Northwest Eye Surgeons
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NORTHWEST EYE SURGEONS NOTICE OF PRIVACY PRACTICES

PLEASE REVIEW THIS INFORMATION CAREFULLY

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

THIS NOTICE APPLIES TO ALL PATIENT RECORDS OF CARE GENERATED BY THIS PRACTICE (INCLUDING MINORS).
Northwest Eye Surgeons provides this Notice to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This notice describes our policies, which extend to:
  • Any health care professional authorized to enter information into your chart (including physicians, optometrists, nurses, ophthalmic assistants, etc.);
  • All areas of the Practice (front desk, administration, billing, scheduling, etc.);
  • All employees, staff and other personnel that work for or with our Practice;
  • Business Associates who perform services (such as transcription, billing or collection services) on our behalf. We will enter into contracts with Business Associates to assure they protect the privacy of your health information.

Some of our patients are under the age of 18. HIPAA works with Ohio law regarding the rights of parents and minors. It looks to Ohio Law for defining the rights of custodial and non-custodial parents. When our patient is under 18, we will give the Notice to the minor's responsible person (e.g. parent or guardian). We will give one Notice per household, unless you request more. The responsible person can sign the Acknowledgement for all minors seen by our office. If the minor is 14 or older, we encourage you to share the Notice with him/her. If the patient is over 18, we will give him/her a separate Notice of Privacy Practices.

The Notice refers to "your" health information and "your" rights. The use of "your" applies to the patient and his or her responsible person, who may exercise rights on the patient's behalf.

OUR THOUGHTS ABOUT YOUR PROTECTED HEALTH INFORMATION
We understand that your medical information is personal to you, and we are committed to protecting the information about you. As our patient, we create paper and electronic medical records about your health, our care for you, and the services and/or items we provide to you as our patient. We need this record to provide for your care and to comply with certain legal requirements. The law requires us to:
  • Make sure the protected health information about you is kept private.
  • Provide you with a Notice of Privacy Practices and your legal rights with respect to protected health information about you.
  • Follow the conditions of the Notice that is currently in effect.


If you have any questions about our Privacy Practices, including your rights and ability to voice your concerns, please call our Practice Administrator, the Privacy Officer, at (614) 451-7550.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose protected health information that we have and share with others. Each category of uses or disclosures provides a general explanation and provides some examples of uses. Not every use or disclosure in a category is either listed or actually in place. The explanation is provided for your general information only.

HOW WE USE AND DISCLOSE HEALTH INFORMATION FOR TREATMENT, PAYMENT, AND HEALTHCARE OPERATIONS
HIPAA's Privacy Rule allows us to use and disclose your health information for treatment, payment, and healthcare operations, without your having to sign an Authorization.
 Medical Treatment: We use previously given medical information about you to provide you with current or prospective medical treatment or services. Therefore we may, and most likely will, disclose medical information about you to doctors, nurses, technicians, medical students, or hospital personnel who are involved in taking care of you. For example, a doctor to whom we refer you for ongoing or further care may need your medical record. Different areas of the Practice also may share medical information about you including your record(s), prescriptions, requests of lab work and x-rays. We may also discuss your medical information with you to recommend possible treatment options or alternatives that may be of interest to you. We also may disclose medical information about you to people outside the practice who may be involved in your medical care after you leave Northwest Eye Surgeons; this may include your family members, or other personal representatives authorized by you or by a legal mandate (a guardian or other person who has been named to handle your medical decisions, should you become incompetent).
Payment: We may use and disclose medical information about you for services and procedures so they may be billed and collected from you, an insurance company, or any other third party. For example, we may need to give your health information, about treatment you received at Northwest Eye Surgeons, to obtain payment or reimbursement for the care. We may also tell your health plan and/or referring physician, or the like.
Health Care Operations: We may use and disclose medical information about you so that we can run our practice more efficiently and make sure that all of our patients receive quality care. These uses may include reviewing our treatment and services to evaluate the performance of our staff, deciding what additional services to offer and where, deciding what services are needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other personnel for review and learning purposes. We may also combine the medical information we have with medical information from other practices to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

OTHER USES AND DISCLOSURES OF INFORMATION
Patient Appointment Recall Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for medical care with Northwest Eye Surgeons or that you are due to receive periodic care from the practice. This contact may be by phone, in writing, e-mail, or otherwise and may involve leaving an e-mail, a message on an answering machine, or otherwise which could (potentially) be received or intercepted by others.
Emergency Situations: In addition, we may disclose medical information about you to an organization assisting in a disaster relief effort or in an emergency situation so that your family can be notified about your condition, status and location.
Research: Under certain circumstances, we may use and disclose medical information about you for research purposes regarding medications, efficiency of treatment protocols and the like. All research projects are subject to an approval process, which evaluates a proposed research project and its use of medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We will obtain an Authorization from you before using or disclosing your individually identifiable health information unless the authorization requirement has been waived. If possible, we will make the information non-identifiable to a specific patient. If the information has been sufficiently de-identified, an authorization for the use or disclosure is not required.

