NOTICE OF PRIVACY PRACTICES
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.
Eye Physicians of Pinellas, PA, doing business as The Eye Institute of West Florida (“The Eye Institute”) is required by Federal and Florida law to maintain a record of the care and services you receive at The Institute. We understand that this information about you and your health is personal, and we are committed to protecting the privacy and security of your health information.
This NOTICE OF PRIVACY PRACTICES (the “Notice”) describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations, as well as other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected Health Information” (or “PHI”) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services. This Notice applies to all your PHI maintained by The Eye Institute, whether the PHI is created by your treating Eye Institute physician, by your referring physician, by a nurse, or by others working at or with The Eye Institute.
The Eye Institute is required by law to abide by the terms of this Notice. In this regard, we are required by law to:
- Make sure that your PHI is private;
- Give you this Notice of our legal duties and privacy practices with respect to your PHI; and
- Follow the terms of this Notice as currently in effect.
REVISION OF NOTICE OF PRIVACY PRACTICES
We reserve the right to change the terms of this Notice at any time, and we reserve the right to make the changed Notice effective for all health information that we maintain at the time of the revision. If we revise the terms of this Notice, we will post a revised notice at all Eye Institute offices. We will also make paper copies of the revised Notice available upon request.
HOW TO CONTACT THE EYE INSTITUTE
If you would like further information regarding your rights or regarding the uses and disclosures of your health information, you may contact our Privacy Officer at 727-584-1394 or at The Eye Institute of West Florida, 1225 West Bay Drive, Largo, FL 33770.
THIS NOTICE IS EFFECTIVE AS OF APRIL 14, 2003.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION (PHI):
You have the following rights with respect to your protected health information:
Right to Request Restrictions: You may request that we restrict or limit the PHI we use or disclose about you for treatment, payment, or health care operations, or you may request a limit on the PHI we disclose to others who are involved in your care (i.e., a non-Eye Institute physician, a laboratory) or in the payment of your care. We are not required to agree to your request; but if we do, we will honor it. Even if we agree to your request, your restrictions might not be applied in certain situations. For example, in an emergency, we may use or disclose the PHI, without any restriction, to provide emergency treatment to you. To request a restriction or limitation, your request must be made in writing and submitted to the Front Office Manager or designee.
Right to Request Confidential Communications: You have the right to receive communications from us in a confidential manner, and you may request that we communicate with you about your PHI in a certain way (e.g., only by mail, only on your cell phone) or at a certain location (e.g., only at work, only at home). Your request for confidential communications must be made in writing to the Front Office Manager and must specify how and where you wish to be contacted. We will accommodate reasonable requests.
Right to Inspect and Copy: Generally, you may review and obtain a copy of your PHI in a designated record set. This right is subject to certain specific exceptions. Your request must be made in writing to the Front Office Manager. We may charge a reasonable fee to cover our copying, mailing, and any other supplies associated with your request. We will notify you of the fee and you may choose to withdraw or modify your request at that time, before any costs are incurred. We reserve the right to withhold the requested information until payment of the reasonable fee is received.
Right to Amend: You may ask us to amend your PHI if you believe that any of the information is incorrect or incomplete. You have the right to request an amendment for as long as the PHI is maintained by The Eye Institute. We may deny your request for certain specific reasons. For example, we may deny your request if you ask us to amend information that was not created by us; is not part of the PHI maintained by The Eye Institute; is not the type of PHI that you would be permitted to inspect and copy; if we determine that the information is correct and complete, or if you fail to explain the reason(s) for your request in writing. Your request to amend your PHI must be made in writing to the Front Office Manager and must specify the reason(s) that support your request. If we deny your request, we will provide you with a written explanation for the denial and information regarding appeal rights you may have at that point.
Right to an Accounting of Disclosures: You have the right to request a written list of certain disclosures of your PHI made by The Eye Institute. We are not required to account for disclosures made for treatment, payment, healthcare operations (as described below), disclosures that you authorized, and certain other specific disclosure types. Your request must state the time period which the accounting is to cover. This period may not be longer than six (6) years and may not include dates before April 14, 2003. Your request for an accounting of disclosures must be made in writing to the Front Office Manager. The first accounting you request within a twelve (12) month period will be free of charge. For additional accounting requests during that twelve-month period, we may charge a reasonable fee to cover our costs of providing the accounting. We will notify you of the fee and you may choose to withdraw or modify your request at that time, before any costs are incurred. We reserve the right to withhold the requested accounting until payment of the reasonable fee is received.
Right to a Copy of This Notice: You may request a paper copy of this Notice of Privacy Practices at any time.
Complaints: You have the right to complain to us, and the Secretary of the U.S. Department of Health and Human Services, if you believe your privacy rights have been violated. If you choose to file a complaint, you will not be retaliated against in any way. You must submit all complaints in writing to: The Eye Institute of West Florida, Attention: Privacy Officer, 1225 West Bay Drive, Largo, FL 33770.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following categories describe different ways that we use and disclose protected health information. Your PHI may be used and disclosed by your physician, by nurses, technicians, or health care team members, by our office staff, and by others outside of our office that are involved in your care and treatment. When required, we will obtain your authorization before disclosing any of your PHI, and we will use reasonable efforts to share only minimally necessary PHI with others.
Treatment: We may use and disclose your PHI to provide, coordinate, and manage your health care and may related services. For example:
- Your protected health information may be provided to a physician to whom you have been referred, to other physicians who may be treating you, or to a hospital or ambulatory surgery center that is involved in your care, to ensure that the physician, hospital, or ambulatory surgery center has the necessary information to diagnose and/or treat you.
