Privacy Notice
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.
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you a notice of our privacy pratices. This Notice describes how we protect your health information andd what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reasons why we use or disclose your health information is for treatment, payment and health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you testing or examining your eyes prescribing glasses, contact lenses, or eye medications and faxing them to be filled showing you low vision aids referring you to another doctor or clinic for eye care or low vision aids or services or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or vision care plans, or other sources of payment preparing and sending bills or claims and collecting unpaid amounts (either ourselves or through a collection agency or attorney). "Health Care Operations" mean those administrative and managerial functions that we have to do to run our office. Examples of haw we use or disclose your health information for health care operations are: financial and billing audits internal quality assurance personal decisions participation in managed care plans defense of legal mattersbusiness planning and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside our office for these reasons, we usually will not ask you for special written permission.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. These examples are notmeant to be exhaustive, but to describe the types and uses that may be made by our office. Not all of these situations will apply to us some may never come up in our office at all. Such uses and disclosures are:
* when a state or federal law mandates that
that certain health information be
reported for a specific purpose
* for public health purposes, such a
contagious disease reporting,
investigation or surveillance and
notices to and from Federal Food and Drug
Administration regarding drugs and
nedical devices
* disclosures to governmental authorities
about victims of suspected abuse,
neglect or domestic violence
* uses and disclosures for health
oversight activities, such as for the
licensing of doctors for audits by
Medicare or Medicaid or for
investigation of possible violations of
health care laws
* disclosure for judicial and
administrative proceedings, such as in
response to subpeonas or orders of
courts or administrative agencies
* disclosures for law enforcement
purposes, such as to provide information
about someone who is or is suspected to
be a victim of a crime to provide
information about a crime at our
office or to report a crime that
happened somewhere else
* disclosure to a medical examiner to
identify a dead person or to determine
the cause of death or to funeral
directors to aid in burial or to
organizations that handle organ and
tissue donations
* uses and disclosures to prevent serious
threat to health and safety
* uses and disclosures for specialized
governmental functions, such as for the
protction of the president or high
ranking government officials for lawful
national intelligence activities for
military purposes or for the evaluation
and health of members of the foreign
service
* disclosures of de-identified information
* disclosures related to worker's
compensation programs
* disclosures of a "limited data set" for
research, public health, or health care
operations
* incidental disclosures that are an
unavoidable by-product of premitted of
permitted uses or disclosures
* disclosures to "business associates" who
perform health care operation to us and
who commit to respect the privacy of you
health information
Unless you object, we will also share revelant information about your care with your family or friends who are helping you with your eye care.
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled appointments, or that it is time to make a routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you a notice that it is time to schedule a routine appointment. We will call you to remind you of a scheduled appointment, leaving a message for you at your home or at work, or with someone who answers the phone if you are not available.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your health information unless you sign a written "authorization form". The content of an "authorization |form" is determined by federal law. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the authorization process if it's your idea for us to send your information to someone else. Typically in this situation you will give us a properly completed authorization form,or you can use one of ours.
If we initiate the authorization process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign it, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person at the address shown above at the end of this notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding
your health information. You can:
* ask us to restrict our uses and
disclosures for purposes of treatment
(except emergency treatment), payment
and health operations. We do not have to
agree to this, but if we agree, we must
honor the restrictions that you want. To
ask for a restriction, you can give us a
properly completed request form, or you
can use one of ours. You may send the
request to the office contact person at
he address shown at the end of this
notice.
* ask us to communicate with you in a
confidential way, such as phoning you at
work rather than at home, by mailing
health information to a different
address, or by using Email to your
personal Email address. We will
accommodate these requests if they are
resonable, and if you pay us for any
extra cost. If you want to ask for
confidential communtcations, you can
send us a properly completed request
form, available upon request, to the
office contact person at the address
shown at the end of this notice.
* ask to see or get photocopies of your
health information. By law, there are a
few limited situations whichwe can
refuse to permit access or copying. For
the most part, however, you will be able
to review or have a copy of your health
information within thirty (30) days of
asking (or sixty (60) days if stored
off-site. You may have to pay for
photocopies in advance. If we deny your
request, we will send you a written
explanation, and instructions about how
to get an impartial review of our denial
if one is legally available. By law, we
can have a thirty (30) day extension of
time for us to give you access or
photocopies if we send you a written
notice if extension. If you want to
review or get photocopies of your health
information, you can sen us a properly
completed request form, available upon
request, to the office contact person at
the address shown at the end of this
notice.
