USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a surgery may require that your relevant protected health information be disclosed to the health plan to obtain approval for the surgery.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of our practice. These activities include, but are not limited to, quality assessment, employee review, training of staff, licensing, and conducting or arranging for other business activities.
We may use or disclose your protected health information in the following situations without your authorization. These situations include: public health issues as required by law, health oversight, abuse or neglect, food and drug administration requirements, legal proceedings, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military activity and national security, workers’ compensation, inmates, and other required uses and disclosures. We must also disclose your protected health information when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with these requirements.
We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. 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 abide by the same HIPA Privacy standards as outlined in this Notice of Privacy Practice.
Other Permitted Uses and Disclosures Requiring Your Written Authorization
Unless noted above in our Use and Disclosures, all other permitted uses and disclosures of your protected health information will be made only with your consent, authorization or opportunity to object unless required by law. This includes:
You may revoke the authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.
The following are statements of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information. (Please note reasonable fees may apply.) Under federal law, however, you may not inspect or copy the following records: Psychotherapy notes, information compiled in reasonable anticipation of, or used in, a civil, criminal, or administrative action or proceeding, protected health information restricted by law, information that is related to medical research in which you have agreed to participate, information whose disclosure may result in harm or injury to you or to another person, or information that was obtained under a promise of confidentiality.
If your protected health information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. If the protected health information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form.
We have up to 30 days to make your protected health information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information. Although we are not obligated to comply with all requests to restrict the disclosure of your protected health information, we must comply when the protected health information pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. By law, you may not request that we restrict the disclosure of your personal health information for treatment purposes.
You have the right to request to receive confidential communications. We may call you with appointment reminders, cancellations, and may leave voice mail message at your home or place of employment. You have the right to request confidential communication from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, i.e. electronically.
You have the right to request an amendment to your protected health information. If we deny your request for an amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures. You have the right to receive an accounting of all disclosures except for the following disclosures: disclosures pursuant to an authorization, disclosures for purposes of treatment, payment, healthcare operations; disclosures required by law, that occurred prior to April 14, 2003; or disclosures six years prior to the date of this request.
You have the right to receive a Breach Notification. You have the right to receive a notification upon a breach of any of your unsecured protected health information.
You have the right to obtain a paper copy of this notice from us even if you have agreed to receive the notice electronically. We reserve the right to change the terms of this notice and the new terms will apply to all the information we have about you. We will notify you of such changes on the following appointment. We will also make available copies of our new notice if you wish to obtain one.
You may file a complaint or report a problem to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.
For More Information or to Report a Problem Please Contact Us At:
Family Eye Care and Children’s Eye Center of New Mexico
303 Mulberry Street NE
Albuquerque, NM 87106
Phone: (505) 243-9739
Fax: (505) 842-0650
If we are unable to resolve your complaint, the HIPAA regulation enables you to address your concern:
Secretary of the Department of Health and Human Services (HHS)
200 Independence Ave., SW
Washington, DC 20201
We will never retaliate against you for filing a complaint. We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. We are also required to abide by the terms of the notice currently in effect. If you have any questions in reference to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our main phone number.