- We may disclose your PHI from time to time to another physician or health care provider (e.g., a specialist, imaging center or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or plan of treatment.
- We may disclose your PHI to a pharmacy when calling in a prescription.
Payment: Your PHI may be used and disclosed by the business office to process your payment for the health care services provided to you. For example:
- Before you receive scheduled services, we may share information with your health plan in order to verify eligibility, to ask whether coverage is provided by your plan or policy, to obtain required pre-certification, or to obtain prior approval of payment.
- After you receive services, we may share information with your health plan to support our claim for payment, to review services provided to you for medical necessity, and for utilization review activities.
Health Care Operations: We may use or disclose, as needed, your PHI in order to support the business activities and operations of The Eye Institute. These activities include, but are not limited to, reviewing the quality of the care you received, quality assessment activities, employee review activities, training of healthcare students, licensing and marketing activities, compliance with applicable laws, and conducting or arranging for other business activities. For example:
- We review the quality, efficiency and cost of care that we provide to you and our other patients in order to find more efficient and effective ways to provide service, to develop ways to assist our health care providers and staff in deciding what additional services The Eye Institute should offer, and to evaluate whether new treatments are effective.
- We may share your PHI with third party “business associates” who perform various activities for The Eye Institute (e.g., accountants, lawyers, transcription, copy, billing, and collection services). Whenever an arrangement between The Eye Institute and a business associate involves the use or disclosure of your PHI, we will have a written contract with the business associate that contains terms that will protect the privacy of your PHI.
Disclosure to Department of Health and Human Services: We may disclose your PHI when required by the U.S. Department of Health and Human Services, the Florida Department of Health or Agency for Health Care Administration, or their agents, as part of an investigation or determination of our compliance with relevant laws.
Health Oversight Activities: We may disclose your PHI to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.
Abuse or Neglect: We may disclose your PHI, in accordance with applicable federal, state and local law, when it concerns abuse, neglect, or violence to you.
Law Enforcement and Legal Proceedings: As required by law, we may disclose your PHI for law enforcement purposes or other specialized government functions. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts, as required by law, have been made to tell you about the request or to obtain an order protecting the requested information.
Coroners, Medical Examiners, and Funeral Directors: We may disclose your PHI to a coroner, medical examiner or a funeral director.
Information Not Personally Identifiable: We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.
Organ Donation: We may disclose your PHI to an organ donation and procurement organization.
Medical Education: We may use and disclose PHI about you in the teaching of medical students and/or physicians in training (residents) who receive a portion of their medial education from observing, assisting, or participating in the care of patients within The Eye Institute.
Military, Veterans, National Security and Intelligence: If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release PHI about you. We may also release information about foreign military personnel to the appropriate foreign military agency.
Research: Under certain circumstances, we may use and disclose your PHI for research purposes. For example, a research project may involve comparing health and recovery of all patients who received one medication to those who received another for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with patients’ need for privacy of their PHI. Before we use or disclose PHI for research, the project will have been approved through this research approval process. We also may disclose your PHI to people preparing to conduct a research project. For example, we may help potential researchers look for patients with specific health needs, as long as the health information they review does not leave The Eye Institute’s offices. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care.
Public Health and Safety: We may use or disclose your PHI for public health activities, including but not limited to the reporting of disease, injury, vital events, conducting of public health surveillance, investigation and intervention, child abuse or neglect, and for activities related to quality and safety of FDA-regulated products or activities. We may use or disclose your PHI to prevent or lessen a serious threat to the health or safety of another person or to the public, or for national security and intelligence activities authorized by law.
Workers’ Compensation: We may disclose your PHI as authorized by laws relating to Workers’ Compensation or similar programs.
Notification of Family and Friends: We may disclose your PHI to family members, other relatives, or other person(s) you identify if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We also may disclose PHI to your family or friends if we can infer from the circumstances, based on our professional judgment that you would not object. For example, we may assume you agree to our disclosure of your PHI to your spouse when you bring your spouse with you into the exam room during treatment or while treatment is discussed. We may disclose your PHI to others who may be involved in your health care, to notify a family member, or another person responsible for your care of your location, general condition or death. If you are unable to agree or object to such a disclosure, we may disclose such information, as necessary, if we determine that it is in your best interest, based on our professional judgment. We may also use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up, for example, filled prescriptions, medical supplies or x-rays. We also may disclose your PHI to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts. We may disclose such information, as necessary, based on our professional judgment to respond to the emergency circumstances.
Appointment Reminders: We may use or disclose your PHI, as necessary, to contact you to provide appointment reminders or to reschedule your appointment. We may leave brief messages about your appointment on your answering machine or voice mail and/or may contact you by postcard.
Alternative Treatment Information: The Eye Institute is always interested in improving health care and lowering costs for groups of people who have similar health problems, and to help manage and coordinate the care for these groups of people. We may use your PHI to identify groups of people with similar health problems, to provide them with information about treatment alternatives or other health-related benefits and services that we believe may be of interest to them. We may also use and disclose your PHI for other marketing activities. For example, your name and address may be used to send you a newsletter about our practice and the services we offer, or we may send you information about products or services that we believe may be beneficial to you. You may contact our Privacy Officer in writing to request that these materials not be sent to you.
ANY OTHER USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION ABOUT YOU REQUIRES YOUR WRITTEN AUTHORIZATION
We will not use or disclose your health information for any other purpose without your written authorization. Once you give written authorization, you may cancel your authorization in writing at any time. If you cancel your authorization, we will not disclose protected health information about you after we receive your cancellation, except for disclosures made or processed, before we received your cancellation.