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.
OUR DUTIES
We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices. We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change those terms and any changes made will be effective for all medical information we mainatain. A copy of a revised notice will be available by contacting our Privacy Coordinator by calling (585)924-4430 or by writing to C & R Vision, 274 W. Main St., Victor, NY 14564, ATTN: Privacy Coordinator. You may also address questions regarding our privacy practices, your privacy rights, or requests for additional information regarding your privacy, to this person.
PERMITTED USES
We may use and disclose your medical information for specific reasons: -Treatment: We will provide your doctor or other health care provider with the results of the exams we perform. We may contact you before the exam to remind you of your appointment or to talk with you about the exam. -Payment: We expect co-payments to be paid at the time of your exam and will bill your insurance company directly for any balance that they will pay. We are not providers of some private insurance companies therefore; you may be responsible for paying in full. As a courtesy, we will bill your insurance company with payments being made to you. Eyeglasses and contacts require a 50% deposit upon ordering and should be paid in full upon delivery. -Health Care Operations: We routinely review past exams performed to maintain quality assurance goals. Some insurance companies require us to send exam results for auditing purposes. We may also select your billing information for review by your internal compliance department or by external auditors.
DISCLOSURES WITHOUT AUTHORIZATION
We may use and disclose medical information about you, without your specific authorization in cases such as: -Disclosures Required by Law -Public Health Activities -Victims of Abuse, Neglect, or Domestic Violence -Health Oversight Activities -Judicial and Administrative Proceedings -Law Enforcement -Serious Threats to Health or Safety -Military Personnel -Worker's Compensation
PATIENTS RIGHTS
You have certain rights with respect to your medical information. -Requesting Restrictions: You may ask us to limit our use or disclosure of your Protected Health Information (PHI). We are not required to agree to your request, but if we agree to it, we will abide by your request except as required by law, in emergencies, or when the information is necessary to treat you. Your request must:
1)Be in writing.
2) Describe the information that you want restricted.
3)State if the restriction is limited to our use or disclosure.
4)State to whom the restriction applies.
-Confidential Communications: You may ask that we communicate with you in a particular way, or at a certain location, to maintain your confidentiality. Your request must be in writing and must tell us how you intend to satisfy your financial responsibility and specify an alternate way that we can contact you confidentially. You do not have to give a reason for your request.
-Inspect and Copy: You may request access to inspect and copy your medical information maintained in our records, including medical and billing records. Your request must be in writing. We will act on your request within 30 days after we get it. If we must deny your request, we will send you a written denial. If this happens you may request a review of the denial. We may charge you a fee for this service.
-Amendment: You may ask us to amend your health information if you believe that it is incorrect or incomplete. Your request must be in writing and must include a reason to support the amendment. Your request may be denied if we believe that the information is complete and accurate, if the information is not part of the medical information that you would be permitted to inspect or copy, or if we did not create the information.
Accounting of Disclosures: This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described above. You may request a list of disclosures we have made of your PHI. You have the right to receive specific information regarding these disclosures that occured after April 14, 2003. Paper Copy of this Notice: You are entitled to receive a paper copy of our Notice of Privacy Practices by using the contact information supplied on the first page.
Filing a Complaint: If you believe that we have violated your privacy rights, you may file a complaint directly with us by using the contact information on the first page. You may also file a complaint directly with us by using the contact information on the first page. You may also file a complaint with teh Secretary of the Department of Health and Human Services. You will not be penalized for complaining. Provide an Authorization for Other Uses and Disclosures: We will request your written authorization for uses and disclosures of your medical information that are not identified in this notice or permitted by law. You may revoke your authorization at any time in writing.
