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.
THIS NOTICE IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.
Right to Notice
As a patient, you have the right to adequate notice of the uses and disclosures
of your protected health information. Under the Health Insurance Portability
and Accessibility Act (HIPAA), the practices of The Eyecare Alliance can use
your protected health information for treatment, payment and health care operations.
a) Treatment - We may use or disclose your health information to a physician
or other healthcare provider providing treatment to you.
b) Payment - We may use and disclose your health information to obtain payment
for services we provide you.
c) Health care operations - We may use and disclose your health information
in connection with our healthcare operations. Healthcare operations include
quality assessment and improvement activities, reviewing the competency or
qualifications of healthcare professionals, evaluating provider performance,
conducting training programs, accreditation, certification, licensing or credentialing
activities.
Your Authorization
Most uses and disclosures that do not fall under treatment, payment, health
care operations will require your written authorization. Upon signing, you
may revoke your authorization (in writing) through our practice at any time.
Emergency Situations
In the event of your incapacity or an emergency situation, we will disclose
health information to a family member, or another person responsible for your
care, using our professional judgment. We will only disclose health information
that is directly relevant to the person's involvement in your healthcare.
Marketing
We will not use your health information for marketing communications without
your written authorization.
Required by Law
We may also use or disclose your health information when we are required to
do so by law.
Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably
believe that you are a possible victim of abuse, neglect, or domestic violence
or the victim of other crimes. We may disclose your health information to
the extent necessary to avert a serious threat to your or other people's health
or safety.
National Security
We may disclose the health information of Armed Forces personnel to military
authorities under certain circumstances. We may disclose health information
to authorized federal officials required for lawful intelligence, counterintelligence
and other national security activities. We may disclose health information
of inmates or patients to the appropriate authorities under certain circumstances.
Appointment Reminders
We may use or disclose your health information to provide you with appointment
reminders via phone, e-mail or letter.
Your Rights as a Patient
You have the right to restrict the disclosure of your protected health information
(in writing). The request for restriction may be denied if the information
is required for treatment, payment or health care operations.
-You have the right to receive confidential communications regarding your
protected health information.
-You have the right to inspect and copy your protected health information.
-You have the right to amend your protected health information.
-You have the right to receive an account of disclosures of your protected
health information.
-You have the right to a paper copy of this notice of privacy practices.
Legal Requirements
The practices of Clarkson Eyecare are required by law to maintain the privacy
of your protected health information. We are required to abide by the terms
of this notice as it is currently stated, and reserve the right to change
this notice. The policies in any new notice will not be in effect until they
are posted to this site, or are available within our office.
Complaints
If you have complaints regarding the way your protected health information
was handled, you may submit a complaint in writing to our office. You will
not be retaliated against in any manner for a complaint.
Contact Information
For further information about the practices of Clarkson Eyecare's privacy
policies, please contact us at the following address or phone number:
217 Clarkson Road
Ellisville, MO 63011
888.EYECARE