NOTICE OF PRIVACY PRACTICES Tri-Century Eye Care, P.C. Effective January 1, 2021
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
INTRODUCTION
At Tri-Century Eye Care, P.C., we are committed to using your health information responsibly. This Notice of Privacy Practices describes the nature of your protected health information (“PHI”), and how and when we use or disclose that information. It also describes your rights as they relate to your PHI.
The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives you, the patient, the right to understand and control how your PHI is used. HIPAA provides penalties for covered entities and Business Associates that misuse personal health information.
As required by HIPAA, we prepared this explanation of how we are to maintain the privacy of your health information and how we may disclose your personal information.
UNDERSTANDING YOUR HEALTH INFORMATION
Protected health information is any information that relates to your past, present, or future physical or mental health or condition, including treatment and payment for services. Each time you come to our practice, we create a record of your visit. Typically, this record contains information about your personal demographics, medical exam, diagnoses, test results, treatment, and other pertinent data. Understanding what is in your health record and how your health information is used helps you ensure its accuracy, determine what entities have access to your health information, and make an informed decision when authorizing the disclosure of this information to other individuals.
OUR RESPONSIBILITIES
Our practice is required to:
Maintain the privacy of your health information and use, disclose, or request such information only to the extent minimally necessary to accomplish the intended purpose of the use, disclosure, or request.
Provide you with this Notice and abide by its terms.
HOW WE MAY USE AND/OR DISCLOSE YOUR HEALTH INFORMATION
Treatment Your health information may be used by the staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, providing treatment, and coordinating your care. An example of this would include referring you to a retina specialist.
Payment Your health plan (or other third-party payer) may request and receive information on dates of service, services provided, and the medical conditions(s) being treated in order to make payment, confirm coverage, billing or collection activities and utilization review under the relevant insurance policy. An example of this would include sending your insurance company a bill for your visit and/or verifying coverage prior to a surgery.
Regular Health Operations Your health information may be used, as necessary, to support the day-to-day activities and management of our practice. These activities include, but are not limited to, quality assessments, employee training and reviews and other business and health operations. An example of this would be new patient survey cards or a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you.
Business Associates In some instances, we have contracted separate entities to provide services for us. These "business associates" require your health information in order to accomplish the tasks that we ask them to provide. Some examples might be a billing service, answering service, or computer software provider. They are required to treat your PHI in the same manner that we do.
Communication with Family Due to the nature of our field, we will use our best judgment when disclosing health information to a family member or any other person that is involved in your care or that you have authorized to receive this information. Please inform the practice when you do not wish a family member or other individual to receive your health information.
Research/Teaching/Training We may use your health information for the purpose of research, teaching, and training.
Healthcare Oversight Federal law requires us to release your information to an appropriate health oversight agency, public health authority, or other federal or state appointee if there are circumstances that require us to do so.
Public Health Reporting Your health information may be disclosed to public health agencies as required by law.
Law Enforcement The practice may also disclose your PHI for law enforcement and other legitimate reasons although we shall do our best to assure its continued confidentiality to the extent possible
Appointment Reminders The practice may use your information to remind you about upcoming appointments by phone or in writing. Typically, a brief, non-specific message will be left on your answering machine.
Fundraising Communications We may contact you, by phone or in writing, to provide information about treatment alternatives or other health-related benefits and services, in addition to other fundraising communications, that may be of interest to you. You do have the right to "opt out" with respect to receiving fundraising communications from us.
We may also create and distribute de-identified health information by removing all reference to individually identifiable information.
The following use and disclosures of PHI will only be made pursuant to us receiving a written authorization from you:
Most uses and disclosure of psychotherapy notes;
Uses and disclosure of your PHI for marketing purposes, including subsidized treatment and health care operations;
Disclosures that constitute a sale of PHI under HIPAA; and
Other uses and disclosures not described in this notice.
You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
YOUR RIGHTS
You have certain rights under the federal privacy standards with respect to your PHI.
The right to request restrictions on certain uses and disclosures of PHI, including those related to disclosures of family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to honor a request restriction except in limited circumstances which we shall explain if you ask. If we do agree to the restriction, we must abide by it unless you agree in writing to remove it.
The right to receive confidential communications of PHI from us by alternative means or at alternative locations.
The right to inspect and copy your PHI.
The right to amend your PHI.
The right to receive an accounting of disclosures of your PHI.
The right to obtain a paper copy of this notice from us upon request.
The right to be advised if your unprotected PHI is intentionally or unintentionally disclosed.
If you paid for services "out of pocket", in full, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.
This notice is effective as of January 1, 2021 and it is our intention to abide by the terms of the Notice of Privacy Practices and HIPAA Regulations currently in effect. We reserve the right to change the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI that we maintain. We will post and you may request a written copy of the revised Notice of Privacy Practice from our office.
For More Information or to Report a Problem
If you have questions, complaints, or would like additional information regarding this notice or our privacy practices, please contact:
Privacy Officer Tri-Century Eye Care, P.C. 319 Second Street Pike Southampton, PA 18966
If you believe that your privacy rights have been violated, please contact the aforementioned Privacy Officer for Tri-Century Eye Care, P.C. You may also file a complaint 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 practice's Privacy Official or with the Office for Civil Rights.
