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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.
The Health Insurance Portability & Accountability Act of
1996 ("HIPAA") is a federal program that requires 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,
significant new rights to understand and control how your health
information is used. "HIPAA" provides penalties for covered entities
that misuse personal health information.
As required by "HIPAA", we have prepared this
explanation of how we are required to maintain the privacy of your
health information and how we may use and disclose your health
information.
We may use and disclose your protected health
information for purposes of providing treatment, obtaining payment for
treatment and conducting health care operations. Your protected health
information may be used or disclosed only for these purposes unless we
have obtained your authorization or the use or disclosure is otherwise
permitted by the HIPAA Privacy Regulations or State Law. Disclosures of
your protected health information may be made in writing, orally,
facsimile or electronic transmission.
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Treatment means providing, coordinating, or
managing health care and related services by one or more health care
providers. For example, we may disclose your protected health
information to fulfill a prescription, to a hospital to board you for
surgery or to other physicians who may be treating you or consulting
with your physician with respect to your care.
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Payment means such activities as obtaining
reimbursement for services, confirming coverage, billing or collection
activities, and utilization review. For example, we may disclose your
protected health information to determine whether you are eligible for
benefits or whether a particular service is covered under your health
plan to or bill your health plan for services we have provided.
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Health care operations include the business
aspects of running our practice such as quality assessment and
improvement activities, employee reviews, training programs,
accreditation, certification, licensing or credentialing activities,
reviews and auditing, including compliance reviews, medical reviews,
legal services or business management and general administrative
activities.
We may also create and distribute de-identified health
information by removing all references to individually identifiable
information.
We may contact you to provide appointment reminders or
information about treatment alternatives or other health-related
benefits and services that may be of interest to you.
Any other uses and disclosures will be made only with your written
authorization. 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.
You have the following rights with respect to your
protected health information, which you can exercise by presenting a
written request to the Privacy Officer:
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The right to request restrictions on certain uses and
disclosures of protected health information, including those related
to disclosures to family members, other relatives, close personal
friends, or any other person identified by you. We are, however, not
required to agree to a requested restriction. If we do agree to a
restriction, we must abide by it unless you agree in writing to remove
it.
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The right to reasonable requests to receive
confidential communications of protected health information from us by
alternative means or at alternative locations.
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The right to inspect and copy your protected health
information. The right to amend your protected health information.
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The right to receive an accounting of disclosures of
protected health information. The right to obtain a paper copy of this
notice from us upon request.
We are required by law to maintain the privacy of your
protected health information and to provide you with notice of our legal
duties and privacy practices with respect to protected health
information.
This notice is effective April 14, 2003 and we are
required to abide by the terms of the Notice of Privacy Practices
currently in effect. We reserve the right to change the terms of our
Notice of Privacy Practices and to make the new notice provisions
effective for all protected health information that we maintain. We will
post and you may request a written copy of a revised Notice of Privacy
Practices from this office.
You have recourse if you feel that your privacy
protections have been violated. You have the right to file a written
complaint with our office, or with the Department of Health & Human
Services, Office of Civil Rights, about violations of the provisions of
this notice or the policies and procedures of our office. We will not
retaliate against you for filing a complaint.
Please contact us for more information:
Clavenna Vision Institute
600 S. Adams Rd., Suite 200
Birmingham, MI 48009
Attn: Privacy Officer
For more information about HIPAA or to file a complaint:
The U.S. Department of Health and Humans Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775 |
