ABOUT OUR POLICIES
The
staff at Pediatric Eye Associates, Inc. are committed to serving you.
They understand that you are here to be treated professionally and
with respect. All Dr. Lal's staff members, will respect your needs
and perform their duties as professionals.
Pediatric Eye Associates, Inc.'s office hours are Monday to Friday from 9am to 5pm. While the
office accepts most private insurance coverage as well as the majority
of HMO's and PPO's, you may want to verify our association with your
specific coverage when you call for your first appointment. And be
sure to bring your insurance card and any necesary referals with you.
If you cannot
make a scheduled appointment, please phone and cancel 24 hours in advance,
so someone else can take advantage of that time. Missed appointments
without notification may result in a charge. It is standard policy
that a deposit be require
NOTICE OF PRIVACY
POLICIES
For
Pediatric Eye Associates
THIS NOTICE DESCRIBES HOW INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
Introduction
At Miramar Dermatolgoy/Skin and Cancer
Associates, we are committed to treating and using protected health information
about you responsibly. This Notice of Health Information Practices describes
the personal information we collect, and how and when we use or disclose
that information. It also describes your rights as they relate to your
protected health information. This Notice is effective 04-15-03 and applies
to all protected health information as defined by federal regulations.
Understanding Your Health Record/Information
Each time you visit Pediatric Eye Associates, a record of your visit is made. Typically, this
record contains your symptoms, examination and test results, diagnoses,
treatment, and a plan for future care or treatment. This information,
often referred to as your health or medical record, serves as a:
• Basis for
planning your care and treatment,
• Means of communication among the many health professionals who
contribute to your care,
• Legal document describing the care you received,
• Means by which you or a third-party payer can verify that services
billed were actually provided,
• A tool in educating heath professionals,
• A source of data for medical research,
• A source of information for public health officials charged with
improving the health of this state and the nation,
• A source of data for our planning and marketing,
• A tool with which we can assess and continually work to improve
the care we render and the outcomes we achieve,
Understanding what is in your record and
how your health information is used helps you to: ensure its accuracy,
better understand who, what, when, where, and why others may access your
health information, and make more informed decisions when authorizing
disclosure to others.
Your Health Information Rights
Although your health record is the physical
property of Pediatric Eye Associates the information
belongs to you. You have the right to:
• Obtain a
paper copy of this notice of information practices upon request,
• Inspect and copy your health record as provided for in 45 CFR 164.524,
• Request we amend your health record as provided in 45 CFR 164.528,
• Obtain an accounting of certain disclosures of your health information
as provided in 45 CFR 164.528,
• Request communications of your health information by alternative
means or at alternative locations,
• Request a restriction on certain uses and disclosures of your information
as provided by 45 CFR 164.522, and
• Revoke your authorization to use or disclose health information
except to the extent that action has already been taken.
Our Responsibilities
Pediatric Eye Associates
is required to:
• Maintain
the privacy of your health information,
• Provide you with this notice as to our legal duties and privacy
practices with respect to information we collect and maintain about you,
• Abide by the terms of this notice,
• Notify you if we are unable to agree to a requested restriction,
and
• Accommodate reasonable requests you may have to communicate health
information by alternative means or at alternative locations.
We reserve the right to change our practices
and to make the new provisions effective for all protected health information
we maintain. Should our information practices change, we will post a revised
notice.
We will not use or disclose your health
information without your authorization, except as described in this notice.
We will also discontinue to use or disclose your health information after
we have received a written revocation of the authorization according to
the procedures included in the authorization.
Examples of Disclosures for Treatment,
Payment and Health Operations
We will use your health information for
treatment.
For example: Information obtained by a
nurse, physician, or other member of your health care team will be recorded
in your record and used to determine the course of treatment that should
work best for you. Your physician will document in your record his or
her expectations of the members of your health care team. Members of your
health care team will then record the actions they took and their observations.
In that way, the physician will know how you are responding to treatment.
We may also provide other physicians or
subsequent health care providers with copies of various reports that should
assist him or her in treating you.
We will use your health information for
payment.
For example: A bill may be sent to you
or a third-party payer. The information on or accompanying the bill may
include information that identifies you, as well as your diagnosis, procedures,
and supplies used.
We will use your health information for
regular health operations.
For example: Your information may be used
in an effort to continually improve the quality and effectiveness of the
healthcare and service we provide.
Business associates: There are some services provided in our organization
through contacts with business associates. When these services are contracted,
we may disclose your health information to our business associate so
that they can perform the job we’ve asked them to do to protect
your health information, however, we require the business associate to
appropriately safeguard your information.
Notification: We may
use or disclose information to notify or assist in notifying a family
member, personal representative, or another person responsible for your
care, of your location, and general condition. We may call to confirm
appointments and communicate lab results.
Communication with family: Health
professionals, using their best judgment, may disclose to a family
member, other relative, close personal friend or any other person you
identify, health information relevant to that person’s involvement
in your care or payment related to your care.
Research: We may disclose information
to researchers when an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of your
health information has approved their research.
Marketing: We may contact
you to provide appointment reminders or information about treatment alternatives
or other health-related benefits and services that may be of interest
to you.
Food and Drug Administration (FDA):
We may disclose to the FDA health information relative to adverse events
with respect to food, supplements, product and product defects, or post
marketing surveillance information to enable product recalls, repairs,
or replacement.
Workers compensation:
We may disclose health information to the extent authorized by and to
the extent necessary to comply with laws relating to workers compensation
or other similar programs established by law Public health: As required
by law, we may disclose your health information to public health or legal
authorities charged with preventing or controlling disease, injury, or
disability.
Law enforcement: We may
disclose health information for law enforcement purposes as required by
law or in response to a valid subpoena.
Federal law makes provision for your health
information to be released to an appropriate health oversight agency,
public health authority or attorney, provided that a work force member
or business associate believes in good faith that we have engaged in unlawful
conduct or have otherwise violated professional or clinical standards
and are potentially endangering one or more patients, workers or the public.
For More Information or to Report a Problem
If have questions
and would like additional information, you may contact the practice’s
Privacy Officer, Darlene Tomlinson at 1-888-479-6415 Ext 636.
If you believe
your privacy rights have been violated, you can file a complaint with
the practice’s Privacy
Officer, or with the Office for Civil Rights, U.S. Department of Health
and Human Services. There will be no retaliation for filing a complaint
with either the Privacy Officer or the Office for Civil Rights. The
address for the OCR is listed below:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
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