* ask us to amend your health information
if you think it is incomplete or
inaccurate. If we agree, we will amend
the information within sixty (60) days
from when you ask us. We will send the
corrected information to persons we know
got the wrong information, and others
you specify. If we do not agree, you can
write a statement of your position, and
we will include it with your health
information along with any rebuttal
statement we might write. Once your
statement of postions and/or our
rebuttalis included in your health
information, we will send it along
whenever we are permitted disclosure of
you health information. By law, we can
have one thirty (30) day extension of
time to consider a request of amendment
if we notify you of the extension. If
you want to ask us to amend your health
information, you can send us a properly
completed request form, available upon
request, to the office contact person
at the address shown at the end of this
notice.
* get a list of disclosures that we have
made of your health information since
April 14, 2003. After April 14, 2009,
the accounting will be provided for the
past six (6) years (or a shorter period
if you want). By law, the list will not
include: disclosures for purposes or
treatment, payment or health care
operations disclosures with your
authorization incidental disclosures
disclosures required by law and some
other limited disclosures. You are
entitled to one such list per year
without charge. If you want more
frequent lists, you will have to pay for
them in advance. We will usually respond
to your request within 60 (sixty) days
of receiving it, but by law we can have
one thirty (30) day extension of time if
we notify you of the extension in
writing. If you want a list of
disclosures, you can send us a properly
completed request form, available upon
request, to the office contact person at
the address shown at the end of this
notice.
* to get additional paper copies of this
notice upon request Send a written
request to the office contact person
listed at the end of this notice.
OUR NOTICE OF PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to
change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available at our office, and post it on our Website.
COMPLAINTS
If you think we have improperly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Resources, Office of Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact person listed at the end of this Notice. If you prefer, you can discuss your complaint in person or by telephone.
FOR MORE INFORMATION
If you want more information about our privacy practices, call or visit our office contact person listed at the end of this Notice.
NAME OF CONTACT PERSON: Privacy Officer/Public Information Officer: Debba Trueblood
TELEPHONE: 860-677-7444
FAX: 860-677-4836
ADDRESS: Avon Vision Associates
40 Avon Meadow Lane
Avon, CT 06001
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you a notice of our privacy pratices. This Notice describes how we protect your health information andd what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reasons why we use or disclose your health information is for treatment, payment and health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you testing or examining your eyes prescribing glasses, contact lenses, or eye medications and faxing them to be filled showing you low vision aids referring you to another doctor or clinic for eye care or low vision aids or services or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or vision care plans, or other sources of payment preparing and sending bills or claims and collecting unpaid amounts (either ourselves or through a collection agency or attorney). "Health Care Operations" mean those administrative and managerial functions that we have to do to run our office. Examples of haw we use or disclose your health information for health care operations are: financial and billing audits internal quality assurance personal decisions participation in managed care plans defense of legal mattersbusiness planning and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside our office for these reasons, we usually will not ask you for special written permission.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. These examples are notmeant to be exhaustive, but to describe the types and uses that may be made by our office. Not all of these situations will apply to us some may never come up in our office at all. Such uses and disclosures are:
* when a state or federal law mandates that
that certain health information be
reported for a specific purpose
* for public health purposes, such a
contagious disease reporting,
investigation or surveillance and
notices to and from Federal Food and Drug
Administration regarding drugs and
nedical devices
* disclosures to governmental authorities
about victims of suspected abuse,
neglect or domestic violence
* uses and disclosures for health
oversight activities, such as for the
licensing of doctors for audits by
Medicare or Medicaid or for
investigation of possible violations of
health care laws
* disclosure for judicial and
administrative proceedings, such as in
response to subpeonas or orders of
courts or administrative agencies
* disclosures for law enforcement
purposes, such as to provide information
about someone who is or is suspected to
be a victim of a crime to provide
information about a crime at our
office or to report a crime that
happened somewhere else
* disclosure to a medical examiner to
identify a dead person or to determine
the cause of death or to funeral
directors to aid in burial or to
organizations that handle organ and
tissue donations
* uses and disclosures to prevent serious
threat to health and safety
* uses and disclosures for specialized
governmental functions, such as for the
protction of the president or high
ranking government officials for lawful
national intelligence activities for
military purposes or for the evaluation
and health of members of the foreign
service
* disclosures of de-identified information
* disclosures related to worker's
compensation programs
* disclosures of a "limited data set" for
research, public health, or health care
operations
* incidental disclosures that are an
unavoidable by-product of premitted of
permitted uses or disclosures
* disclosures to "business associates" who
perform health care operation to us and
who commit to respect the privacy of you
health information
Unless you object, we will also share revelant information about your care with your family or friends who are helping you with your eye care.
