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HIPPA Standards
Lima Eye
Surgeons, Inc. – Fox Eye Surgeons
Notice of Privacy Practices
This notice describes how your
medical information may be used and disclosed and how you can obtain this
information.
Please review
carefully.
Uses and Disclosures
Treatment. Your health information
may be used by staff members or disclosed to other health care professionals
for the purpose of evaluating your health, diagnosis, and providing treatment.
Such disclosures may include the results of laboratory tests and procedures
made available in your medical record to all health professionals who may
provide treatment or who may be consulted by staff members.
Payments. Your health information
may be used to seek payment from your health plan, from other sources of
coverage such as other insurers, or from credit card companies that you use for
paying services. An example would be your health plan may request and receive
information on dates of service, services provided and medical condition being
treated.
Health care operations. Your health
information may be used as necessary to support the daily activities of Fox Eye Surgeons.
As an example, information on
the services you received may be used to support financial reporting,
projections, and steps for evaluating and promoting quality care.
Legal. Your health information may be disclosed to public
health agencies as required by law. An example would be if we are required to
report some communicable diseases to the state’s public health department.
Other uses and disclosures requiring authorization.
Disclosure of your health information or its use for any purpose other than
that above requires your specific written authorization. If you change your
mind after authorizing a use or disclosure of your information you may submit a
written revocation of the authorization. This decision to revoke the
authorization will not affect or undo any use or disclosure of information that
occurred before your notification to revoke your authorization.
Additional Uses of Information
Your health information will
be used by our staff to send you appointment reminders. Your health information
may be used to send you information on the treatment and management of your
medical condition. We may also send you information describing other
health-related products and services.
Individual Rights
You have certain rights under
the federal privacy standards. These include:
1.
The right to
receive a printed copy of this notice.
2.
The right to
receive an accounting of how and to whom your protected health information has been
disclosed.
3.
The right to
receive confidential communications concerning your medical condition and
treatments.
4.
The right to
inspect and copy your protected health information.
5.
The right to amend
or submit corrections to your protected health information.
6.
The right to
request restrictions on the use and disclosure of your protected health
information.
Fox Eye Surgeons Duties
We are required by law to
maintain the privacy of your protected health information and to give this
notice of privacy practices. We are also required to abide by the privacy
policies that are outlined in this notice.
Revising Privacy Practices
We reserve the right, as
legally permitted, to amend or modify our privacy policies and practices. These
changes in our policies and practices may be required because of changes in
federal and state laws and regulations. Upon request, we will provide you with
the revised notice at the time of your office visit. These will be applied to
all protected health information we maintain.
Requests to Inspect Protected Health
Information
You may generally inspect or
copy the protected health information that we maintain. As permitted by federal
regulation, we require that requests to inspect or copy protected health
information be submitted in writing. You may request access to your records by
contacting our receptionist or privacy official. Your request will be reviewed
and will generally be approved unless there are legal or medical reasons to
deny the request.
For more information about HIPAA:
US Department of Health & Human Services
202-619-0257
Toll Free: 1-877-696-6775
750 W. High Street, Suite #210 •
Lima, OH • Phone: 419-224-3937(EYES) • Fax: 419-224-2144 •
Toll
Free Number: 888.554.3937 (EYES)