USE AND DISCLOSURE OF INFORMATION WITHOUT WRITTEN AUTHORIZATION AS PERMITTED OR REQUIRED BY LAW
To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat either to your specific health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Workers' Compensation: We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
Investigation and Government Activities: We may disclose medical information to a local, state or federal agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the payor, the government and other regulatory agencies 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 a dispute, we may disclose medical information about you in response to a court or administrative order. This is particularly true if you make your health an issue. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. We will get written Authorization from you to release this information unless required to release it by court order. We may also use such information to defend ourselves or any member of our Practice in any actual or threatened action.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency when it is likely that a crime has occurred.
Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the Practice to funeral directors as necessary to carry out their duties.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

USE AND DISCLOSURE OF HEALTH INFORMATION YOU AUTHORIZE AND YOUR RIGHT TO REVOKE AUTHORIZATION
We will not use or disclose your health information for purposes other than treatment, payment or healthcare operations (unless permitted or required to do so by law) without your signed, written Authorization.

For example, we will not give medical information about you to your employer without your Authorization. To protect the doctor-patient privilege, our general policy is not to disclose your medical records, even if we receive a subpoena, unless you sign an Authorization or we receive a court order. We will ask you to sign an Authorization if you take part in certain research studies.

You may ask us to disclose health information to persons who are not covered by HIPAA. Once that information is disclosed, HIPAA no longer applies.

You may revoke (cancel) the Authorization in writing at any time. Once we receive your written revocation, we no longer will use or disclose health information. We cannot be held responsible for any use or disclosure of health information, permitted by the Authorization, before we received your written revocation.

PATIENT RIGHTS
THIS SECTION DESCRIBES YOUR RIGHTS AND THE OBLIGATIONS OF THIS PRACTICE REGARDING THE USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION.

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes your own medical and billing records, but under federal law does not include psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Upon proof of an appropriate legal relationship, records of others related to you and under your care (guardian or custodial) may also be disclosed. To inspect and copy your medical record, you must submit your request in writing to our Privacy Officer. Ask the front desk person for the name of the Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies (tapes, disks, etc.) associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that our Privacy Committee review the denial. Another licensed health care professional chosen by the Practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome and recommendations from that review.
Right to Amend: If you feel that the medical information we have about you is incorrect or incomplete, then you may ask to amend the information, following the procedure below. You have the right to request an amendment for as long as the Practice maintains your medical record. To request an amendment, your request must be submitted in writing, along with your intended amendment and a reason that supports your request to amend. The amendment must be dated and signed by you and notarized. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that, (1) was not created by us, unless the person or entity that created the information is not longer available to make the amendment, (2) is not part of the medical information kept by or for the Practice, (3) is not part of the information which you would be permitted to inspect and copy; or (4) is inaccurate and incomplete
Right to an Accounting of Disclosures: This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 13, 2003. You may request shorter timeframes. The right to receive this information is subject to certain exceptions, restrictions and limitations. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care (a family member or friend). For example, you could ask that we not use or disclose information about a particular treatment you received. We are not required to agree to your request and we may not be able to comply with your request. If we do agree, we will comply with your request except that we shall not comply, even with a written request, if the information is excepted from the consent requirement or we are otherwise required to disclose the information by law. To request restrictions, you must make your request in writing. In your request, you must indicate, (1) what information you want to limit, (2) whether you want to limit our use, disclosure or both, and (3) to whom you want the limits to apply, (e.g., disclosures to your children, parents, spouse, etc.)
Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail, that we not leave voice mail or e-mail, or the like. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish us to contact you.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we may receive from you in the future. We will post a copy of the current notice in the Practice. The notice will contain on the first page, in the top right-hand corner, the date of the last revision and effective date. In addition, each time you visit the Practice for treatment or health care services you may request a copy of the current notice in effect.

PATIENT CONCERN AND COMPLAINT RESOLUTION PROCEDURE
We are committed to protecting your health information. Despite our good faith efforts, there may be times when questions, concerns, or problems arise. If you have a concern or believe we may have violated your Privacy rights, we encourage you to bring that to our attention immediately. You may do so by filling out a complaint form or (if you feel more comfortable) you may tell us your concern by calling (614) 451-7550 and speaking with our Privacy Officer. You may identify yourself or you may remain anonymous.

We take all concerns and complaints very seriously and will investigate each one promptly. If we made a mistake, we will do what we can to correct it and take steps to prevent such mistakes from recurring in the future. If we did not make a mistake, we will provide you with an explanation (unless you expressed your concern anonymously). We will make every effort to complete our investigation within 30 days.

Under no circumstances will we "retaliate" against you for expressing a concern or filing a complaint relating to your Privacy rights. You also have the right to contact the DHHS Secretary if you believe your privacy rights have been violated.