Five Points Eye Care

Privacy Policy

This notice takes effect on 4/15/03 and remains in effect until we replace it.
NOTICE OF PRIVACY PRACTICES
Five Points Eye Care Center
698 South Milledge Ave, Athens, GA 30605, (706) 543-2020, fax: (706) 549-6618,
email: officemanager@fivepointseyecare.com, Privacy Officer: Meg Brya
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.
_____________________________________________________________________________________________
We respect our legal obligation to keep health information that identifies you private.  We are obligated by law to give you notice of our privacy practices.  This Notice describes how we protect your health information and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your health information is for treatment, payment or health care operations.  Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to healthcare providers, whether on this office’s staff or not, who are involved in your medical care.  Payment: We may use and disclose your medical information for payment purposes directly to or through a billing service, to appropriate third party payers, pursuant to their billing and payment requirements and/or to collection agencies or attorneys for collecting unpaid amounts.  Health care operations: mean those administrative and managerial functions that we have to do in order to run our office.  This includes financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permission.  If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission. 
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
 In some limited situations, the law allows or requires us to use or disclose your health information without your permission.  Not all of these situations will apply to us; some may never come up at our office at all. Not every use or disclosure will be listed, however, we have listed all of the different ways we are permitted to use and disclose medical information.  Such uses or disclosures are:
• when required by law, where a state or federal law mandates that certain health information be reported for a specific purpose;
• for public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices;
• disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
• uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
• disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;
• disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;
• disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
• uses or disclosures for health related research;
• uses and disclosures to prevent a serious threat to health or safety;
• uses or disclosures for national security and intelligence activities, in order to provide authorized government officials with necessary intelligence information as authorized by law; for military purposes; or for the evaluation and health of members of the military, veterans or foreign service;
• disclosures of de-identified information, where personally identifying information is removed, in accordance with applicable laws;
• disclosures relating to worker’s compensation programs designed to provide benefits for work-related injuries;
• disclosures of a “limited data set” for research, public health, or health care operations;
• incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
• disclosures to “business associates” who perform health care operations for us and who commit to respect the privacy of your health information.  We will obtain satisfactory written assurance from the business associate, in accordance with applicable laws, that the business associate will appropriately safeguard the protected information;
• disclosures to a “personal representative”.  If applicable under Georgia law a person has the authority to represent you in making decisions related to your health care, information may be disclosed to that person without prior written consent;
• disclosures due to communication barriers.  If, due to substantial communication barriers or inability to communicate, this office has been unable to obtain consent and this office determines, in the exercise of its professional judgment, that your consent to receive treatment is clearly inferred from the circumstances.  Translators provided by you or us may be used for communication of your health information and your treatment;
• disclosures due to emergency situations for the purpose of obtaining or rendering treatment to you, if we attempt to obtain consent but are unable to do so or for the purpose of coordinating your care with a private or public entity authorized by law or by its charter to assist in disaster relief efforts;
• disclosures in order to maintain a directory of individuals in this office, their location, their condition in non-specific general terms, and their religious affiliation.  This information may be made available to members of the clergy and, except for religious affiliation, to anyone asking for you by name;
• in accordance with applicable laws, disclosure may be made to your family member, other relatives, close personal friends and/or any other person identified by you, of such information that is relevant to the person’s involvement with your care or payment related to your care;
• disclosures in order to notify or assist in the notification of a family member, a personal representative or another person responsible for your care of your location or general condition;
• disclosures in order to provide you with appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.  We may call or write to remind you of scheduled appointments, or that it is time to make a routine appointment.  Unless you tell us otherwise, we will mail you an appointment reminder on a post card, and/or leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.
 Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your eye care.
OTHER USES AND DISCLOSURES
Other uses and disclosures will be made only with your written authorization and you may revoke any authorization as set forth in this notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding your health information.  You can:
• revoke any authorization and/or consent, in writing, at any time.  To request a revocation, please submit a written request to our privacy officer at the address shown at the beginning of this Notice.
• ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations.  We do not have to agree to do this, but if we agree, we must honor the restrictions that you want.  To ask for a restriction, send a written request to our privacy officer at the address shown at the beginning of this Notice.
• ask us to communicate with you in a confidential way.  We will accommodate these requests if they are reasonable, and if you pay us for any extra cost.  You must specify how and where you wish to be contacted.  If you want to ask for confidential communications, send a written request to our privacy officer at the address shown at the beginning of this Notice.
• ask to see or to get photocopies of your health information as provided by law.  You will be able to review or have a copy of your health information within 30 days of asking us (or sixty days if the information is stored off-site).  You may have to pay for photocopies in advance.  If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally available.  By law, we can have one 30 day extension of the time for us to give you access or photocopies if we send you a written notice of the extension.  If you want to review or get photocopies of your health information, send a written request to our privacy officer at the address shown at the beginning of this Notice.
• ask us to amend your health information if you think that it is incorrect or incomplete.  You must provide a written reason that supports your request for the amendment(s).  If we agree, we will amend the information within 60 days from when you ask us.  We will send the corrected information to persons who we know got the wrong information, and others that you specify.  If we do not agree, you can write a statement of your position, and we will include it with your health information along with any rebuttal statement that we may write.  Once your statement of position and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information.  By law, we can have one 30 day extension of time to consider a request for amendment if we notify you in writing of the extension.  If you want to ask us to amend your health information, send a written request, including your reasons for the amendment,  to our privacy officer at the address shown at the beginning of this Notice.
• get a list of the disclosures (but not the uses) that we have made of your health information.  The request of disclosures must be in writing, must state a time period no longer than six years and may not include dates before April 14, 2003, and must state in what form you want the list (such as paper or electronic copy).  By law, the list will not include:  disclosures for purposes of treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures.  You are entitled to one such list per year without charge.  If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30 day extension of time if we notify you of the extension in writing.  If you want a list, send a written request to our privacy officer at the address shown at the beginning of this Notice.
• get additional paper copies of this Notice of Privacy Practices upon request.  If you want additional paper copies, send a written request to our privacy officer at the address shown at the beginning of this Notice.
• to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights if you believe your privacy rights have been violated.  We will not retaliate against you if you make a complaint.  If you want to complain to us, send a written complaint to our privacy officer at the address shown at the beginning of this Notice.  If you prefer, you can discuss your complaint in person, by phone, or by email using contact listed in beginning of Notice.
• to obtain more information on, or have your questions about your rights answered, contact our privacy officer at the address shown at the beginning of this Notice.
OUR NOTICE OF PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it.  We reserve the right to change this notice at any time as allowed by law.  If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future.  If we change our Notice of Privacy Practices, it will be available upon request and we will post the new notice in our office, have copies available in our office, and post it on our Web site.