HIPAA Notice
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NOTICE OF PRIVACY PRACTICES 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. THIS NOTICE IS EFFECTIVE AS OF FEBRUARY 26, 2004. 1. Why am I getting this notice? At For Eyes Optical Company ("For Eyes"), our top priority is providing for the eye care needs of our patients. We do this, in part, by working closely with you, other health care or eye care practitioners who care for you, and with your insurance company or other third party payors who help pay the cost of your eye care. In the process of providing you with our services, we may need to use or disclose your health information to help us accomplish our mission. However, we are committed to safeguarding the privacy and confidentiality of your personal health information. 2. What is HIPAA and what does it do for me? The Health Insurance Portability and Accountability Act of 1996, or "HIPAA" is a federal law. One of its primary purposes is to make sure that information about your health is handled with special respect for your privacy. HIPAA contains numerous safeguards designed to protect your personal health information, called "protected health information." HIPAA requires us to establish policies and procedures to insure that the privacy of your health information is maintained, and to provide you with this notice of our privacy practices to explain your rights, and our duties with respect to your health information. We are required to abide by the terms of this notice as currently in effect. However, the practices and policies described in this notice may be changed at any time and the changes can apply to information already held by For Eyes at the time of change. If this notice is revised, a current copy will be made available to you upon request. 3. Can For Eyes use my protected health information without my authorization? Yes. The ways your information is used without your authorization and the ways it can be used only with your authorization are both covered in this notice. 4. How can For Eyes use my protected health information without my authorization? For Eyes must use information about you in many ways. If you think about how you receive any kind of health care, including eye care, and all the things that must happen behind the scenes in the process of providing that care, you will see that your information must be used to perform many important functions, such as those described below. In each of the areas described below, For Eyes is not required to ask for your consent and will not ask for your consent to use or disclose your protected health information. A. Uses of information for payment purposes i. To obtain payment for the services we provide. For Eyes will use and disclose your personal and health information in order to process and pay your health care claims. Information will be shared with your health plans or programs that provide health insurance coverage for you; information will be disclosed regarding treatment we provide to you so your health insurance plan can apply its terms and determine what it must pay with respect to any service received; and information may be used to perform utilization review activities, including pre-authorization for certain services, or concurrent case management and retrospective review to make sure our services are being used appropriately. B. Uses of Information For Treatment Purposes i. If you need assistance. For Eyes is permitted to use your private health information to help you obtain treatment. We may disclose information about you to other providers, including physicians, optometrists, ophthalmologists, nurses, or technicians involved with your eye care. For example, For Eyes or one of its business associates might disclose information about your prescription to a physician to determine if any additional treatment is required. [Is there a better example that could be inserted here?] ii. To tell you about special programs. For Eyes may contact you with information about eye care and treatment alternatives or other health-related benefits and services that may be of interest to you. For example, if you have a particular vision problem, we may send you information that describes new treatments or procedures that may be right for you. C. Uses of Information For Health Care Operations i. To make sure the network is adequate. For Eyes may collect demographic information and usage patterns about you to make sure our services are adequate to serve our customers' needs. ii. Quality control and improvement. For Eyes may collect and analyze eye care and eye wear use data so we can evaluate and further develop existing services and eye care programs, monitor quality of eye care delivery, and perform other activities related to our overall operation. iii. Legal and other services. Your information may be used by For Eyes in connection with professional services we obtain, such as legal services or audit services, and for our legal compliance programs. 5. Are there any other ways For Eyes can use my health information without my authorization? Yes. The HIPAA rules delineate situations where For Eyes is required to disclose your private health information and a separate list of other situations where we are permitted to disclose such information without your authorization. A. When disclosure is required by law or in accordance with law enforcement efforts, including:
