Notice of Privacy Policy
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.
Who Will Follow This Notice
This notice describes the information privacy practices
followed by our employees, staff and other office personnel. The
practices described in this notice will also be followed by
health care providers you consult with by telephone (when your
regular health care provider from our office is not available)
who provide “call coverage” for your health care provider.
Your Health Information
This notice applies to the information and records we have
about your health, health status, and the health care and
services you receive at this office. We are required by law
to give you this notice. It will tell you about the ways in
which we may use and disclose health information about you and
describes your rights and our obligations regarding the use and
disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment
We may use health information about you to provide you with
medical treatment or services. We may disclose health
information about you to doctors, nurses, technicians, office
staff or other personnel who are involved in taking care of you
and your health. For example, your doctor may be treating you
for a heart condition and may need to know if you have other
health problems that could complicate your treatment. The doctor
may use your medical history to decide what treatment is best
for you. The doctor may also tell another doctor about your
condition so that doctor can determine the most appropriate care
for you.
Different personnel in our office may share information about
you and disclose information to people who do not work in our
office in order to coordinate your care, such as phoning in
prescriptions to your pharmacy, scheduling lab work and ordering
x-rays. Family members and other health care providers may be a
part of your medical care outside this office and may require
information about you that we have.
We have an open waiting room. We will attempt to keep your
personal health information (PHI) to the minimum.
For Payment
We may use and disclose health information about you so that
the treatment and services you receive at this office may be
billed to and payment may be collected from you, an insurance
company or a third party. For example, we may need to give your
health plan information about a service you received here so
your health plan will pay us or reimburse you for the service.
We may also tell your health plan about a treatment you are
going to receive to obtain prior approval, or to determine
whether your plan will cover the treatment.
For Health Care Operations
We may use and disclose health information about you in order
to run the office and make sure that you and our other patients
receive quality care. For example, we may use your health
information to evaluate the performance of our staff in caring
for you. We may also use health information about all or many of
our patients to help us decide what additional services we
should offer, how we can become more efficient, or whether
certain new treatments are effective.
Appointment Reminders
We may contact you as a reminder that you have an appointment
for treatment or medical care at the office.
Treatment Alternatives
We may tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
Health Related Products or Services
We may tell you about health related products or services
that may be of interest to you.Please notify us if you do not
wish to be contacted for appointment reminders, or if you do not
wish to receive communications about treatment alternatives or
health related products or services. If you advise us in writing
(at the address listed on the end of this Notice) that you do
not wish to receive such communications, we will not use or
disclose your information for these purposes.
You may
revoke your Consent at any time by giving us written notice.
Your revocation will be effective when we receive it, but it
will not apply to any uses and disclosures which occurred before
that time.
If you do revoke your Consent, we will not be
permitted to use or disclose information for purpose of
treatment, payment or health care operations, and we may
therefore choose to discontinue providing you with health care
treatment and services.
SPECIAL SITUATIONS
We may use or disclose health
information about you without your permission for the following
purposes, subject to all applicable legal requirements and
limitations.
To Avert a Serious Threat to Health or Safety
We may use and disclose health information
about you when necessary to prevent a serious threat to your
health and safety of the public or another person.
Required by Law
We
will disclose health information about you when required to do
so by federal, state, or local law.
Research
We may use and
disclose health information about you for research projects that
are subject to a special approval process. We will ask you for
your permission if the researcher will have access to your name,
address or other information that reveals who you are, or will
be involved in your care at the office.
Organ and Tissue Donation
If you are an
organ donor, we may release health information to organizations
that handle organ procurement or organ, eye or tissue transplant
or to an organ donation bank, as necessary to facilitate such
donation and transplantation.
Military, Veterans, National Security and Intelligence
If you are or were a member
of the armed forces, or part of the national security or
intelligence communities, we may be required by military command
or other government authorities to release health information
about you. We may also release information about foreign
military personnel to the appropriate foreign military
authority.
Workers' Compensation
We may release health information about you
for workers’ compensation or similar programs. These programs
provide benefits for work-related injuries or illness.
Public Health Risks
We
may disclose health information about you for public health
reasons in order to prevent or control disease, injury or
disability; or report births, deaths, suspected abuse or
neglect, non-accidental physical injuries, reactions to
medications or problems with products.
Health Oversight Activities
We may disclose
health information to a health oversight agency for audits,
investigations, inspections, or licensing purposes. These
disclosures may be necessary for certain state and federal
agencies to monitor the health care system, government programs,
and compliance with civil laws.
Lawsuits and Disputes
If you are involved in a
lawsuit or a dispute, we may disclose health information about
you in response to a court or administrative order. Subject to
all applicable legal requirements, we may also disclose health
information about you in response to a subpoena.
Law Enforcement
We may
release health information if asked to do so by a law
enforcement official in response to a court order, subpoena,
warrant, summons or similar process, subject to all applicable
legal requirements.
Coroners, Medical Examiners, and Funeral Directors
We may release health information to
a coroner or medical examiner. This may be necessary, for
example, to identify a deceased person or determine cause of
death.
Information Not Personally Identifiable
We may use or disclose health information about
you in a way that does not personally identify you or reveal who
you are.
Family and Friends
We may disclose health information about you to
your family members or friends if we obtain your verbal
agreement to do so or if we give you an opportunity to object to
such disclosure and you do not raise an objection. We may also
disclose health information to your family or friends if we can
infer from the circumstances, based on our professional judgment
that you would not object. For example, we may assume you agree
to our disclosure of your personal health information to your
spouse when you bring your spouse with you into the exam room
during treatment or while treatment is being discussed.
