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Southwestern Eye Center Notice of Privacy Practices

HIPAA Notice of Privacy Practices

Effective Date: October 1, 2020

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.

(a) Your medical information is personal. We are a Covered Entity under HIPAA and are required by law to maintain the privacy of your personal health information (“PHI”). These laws require us to provide you with notice of our legal duties and privacy practices, and to notify affected individuals following a breach of unsecured PHI. We are required to abide by the terms of notice of privacy practices currently in effect. Permitted Disclosures of PHI. We may disclose your PHI without authorization for the following reasons:

    • Treatment We may disclose your PHI to a physician or other health care providers providing treatment to you. For example, we may disclose medical information about you to physicians, nurses, technicians or personnel who are involved with the administration of your care.
    • Payment. We may disclose your PHI to bill and collect payment for the services we provide to you. For example, we may send a bill to you or to a third party payor (e.g., your health insurance company) for the rendering of services by us. The bill may contain information that identifies you, your diagnosis and procedures and supplies used. We may need to disclose this information to insurance companies to establish insurance eligibility benefits for you. We may also provide your PHI to our Business Associates, such as billing companies, claims processing companies and others that process our health care claims.
    • Health Care Operations. We may disclose your PHI in connection with our health care operations. Health care operations include quality assessment activities, reviewing the competence or qualifications of health care professionals, evaluating our performance, and other business operations. For example, we may use your PHI to evaluate the performance of the health care services you received. We may also provide your PHI to accountants, attorneys, consultants and others to make sure we comply with the laws that govern us.
    • Emergency Treatment. We may disclose your PHI if you require emergency treatment or are unable to communicate with us.
    • Family and Friends. We may disclose your PHI to a family member, friend or any other person who you identify as being involved with your care or payment for care, unless you object.
    • Required by Law. We may disclose your PHI for law enforcement purposes and as required by state or federal law. For example, the law may require us to report instances of abuse, neglect or domestic violence; to report certain injuries such as gunshot wounds; or to disclose PHI to assist law enforcement in locating a suspect, fugitive, material witness or missing person. We will inform you or your representative if we disclose your PHI because we believe you are a victim of abuse, neglect or domestic violence, unless we determine that informing you or your representative would place you at risk. In addition, we must provide PHI to comply with an order in a legal or administrative proceeding. Finally, we may be required to provide PHI in response to a subpoena discovery request or other lawful process, but only if efforts have been made, by us or the requesting party, to contact you about the request or to obtain an order from a court or administrative body to protect the requested PHI.
    • Serious Threat to Health or Safe We may disclose your PHI if we believe it is necessary to avoid a serious threat to the health and safety of you or the public.
    • Public Health. We may disclose your PHI to public health or other authorities charged with preventing or controlling disease, injury or disability, or charged with collecting public health data.
    • Health Oversight Activities. We may disclose your PHI to a Health Oversight Agency for activities authorized by law. These activities include audits; civil, administrative or criminal investigations or proceedings; inspections; licensure or disciplinary actions; or other activities necessary for oversight of the health care system, government programs and compliance with civil rights laws.
    • Research. We may disclose your PHI for certain research purposes, but only if we have protections and protocols in place to ensure the privacy of your PHI.
    • Workers’ Compensatio We may disclose your PHI to comply with laws relating to workers’ compensation or other similar programs.
    • Specialized Government Activities. If you are active military or a veteran, we may disclose your PHI as required by military command authorities. We may also be required to disclose PHI to authorized federal officials for the conduct of intelligence or other national security activities.
    • Coroners, Medical Examiners, Funeral Directors. We may disclose your PHI to coroners, or medical examiners for the purposes of identifying a deceased person or determining the cause of death, and to funeral directors as necessary to carry out their duties.
    • Disaster Relief. Unless you object, we may disclose your PHI to a governmental agency or private entity (such as FEMA or Red Cross) assisting with disaster relief efforts.
    • Daily Operations. On the day of your appointment, we may ask you to sign your name on a log or “Sign in Sheet” where it could be viewed by other individuals. Throughout your appointment, your full name may be called in our reception area(s) where others may overhear. 
      •  We may use and disclose medical information to contact you as a reminder that you have an appointment for medical care or that you are due to receive periodic care. 
      • We may contact you by phone, text message, voicemail message, e-mail or in writing with appropriate administrative, technical, and physical safeguards. These notifications could be (potentially) intercepted by others. We will disclose as little information as possible.
      • Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