For Eyes may use your protected health information for marketing in limited circumstances permitted by law. For example, we may use your name and address to communicate with you about other health or eye care related products or services that we provide. We may send you newsletters, communicate with you face-to-face, and send you promotional items of nominal value. There are other special situations where For Eyes may use your health information. Mostly, these are for public health purposes. We may disclose your health information to government officials in charge of collecting information to prevent or control disease, report injury or disability, or to report product defects or problems. For Eyes may disclose your health information to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system, government programs, and compliance with civil rights laws. For Eyes may disclose protected health information to coroners, medical examiners, and funeral directors for the purpose of identifying a decedent, determining a cause of death, or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law. For Eyes may release protected health information to determine your eligibility for workers' compensation or similar programs. Finally, if you are member of the armed forces, For Eyes may release your protected health information as required by the military. 6. If For Eyes uses or discloses information about me, how much information will be used or disclosed? For Eyes will normally use and/or disclose only the minimum amount of information that is necessary to perform certain activities. For example, if your insurance company calls with a question about services we provided to you, we will only discuss information relevant to the payment of your claim. However, this "minimum necessary" policy does not apply when you or another health care provider involved in you care requests information, when information disclosure is required by law or when you authorize the disclosure of your information to a third party. 7. What about other uses? For Eyes must obtain your specific written authorization to use or disclose your protected health information in any way not outlined in this notice. You may revoke such a written authorization at any time. However, your revocation must be submitted to us in writing and will not be effective to the extent we have already acted in reliance on the authorization. 8. Will information be disclosed to my employer? Your information will not be disclosed to your employer unless you authorize the disclosure in writing. 9. What about disclosure of HIV/AIDS status or disclosure of genetic information? It is extremely unlikely that For Eyes would obtain such information about you. In addition, most states have special laws that restrict the use and disclosure of certain kinds of particularly sensitive health information without your prior written authorization. Such laws remain valid. Accordingly, For Eyes will obtain your prior authorization before disclosing such information when applicable. 10. What rights do I have under HIPAA? You may exercise any of the following rights by contacting the For Eyes Privacy Officer identified below: A. You have the right to ask For Eyes to restrict the use and disclosure of your protected health information beyond the restrictions described in this notice. However, For Eyes is not required to agree to your request. B. You have the right to inspect and copy any protected health information maintained by us in a designated record set. This right does not apply to information compiled in reasonable anticipation of a legal or administrative proceeding. Your request to inspect or obtain copies of your protected health information must be in writing. If you request photocopies of protected health information, we will charge a reasonable cost-based fee that includes only the cost of copying, staff time to copy, postage, and preparing an explanation or summary of the requested information if you tell us in advance that you only want a summary. You may request copies of protected health information that we maintain in a format other than photocopies. We will respond in the format that you request if the protected health information is readily producible in that format. If you request a format other than photocopies, we may charge you a cost-based fee for providing the information in that format. If your request is denied, you have the right to have your request reviewed under most circumstances. You may get in touch with our Privacy Officer for more information about access. C. You have the right to ask, in writing, that For Eyes amend your health information maintained by us in a designated record set that you believe is incomplete or incorrect. Your written request must contain the reason(s) that you request the amendment. You will receive a response to your request. Your request may be denied by the us if the information was not created by For Eyes, or if For Eyes determines that the information is complete and correct. D. You have the right to receive a list of how many times and to whom your protected health information has been disclosed by us during the six years prior to the date of your request. There are significant exceptions to this rule under federal regulations. For example, we do not have to give you a list of those disclosures made for treatment, payment or health care operations, or disclosures made to you or to others with your written authorization. Other exceptions exist. Furthermore, the list of disclosures only includes disclosures made on or after April 14, 2003. E. You have the right to receive a paper copy of this notice upon your request. 11. What can I do if I have a complaint about how my health information is used? For Eyes wants to hear from you if you have any questions, concerns or complaints about the privacy of your health information. Please contact us by telephone, mail or e-mail: For Eyes Attention: Privacy Officer Address: 285 W 74 Place, Hialeah, FL 33014 Phone: 305-557-9004 Fax: 305-822-8649 E-Mail: info@foreyes.com You also file a complaint with the Secretary of Health and Human Services at the following address: HIPAA Complaint 7500 Security Boulevard C5-24-04 Baltimore, Maryland 21244 No one at For Eyes will retaliate or take any action against you for filing a complaint. |