In
situations where you are not capable of giving consent (because
you are not present or due to your incapacity or medical
emergency), we may, using our professional judgment, determine
that a disclosure to your family member or friend is in your
best interest. In that situation, we will disclose only health
information relevant to the person’s involvement in your care.
For example, we may inform the person who accompanied you to the
emergency room that you suffered a heart attack and provide
updates on your progress and prognosis. We may also use our
professional judgment and experience to make reasonable
inferences that it is in your best interest to allow another
person to act on your behalf to pick up, for example, filled
prescriptions, medical supplies, or x-rays.
OTHER USES & DISCLOSURES OF HEALTH INFORMATION
We will
not use or disclose your health information for any purpose
other than those identified in the previous sections without
your specific, written Authorization. We must obtain your
Authorization separate from any Consent we may have obtained
from you. If you give us Authorization to use or disclose health
information about you, you may revoke that Authorization, in
writing, at any time. If you revoke your Authorization, we will
no longer use or disclose information about you for the reasons
covered by your written Authorization, but we cannot take back
any uses or disclosures already made with your permission. If
we have HIV or substance abuse information about you, we cannot
release that information without a special signed, written
authorization (different than the Authorization and Consent
mentioned above) from you. In order to disclose these types of
records for purposes of treatment, payment or health care
operations, we will have to have both your signed Consent and a
special written Authorization that complies with the law
governing HIV or substance abuse records.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your health information for any
purpose other than those identified in the previous sections
without your specific, written Authorization. We must obtain
your Authorization separate from any Consent we may have
obtained from you. If you give us Authorization to use or
disclose health information about you, you may revoke that
Authorization, in writing, at any time. If you revoke your
Authorization, we will no longer use or disclose information
about you for the reasons covered by your written Authorization,
but we cannot take back any uses or disclosures already made
with your permission.
If we have HIV or substance abuse information about you, we
cannot release that information without a special signed,
written authorization (different than the Authorization and
Consent mentioned above) from you. In order to disclose these
types of records for purposes of treatment, payment or health
care operations, we will have to have both your signed Consent
and a special written Authorization that complies with the law
governing HIV or substance abuse records.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have
the following rights regarding health information we maintain
about you:
Right to Inspect and Copy
You have the right to inspect and copy your
health information, such as medical billing records, that we use
to make decisions about your care. You must submit a written
request to our privacy official in order to inspect and/or copy
your health information. If you request a copy of the
information, we may charge a fee for the costs of copying,
mailing or other associated supplies. We may deny your request
to inspect and/or copy in certain limited circumstances. If you
are denied access to your health information, you may ask that
the denial be reviewed. If such a review is required by law, we
will select a licensed health care professional to review your
request and our denial. The person conducting the review will
not be the person who denied your request, and we will comply
with the outcome of the review.
Right to Amend
If you believe health
information we have about you is incorrect or incomplete, you
may ask us to amend the information. You have the right to
request an amendment as long as the information is kept by this
office. To request an amendment, complete and submit a
Medical Record Amendment/Correction Form to our privacy
official. We may deny your request for an amendment if it is not
in writing or does not include a reason to support the request.
In addition, we may deny your request if you ask us to amend
information that:a. We did not create, unless the person or
entity that created the information is no longer available to
make the amendment.b. Is not part of the health information that
we keep.c. You would not be permitted to inspect and copy.d. Is
accurate and complete.
Right to an Accounting of Disclosures
You have the right to request
an “accounting of disclosures.” This is a list of the
disclosures we made of medical information about you for the
purposes other than treatment, payment and/or health care
operations. To obtain this list, you must submit your request in
writing to our privacy official. It must state a time period,
which may not be longer than six years and may not include dates
before April 14, 2003. Your request should indicate in what form
you want the list (for example, on paper, electronically). We
may charge you for the costs of providing the list. We will
notify you of the cost involved and you may choose to withdraw
or modify your request at that time before any costs are
incurred.
Right to Request Restrictions
You have the right to request a restriction or
limitation on the health information we use or disclose about
you for treatment, payment or health care operations. You also
have the right to request a limit on the health information we
disclose about you to someone who is involved in your care or
the payment for it, like a family member or friend. For example,
you could ask that we not use or disclose information about a
surgery you had.
We Are Not Required to Agree to Your Request
If we do agree, we will comply with your
request unless the information is needed to provide you
emergency treatment. To request restrictions, you may
complete and submit a Request for Restricting Uses and
Disclosures and Confidential Communications Form Information to
our privacy official.
Right to Request Confidential Communications
You have the right to request
that we communicate with you about medical matters in a certain
way or at a certain location. For example, you can ask that we
only contact you at work or by mail.
To request confidential
communications, you may complete and submit the Requests for
Restricting Uses and Disclosures and Confidential Communications
to our privacy official. We will not ask you the reason for your
request. We will accommodate all reasonable requests. You
request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You
may ask us to give you a copy of this notice at any time. Even
if you have agreed to receive it electronically, you are still
entitled to a paper copy. To obtain such a copy, contact our
privacy official.
CHANGES TO THIS NOTICE
We reserve the right to change this
notice, and to make the revised or changed notice effective for
medical information we already have about you as well as any
information we receive in the future. We will post a summary of
the current notice in the office with its effective date in the
top right hand corner. You are entitled to a copy of the notice
currently in effect.
COMPLAINTS
If you believe your privacy rights
have been violated, you may file a complaint with our office or
with the Secretary of the Department of Health and Human
Services. To file a complaint with our office, contact our
privacy official. You will not be penalized for filing a
complaint.
CONTACT
Dr. Massimo R. Gramanzini Family Eye
Center 12220 W Sunrise Blvd Plantation, FL 33323
Phone - 954.423.8444 Email -
info@TheFamilyEyeCenter.com
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