Reed Eye Associates

4/14/2003  

NOTICE OF PRIVACY PRACTICES

FOR PROTECTED HEALTH INFORMATION

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.

If you have any questions or wish to receive additional information about the matters covered by this Notice of Privacy Practices, please contact Patricia L. Bonino at (585)249-8360. A copy of the full Notice is available on our web site, www.reedeye.com and is posted in each of our offices.

          Reed Eye Associates is required to abide by the terms of this Notice of Privacy Practices (this “Notice”).  The Practice reserves the right to change the terms of this Notice at any time.  The revised Notice will apply to all protected health information the Practice received or created in the past as well as all protected health information the Practice receives or creates in the future.  If this Notice of Privacy Procedures has been changed since your last appointment, the Practice will provide a copy of the current Notice of Privacy Practices to you when you sign in for your appointment.  Your “protected health information” consists of all individually identifiable information which is created or received by the Practice and which relates to your past, present or future physical or mental health or condition, the provision of health care to you or the past, present or future payment for health care provided to you.

Permitted uses

We may use and disclose your protected health information for specific purposes.

Treatment:  The Practice will use and disclose your information to provide, coordinate or manage your health care and related services by the Practice and other health care providers, including consulting with other health care providers about your health care or referring you to another health care provider for treatment.  We may contact you to remind you of your appointment or talk with you about your care.

Payment:  The Practice may contact your insurance plan to check whether your insurance carrier will cover treatment.  Additionally, the Practice may disclose to your insurance carrier, as necessary, the treatment you received to ensure that the Practice is paid or you are reimbursed for the cost of your treatment.  The Practice will bill your insurance company or whoever is responsible for the your account.

Health Care Operations:  The Practice may use or disclose your protected health information in order to support the business activities of the Practice.  These activities include, quality assessment and improvement activities, reviewing the competence or qualification of health care professionals, business planning and development and business management and general administrative activities

Disclosures without Authorization

Public Health:  The Practice may disclose your protected health information to a public health authority that may be conducting an investigation or requires the reporting of certain diseases or injuries.

Communicable Diseases.  The Practice may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of spreading a disease or condition.

Employer.  The Practice may disclose your protected health information to your employer if the Practice is providing health care to you at the request of your employer to conduct an evaluation relating to medical surveillance relating to your workplace or to evaluate whether you have a work-related illness or injury

Abuse, Neglect or Domestic Violence.  The Practice may disclose your protected health information to a government authority authorized to receive reports of abuse, neglect or domestic violence if the Practice reasonably believes that you are a victim of abuse, neglect or domestic violence

Health Oversight Activities.  The Practice may disclose your protected health information to a health oversight agency such as Medicare if they select your case for a medical review.

Judicial and Administrative Proceedings.  The Practice may, upon certain conditions, disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court, subpoena, or other lawful process.

Law Enforcement Purposes.  The Practice may disclose your protected health information in conjunction with a criminal investigation by a federal, state or law enforcement agency.

Coroners, Medical Examiners and Funeral Directors.  The Practice may disclose your protected health information to a coroner or medical examiner for the purpose of identifying you, determining a cause of death or other duties authorized by law.  The Practice may disclose your protected health information to a funeral director, consistent with all applicable laws, in order to allow the funeral director to carry out his or her duties.

Serious Threat to Health or Safety.  The Practice may disclose your protected health information if it believes that doing so will help avert a serious threat to the public.

Military and Veterans Activities.  The Practice may disclose your information to the appropriate command authorities.

Workers’ Compensation.  The Practice may disclose your protected health information to comply with laws regarding workers’ compensation.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

Restriction of Use and Disclosure.  You have the right to request that the Practice limit its use or disclosure of your protected health information.  The Practice is not required to agree to your request, but if it does, it will abide by the request.  The request must be made in writing and set forth h (1) whether you are restricting the use or the disclosure of your protected health information, (2) what protected health information you wish to limit, and (3) to whom you wish the limits to apply (i.e., your spouse).

Confidential Communications.  You have the right to request that you receive communications of your protected health information form the Practice in alternative means or at alternative locations.  The Practice will accommodate all reasonable requests.

Access to Protected Health Information.  You have the right to inspect and obtain a copy of your protected health information that the Practice maintains in a designated record set.  If you wish to inspect or obtain a copy of your protected health information, please send a written request to the Privacy Officer.  If you request a copy of your protected health information, the Practice may charge a fee for the cost of copying and mailing the information.  The Practice may, for certain limited reasons, deny your request to inspect or obtain a copy of your protected health information.  If the Practice denies your request, you may be entitled to a review of that denial.  If you are entitled to a review and you wish to have the Practice’s decision reviewed, please contact the Privacy Officer.

Amending Protected Health Information.  You have the right to request that the Practice amend your protected health information in a designated record set. To request that an amendment be made to your protected health information, please send a written request to the Privacy Officer.  Your written request must provide a reason that supports the requested amendment.

 Accounting of Disclosures.  You have the right to request a listing of certain disclosures of your protected health information made by the Practice during the period of up to six (6) years prior to the date on which you make your request.  You may not request an accounting for dates of service prior to April 14, 2003.  To request an accounting of the disclosures of your protected health information made by the Practice, please send a written request to the Privacy Officer.  The Practice will provide one free accounting during each twelve (12) month period but will charge for additional lists within the same (12)-month period.

 Obtaining a Copy of this Notice.  You have the right to request and receive a paper copy of this Notice of Privacy Practices from the Practice at any time.

Complaints.  If you believe that your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of Health and Human Services.  To file a complaint with the Practice, please contact Patricia L. Bonino at (585)249-8360.  All complaints must be submitted in writing.  THE PRACTICE WILL NOT RETALIATE AGAINST YOU FOR FILING A COMPLAINT.