  • Disclosures Requiring Written Authorization.
    • Not Otherwise Permitted. In any other situation not described in Section (a) above, we may not disclose your PHI without your written authorization. You have a right to revoke your authorization in writing, except to the extent the practice has taken action in reliance thereon, or the authorization was obtained as a condition of obtaining insurance coverage and other law provides the insurer with the right to contest a claim under the policy or the policy itself.
    • Psychotherapy Notes. We must receive your written authorization to disclose psychotherapy notes, except for certain treatment, payment or health care operations activities.
    • Marketing and Sale of PHI. We must receive your written authorization for any disclosure of PHI for marketing purposes or for any disclosure which is a sale of PHI.
  • Your Rights.
    • Right to Receive a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice upon request.
    • Right to Access PHI. You have the right to inspect and copy your PHI for as long as we maintain your medical record. You must make a written request for access to our representative at the address listed at the end of this Notice. We may charge you a reasonable fee for the processing of your request and the copying of your medical record. In certain circumstances we may deny your request to access your PHI, and you may request that we reconsider our denial. Depending on the reason for the denial, another licensed health care professional chosen by us may review your request and the denial.
    • Right to Request Restrictions. You have the right to request a restriction on the use or disclosure of your PHI for the purpose of treatment, payment, or health care operations, except for in the case of an emergency. However, we are not legally required to agree to such a restriction unless (1) the disclosure is for the purpose of carrying out payment or health care operations and is not required by law, and (2) the PHI pertains solely to a health care item or service for which the individual or person other than the health plan on behalf of the individual, has paid us in full.
    • Right to Request Amendment. You have the right to request that we amend your PHI if you believe it is incorrect or incomplete, for as long as we maintain your medical record. You must make requests for amendment in writing and provide a reason to support a requested amendment. We may deny your request to amend if:
    • we did not create the PHI;
    • is not information that we maintain in your designated record set,
    • is not information that you are permitted to inspect or copy (such as psychotherapy notes), or
    • we determine that the PHI is accurate and complete.
  • Right to an Accounting of Disclosures. You have the right to request and receive an accounting of disclosures of PHI made by us (other than certain types of disclosures including but not limited to those made for treatment, payment or health care operations purposes) during the 6 years prior to the date of your request. You must make a written request for an accounting, specifying the time period for the accounting, to our representative at the address listed at the end of this Notice.
  • Right to Confidential Communications. You have the right to request that we communicate with you about your PHI by certain means or at certain locations. For example, you may specify that we call you only at your home phone number, and not at your work number. You must make a written request, specifying how and where we may contact you, to the HIPAA Privacy Officer at the address listed at the end of this Notice.
  • Reproductive Health Care. We will not use or disclose your PHI to conduct a criminal, civil, or administrative investigation against, to impose liability against, or seek to identify a person for the mere act of seeking, obtaining, providing, or facilitating reproductive health care (including but not limited to pre-conception screening and counseling, contraception, management of pregnancy and pregnancy related conditions) that was lawfully provided.  This applies to a request for PHI: (1) that is related to a criminal, civil, or administrative investigation against a person; (2) where the person is being investigated for the “mere act” of seeking, obtaining, providing, or facilitating reproductive health care; and (3) where the reproductive health care was lawfully provided.  We will not use or disclose PHI potentially related to reproductive health care for certain purposes without obtaining an attestation that is valid under HIPAA from the person requesting the use or disclosure and complying with all applicable conditions of this part. 
  • There is a possibility that information disclosed pursuant to HIPAA could be subject to redisclosure by the recipient and no longer protected by HIPAA.
  • Changes to this Notice. We reserve the right to change this Notice at any time in accordance with applicable law and to make the new notice provisions effective for all PHI we maintain. The revised notice will be available upon request, in our office, and on our website.
  • Acknowledgment of Receipt of Notice. We will ask you to sign an acknowledgment that you received this Notice.
  • Questions and Complaints. If you would like more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made regarding the use, disclosure, or access to you PHI, you may complain to us by contacting the Privacy Officer at the address and phone number at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file such a complaint upon request.
  • Electronic Notice. You acknowledge that we may provide this notice, and any notification of a breach of unsecured protected health information, to you electronically,using the e-mail you have provided to us. 

We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. Please direct any of your questions or complaint:

Attn: Privacy Officer

63 S. Rockford Dr. Suite 220 Tempe, AZ 85288

(602) 508-4837

hipaa@americanvisionpartners.com

WE WILL IN NO WAY PENALIZE YOU FOR FILING A COMPLAINT