business associate such as a billing company, an accountant firm, or a law firm. We may disclose protected health information to our business associates and allow them to create and receive protected health information on our behalf.
15. Incidental disclosures
We may disclose protected health information as by-product of an otherwise permitted use or disclosure. For example, other patients may overhear your name being paged in the waiting room. In addition, you may be shown, in the presence of other patients, educational videos which may incidentally disclose information about your health status.
16. Marketing disclosures
Your protected health information will never be disclosed for marketing purposes, including subsidized treatment communications or sales communication purposes.
C. Uses and disclosures with authorization
For all other purposes which do not fall under a category listed under sections III.A and III.B, we will obtain your written authorization to use or disclose your protected health information. Your authorization can be revoked at any time except to the extent that we have relied on the authorization.
III. PATIENT PRIVACY RIGHTS
You have a right to request that we further restrict use and disclosure of your protected health information (i) to carry out treatment, payment, or health care operations, (ii) to someone who is involved in their care or the payment for your care, or (iii) for notification purposes. We are not required to agree to a request for a further restriction.
To request a further restriction, you must submit a written request to our privacy officer. The request must tell us: (a) what information you want restricted; (b) how you want the information restricted; and (c) to whom you want the restriction to apply.
You have a right to request that we communicate your protected health information to you by a certain means or at a certain location. For example, you might request that we only contact you by mail or at work. We are not required to agree to requests for confidential communications that are unreasonable. To make a request for confidential communications, you must submit a written request to our privacy officer. The request must tell us how or where you want to be contacted. In addition, if another individual or entity is responsible for payment, the request must explain how payment will be handled.
C. Accounting of disclosures
You have a right to obtain, upon request, an "accounting" of certain disclosures of your protected health information by us. This right is limited to disclosures within six years of the request and other limitations. To request an accounting, you must submit a written request to our privacy officer.
D. Inspection and copying
You have a right to inspect and obtain a copy of your protected health information that we maintain regardless of whether the designated record set is an electronic health record. It must be provided in the format requested by the individual, limited only by whether the format requested is readily producible. A covered entity has 30 days to provide access (with a 30-day extension when necessary). This right is subject to limitations and we may impose charge for the labor and supplies involved in providing copies. To exercise your right of access, you must submit a written request to our privacy officer. The request must: (a) describe the health information to which access is requested, (b) state how you want to access the information, (c) specify any requested form or format, such as paper copy or an electronic means, and (d) include the mailing address, if applicable.
You have a right to request that we amend protected health information that we maintain about you if the information is incorrect or incomplete. This right is subject to limitations. To request an amendment, you must submit a written request to our privacy officer. The request must specify each change that you want and provide a reason to support each requested change.
F. Paper copy of privacy notice
You have a right to receive, upon request, a paper copy of our Notice of Privacy Practices. To obtain a paper copy, contact our privacy officer.
G. Right to know of breach
You have a right of notification of any breach of your personal health information.
H. Right to restrict
Individuals have a new right to restrict certain disclosures of protected health information to a health plan when the individual, a family member or other person pays out of pocket in full for the healthcare item or service. This is an exception to the general rule that a covered entity is not required to agree to a restriction. The provider must accommodate the request unless the disclosure is required by law, such as submitting protected health information to a federal health plan like Medicare. Physicians may continue to do so as necessary to comply with that legal mandate.
We reserve the right to change this notice at any time. We further reserve the right to make any change effective for all protected health information that we maintain at the time of the change — including information that we created or received prior to the effective date of the change.
We will post a copy of our current notice in the waiting room for the practice. At any time, patients may review the current notice by contacting our privacy officer. COMPLAINTS
If you believe that we have violated you privacy rights, you may submit a complaint to the practice or the Secretary of Health and Human Services. To file a complaint with the practice, submit the complaint in writing to our privacy officer. We will not retaliate against you for filing a complaint.
This notice is not intended to create contractual or other rights independent of those created in the federal privacy rule.