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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.
The Spokane Eye Clinic and related entities
respect your privacy. We understand that your
personal health information is very sensitive.
We will not disclose your information to others
unless you tell us to do so, or unless the law
authorizes or requires us to do so.
The law protects the privacy of the health
information we create and obtain in providing
our care and services to you. For example, your
protected health information includes your
symptoms, test results, diagnoses, treatment,
health information from other providers, and
billing and payment information relating to
these services. Federal and state law allows us
to use and disclose your protected health
information for purposes of treatment and health
care operations. State law requires us to get
your authorization to disclose this information
for payment purposes.
Examples of Use and Disclosures
of Protected Health Information for Treatment,
Payment, and Health Operations
For treatment:
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Information
obtained by a nurse, physician, or other
member of our health care team will be
recorded in your medical record and used to
help decide what care may be right for you.
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We may also provide information
to others providing you care. This will help
them stay informed about your care.
For payment:
-
We request payment from your
health insurance plan. Health plans need
information from us about your medical care.
Information provided to health plans may
include your diagnoses, procedures performed,
or recommended care.
For health care operations:
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We use your medical records to
assess quality and improve services.
-
We may use and disclose medical
records to review the qualifications and
performance of our health care providers and
to train our staff.
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We may contact you to remind
you about appointments and give you
information about treatment alternatives or
other health-related benefits and services.
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We may use and disclose your
information to conduct or arrange for
services, including:
-
medical quality review by your
health plan;
-
accounting, legal, risk
management, and insurance services;
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audit functions, including
fraud and abuse detection and compliance
programs.
Your Health Information Rights
The health and billing records we create and
store are the property of the practice/health
care facility. The protected health information
in it, however, generally belongs to you. You
have a right to:
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Receive, read, and ask
questions about this Notice;
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Ask us to restrict certain uses
and disclosures. You must deliver this request
in writing to us. We are not required to grant
the request. But we will comply with any
request granted;
-
Request and receive from us a
paper copy of the most current Notice of
Privacy Practices for Protected Health
Information (“Notice”);
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Request that you be allowed to
see and get a copy of your protected health
information.
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You may make this request in
writing. We have a form available for this
type of request.
-
Have us review a denial of
access to your health information—except in
certain circumstances;
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Ask us to change your health
information. You may give us this request in
writing. You may write a statement of
disagreement if your request is denied. It
will be stored in your medical record, and
included with any release of your records.
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When you request, we will give
you a list of disclosures of your health
information. The list will not include
disclosures to third-party payors. You may
receive this information without charge once
every 12 months. We will notify you of the
cost involved if you request this information
more than once in 12 months.
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Ask that your health
information be given to you by another means
or at another location. Please sign, date, and
give us your request in writing.
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Cancel prior authorizations to
use or disclose health information by giving
us a written revocation. Your revocation does
not affect information that has already been
released.
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It also does not affect any
action taken before we have it. Sometimes, you
cannot cancel an authorization if its purpose
was to obtain insurance.
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For help with these rights
during normal business hours, please contact:
The Spokane Eye Clinic, Privacy Officer,
456-0107
Our Responsibilities
We are required to:
We have the right to change our practices
regarding the protected health information we
maintain. If we make changes, we will update
this Notice. You may receive the most recent
copy of this Notice by calling and asking for it
or by visiting our office to pick one up.
To Ask for Help or Complain
If you have questions, want more information, or
want to report a problem about the handling of
your protected health information, you may
contact:
Privacy Officer, 456-0107
If you believe your privacy rights have been
violated, you may discuss your concerns with any
staff member. You may also deliver a written
complaint to the Privacy Officer at our office.
You may also file a complaint with the U.S.
Secretary of Health and Human Services.
We respect your right to file a complaint with
us or with the U.S. Secretary of Health and
Human Services. If you complain, we will not
retaliate against you.
Other Disclosures and Uses of
Protected Health Information
Notification of Family and Others
-
Unless you object,
we may release health information about you to
a friend or family member who is involved in
your medical care. We may also give
information to someone who helps pay for your
care. In addition, we may disclose health
information about you to assist in disaster
relief efforts.
-
You have the right
to object to this use or disclosure of your
information. If you object, we will not use or
disclose it.
We may use and disclose your
protected health information without your
authorization as follows:
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With Medical Researchers—if
the research has been approved and has
policies to protect the privacy of your health
information. We may also share information
with medical researchers preparing to conduct
a research project.
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To Funeral Directors/Coroners
consistent with applicable law to allow them
to carry out their duties.
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To Organ Procurement
Organizations
(tissue donation and transplant) or
persons who obtain, store, or transplant
organs.
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To the Food and Drug
Administration
(FDA) relating to problems with food,
supplements, and products.
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To Comply With Workers’
Compensation Laws—if
you make a workers’ compensation claim.
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For Public Health and Safety
Purposes as Allowed or Required by Law:
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to
prevent or reduce a serious, immediate threat
to the health or safety of a person or the
public.
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to public health or legal
authorities
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to protect public health and
safety
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to prevent or control disease,
injury, or disability
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to report vital statistics such
as births or deaths.
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To
Report Suspected Abuse or Neglect
to public authorities.
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To
Correctional Institutions
if you are in jail or prison, as necessary for
your health and the health and safety of
others.
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For
Law Enforcement Purposes
such as when we receive a subpoena, court
order, or other legal process, or you are the
victim of a crime.
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For
Health and Safety Oversight Activities.
For example, we may share health information
with the Department of Health.
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For
Disaster Relief Purposes.
For example, we may share health information
with disaster relief agencies to assist in
notification of your condition to family or
others.
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For
Work-Related Conditions That Could Affect
Employee Health.
For example, an employer may ask us to assess
health risks on a job site.
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To
the Military Authorities of U.S. and Foreign
Military Personnel.
For example, the law may require us to provide
information necessary to a military mission.
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In
the Course of Judicial/Administrative
Proceedings
at your request, or as directed
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by
a subpoena or court order.
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For
Specialized Government Functions.
For example, we may share information for
national security purposes.
Other Uses and Disclosures of
Protected Health Information
Effective Date:
4/14/03 |
