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PEDIATRIC EYE ASSOCIATES, INC.
HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date (November
1, 2004)
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. If you have
any
questions about this notice, please contact:
Garima Lal at 954-885-6575.
This notice describes the privacy practices at our
office.
We are required by law to:
* Maintain the privacy of protected health information
* Give you this notice of our legal duties and privacy
practices regarding your health information
* Follow the terms of the notice currently in effect.
How we may use and disclose your health information
Described as follows are the ways we may use and disclose
your health information. Except for the following purposes
we will use and disclose your health information only
with
your written permission. You may revoke such permission
at
any time by writing to Garima Lal.
Treatment: We may use and disclose your
health information for your treatment and to provide
you with treatment- related health care services. For
example, we may disclose your health information to
doctors, nurses, technicians, or
other personnel, including people outside our office,
who
are involved in your medical care and need the information
to provide you with medical care.
Payment: We may use and disclose your
health information so
that others or we may bill and receive payment from you,
an
insurance company, or a third party for the treatment
and
services you received. For example, we may give
information
to your health plan so that they will pay for your
treatment.
Health Care Operations: We may use
and disclose your health
information to evaluate and improve our medical care
and
to
operate and manage our office. For example, we may use
and
disclose information to a peer review organization or
a
health plan that is evaluating our care. We may also
share
information with others that have a relationship with
you
for their health care operation activities.
Appointment Reminders, Treatment Alternatives,
and Health- Related Benefits and Services: We may use
and disclose your
health information to contact you and remind you of your
appointment, to tell you about treatment alternatives
or
health-related benefits and services you could use.
Individuals Involved in Your Care or
Payment for Your Care:
When appropriate, we may share your health information
with
a person involved in, or paying for, your care (such
as
your family or a close friend). We may notify your family
about your location or condition or disclose such
information to an entity assisting in disaster relief.
Research: We may use and disclose your
health information for research. For example, a research
project may involve comparing the health of patients
who received one treatment
to those who received another for the same condition.
Before we do so, the project needs to go through a special
approval process. Even without special approval, we
may permit researchers to look at records to help identify
patients who may be included in their research, as long
as
they do not remove or copy any of your health information.
As Required by Law: We will disclose
your health information when required to do so by international,
federal, state or local law.
To Avert a Serious Threat to Health
or Safety: We may use
and disclose your health information when necessary to
prevent a serious threat to the health and safety of
you,
another person, or the public. Disclosures will be made
only to someone who can prevent the threat.
Business Associates: We may disclose
your health information to our business associates that
perform functions on our behalf or provide us with services
if necessary. For example, we may use another company
to perform billing services on our behalf. All of our
business
associates are obligated to protect the privacy of your
information and are not allowed to use or disclose the
information for any other purpose than appears in their
contract with us.
Military and Veterans: If you are a
member of the armed forces, we may release your health
information as required by military command authorities.
If you are a member of a
foreign military we may release your health information
to
the foreign military command authority.
Worker's Compensation: We may release
your health information for worker's compensation or
similar programs that provide benefits for work-related
injuries or illness.
Public Health Risks: We may disclose
your health information for public health activities
to prevent or control disease, injury or disability.
We may use your health information in reporting births
or deaths, suspected
child abuse or neglect, medication reactions or product
malfunctions or injuries, and product recall
notifications.
We may use your health information to notify someone
who
may have been exposed to a disease or may be at risk
for
contracting or spreading a disease or condition. If we
are
concerned that a patient may have been a victim of abuse,
neglect, or domestic violence we may ask your permission
to
make a disclosure to an appropriate government authority.
We will make that disclosure only when you agree or
when required or authorized to do so by law.
Health Oversight Activities: We may
disclose your health information to a health oversight
agency for activities authorized by law. These may include
audits, investigations, inspections, and licensure.
These activities are necessary to for the government
to monitor the health care system, government programs,
and compliance
with civil rights laws.
Lawsuits and Disputes: If you are involved
in a lawsuit or
dispute, we may disclose your health information in
response to a court or administrative order. We may
disclose your health information in response to a
subpoena,
discovery request, or other lawful process by someone
else
involved in the dispute, but only if efforts have been
made
to tell you about the request or to obtain an order
protecting the information requested.
Law Enforcement: We may release your
health information request by law enforcement official
if 1) there is a court
order, subpoena, warrant, summons or similar process;
2)
if
the request is limited to information needed to identify
or
locate a suspect, fugitive, material witness, or missing
person; 3) the information is about the victim of a
crime even if, under certain very limited circumstances,
we are
unable to obtain your agreement; 4) the information is
about a death that may be the result of criminal conduct;
5) the information is relevant to criminal conduct on
our
premises; and 6) it is needed in an emergency to report
a
crime, the location of a crime or victims, or the
identity,
description, or location of the person who may have
committed the crime.
Coroners, Medical Examiners, and Funeral
Directors: We may
release your health information to a coroner, medical
examiner, or funeral director to identify a deceased
person
or cause of death, or other similar circumstance.
National Security and Intelligence Activities:
We may disclose your health information to authorized
federal officials for intelligence and other national
security activities authorized by law.
Inmates or Individuals in Custody: If
you are an inmate of
a correctional institution or in custody we may disclose
your information 1) for the institution to provide you
with
health care, 2) to protect your health and safety or
that
of others, and 3) for the safety and security of the
institution.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Inspect and Copy: You have
the right to inspect and copy your medical and billing
records by written request to Garima Lal.
Right to Amend: You have the right to
request an amendment to your records by written request
to Garima Lal.
Right to an Accounting Of Disclosures:
You have a right to
an accounting of certain disclosures by written request
to
Garima Lal.
Right to Request Restrictions: You have
the right to request restriction or limitation on your
health information used for treatment, payment or health
care operations. You may request us to limit disclosure
to someone involved in your care or in payment for your
care
(such as a spouse) by written request to Garima Lal.
We are not required to agree with your request, but
we will try to comply.
Right to Request Confidential Communication:
You have the
right to request that we communicate with you about
medical
matters in a certain way or at a certain location. You
can
ask, for example, that we contact you only by mail or
at
work. Your written request must specify how or where
you
wish to be contacted and be addressed to Garima Lal.
We will accommodate reasonable requests.
CHANGES TO THIS NOTICE
We may change this notice and make it effective for
medical
information we already have about you as well as new
information. The current notice will be posted and
available at all times. You have a right to request a
paper
copy of the current notice at any visit or by written
request to Pediatric Eye Associates, Inc.
Pediatric Eye Associates, Inc.
Garima
Lal, MD
1951 SW 172nd Avenue,
Suite 301
Miramar, FL 33029
954-885-6575, Ext. 3
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