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled appointments, or that it is time to make a routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you a notice that it is time to schedule a routine appointment. We will call you to remind you of a scheduled appointment, leaving a message for you at your home or at work, or with someone who answers the phone if you are not available.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your health information unless you sign a written "authorization form". The content of an "authorization |form" is determined by federal law. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the authorization process if it's your idea for us to send your information to someone else. Typically in this situation you will give us a properly completed authorization form,or you can use one of ours.
If we initiate the authorization process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign it, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person at the address shown above at the end of this notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding
your health information. You can:
* ask us to restrict our uses and
disclosures for purposes of treatment
(except emergency treatment), payment
and health operations. We do not have to
agree to this, but if we agree, we must
honor the restrictions that you want. To
ask for a restriction, you can give us a
properly completed request form, or you
can use one of ours. You may send the
request to the office contact person at
he address shown at the end of this
notice.
* ask us to communicate with you in a
confidential way, such as phoning you at
work rather than at home, by mailing
health information to a different
address, or by using Email to your
personal Email address. We will
accommodate these requests if they are
resonable, and if you pay us for any
extra cost. If you want to ask for
confidential communtcations, you can
send us a properly completed request
form, available upon request, to the
office contact person at the address
shown at the end of this notice.
* ask to see or get photocopies of your
health information. By law, there are a
few limited situations whichwe can
refuse to permit access or copying. For
the most part, however, you will be able
to review or have a copy of your health
information within thirty (30) days of
asking (or sixty (60) days if stored
off-site. You may have to pay for
photocopies in advance. If we deny your
request, we will send you a written
explanation, and instructions about how
to get an impartial review of our denial
if one is legally available. By law, we
can have a thirty (30) day extension of
time for us to give you access or
photocopies if we send you a written
notice if extension. If you want to
review or get photocopies of your health
information, you can sen us a properly
completed request form, available upon
request, to the office contact person at
the address shown at the end of this
notice.
* ask us to amend your health information
if you think it is incomplete or
inaccurate. If we agree, we will amend
the information within sixty (60) days
from when you ask us. We will send the
corrected information to persons we know
got the wrong information, and others
you specify. If we do not agree, you can
write a statement of your position, and
we will include it with your health
information along with any rebuttal
statement we might write. Once your
statement of postions and/or our
rebuttalis included in your health
information, we will send it along
whenever we are permitted disclosure of
you health information. By law, we can
have one thirty (30) day extension of
time to consider a request of amendment
if we notify you of the extension. If
you want to ask us to amend your health
information, you can send us a properly
completed request form, available upon
request, to the office contact person
at the address shown at the end of this
notice.
* get a list of disclosures that we have
made of your health information since
April 14, 2003. After April 14, 2009,
the accounting will be provided for the
past six (6) years (or a shorter period
if you want). By law, the list will not
include: disclosures for purposes or
treatment, payment or health care
operations disclosures with your
authorization incidental disclosures
disclosures required by law and some
other limited disclosures. You are
entitled to one such list per year
without charge. If you want more
frequent lists, you will have to pay for
them in advance. We will usually respond
to your request within 60 (sixty) days
of receiving it, but by law we can have
one thirty (30) day extension of time if
we notify you of the extension in
writing. If you want a list of
disclosures, you can send us a properly
completed request form, available upon
request, to the office contact person at
the address shown at the end of this
notice.
* to get additional paper copies of this
notice upon request Send a written
request to the office contact person
listed at the end of this notice.
OUR NOTICE OF PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to
change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available at our office, and post it on our Website.
COMPLAINTS
If you think we have improperly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Resources, Office of Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact person listed at the end of this Notice. If you prefer, you can discuss your complaint in person or by telephone.
FOR MORE INFORMATION
If you want more information about our privacy practices, call or visit our office contact person listed at the end of this Notice.
NAME OF CONTACT PERSON: Privacy Officer/Public Information Officer: Debba Trueblood
TELEPHONE: 860-677-7444
FAX: 860-677-4836
ADDRESS: Avon Vision Associates
40 Avon Meadow Lane
Avon, CT 06001