Young Eye Institute
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.
We understand that your health information is
personal to you, and we are committed to protecting the information about you.
This Notice of Privacy Practices (or "Notice") describes how we will
use and disclose protected information and data that we receive or create
related to your health care.
Our Duties We are required by law to
maintain the privacy of your health information, and to give you this Notice
describing our legal duties and privacy practices. We are also required to
follow the terms of the Notice currently in effect.
How We May Use And Disclose Health
Information About You We will not use or disclose your health
information without your authorization, except in the following situations:
Treatment: We will use and disclose your health
information while providing, coordinating or managing your health care. For
example, information obtained by a nurse, physician, or other member of your
healthcare team will be recorded in your record and used to determine the
course of treatment that should work best for you. Your physician will put in
your record his or her expectations of the members of your healthcare team.
Members of your healthcare team will then record the actions they took and
their observations. In that way, the physician will know how you are responding
to treatment. We may also provide other healthcare providers with your
information to assist them in treating you.
Payment: We will use and disclose your medical
information to obtain or provide compensation or reimbursement for providing
your health care. For example, we may send a bill to you or your health plan.
The information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures, and supplies used. As
another example, we may disclose information about you to your health plan so
that the health plan may determine your eligibility for payment for certain
benefits.
Health Care Operations: We will use and disclose
your health information to deal with certain administrative aspects of your
health care, and to manage our business more efficiently. For example, members
of our medical staff may use information in your health record to assess the
quality of care and outcomes in your case and others like it. This information
will then be used in an effort to improve the quality and effectiveness of the
healthcare and services we provide.
Business Associates: There are some services
provided in our organization through contracts with business associates. We may
disclose your health information to our business associates so they can perform
the job weÕve asked them to do. However, we require business associates to take
precautions to protect your health information.
Notification of Family: We may use or disclose
information to relay or assist in relaying your location and general condition
to a family member, personal representative, or other person responsible for
your care.
Communication With Family: We may disclose to a
family member, other relative, close personal friend or any other person you
identify, health information relevant to that personÕs involvement in your
care.
Research: Consistent with applicable law we may
disclose information to researchers when their research has been approved by an
institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your health information.
Funeral Director, Coroner, and Medical
Examiner: Consistent with applicable law we may disclose health information
to funeral directors, coroners, and medical examiners to help them carry out
their duties.
Organ Procurement Organizations: Consistent with
applicable law, we may disclose health information to organ procurement
organizations or other entities engaged in the procurement, banking, or
transplantation of organs for the purpose of tissue donation and transplant.
Fundraising: We may use certain
information for purposes of raising funds.
Food and Drug Administration (FDA): We may disclose to the
FDA health information relative to adverse events, product defects, or post-marketing
surveillance information to enable product recalls, repairs, or replacement.
Public Health: As required by law, we
may disclose your health information to public health or legal authorities
charged with preventing or controlling disease, injury, or disability,
including child abuse and neglect.
Victims of Abuse, Neglect or Domestic
Violence: We may disclose your health information to appropriate
governmental agencies, such as adult protective or social services agencies, if
we reasonably believe you are a victim of abuse, neglect, or domestic violence.
Health Oversight: In order to oversee the
health care system, government benefits programs, entities subject to
governmental regulation and civil rights laws for which health information is
necessary to determine compliance, we may disclose your health information for
oversight activities authorized by law, such as audits and civil,
administrative, or criminal investigations.
Court Proceeding: We may disclose your
health information in response to requests made during judicial and
administrative proceedings, such as court orders or subpoenas.
Law Enforcement: Under certain
circumstances, we may disclose your health information to law enforcement
officials. These circumstances include reporting required by certain laws (such
as the reporting of certain types of wounds), pursuant to certain subpoenas or
court orders, reporting limited information concerning identification and
location at the request of a law enforcement official, reports regarding
suspected victims of crimes at the request of a law enforcement official,
reporting death, crimes on our premises, and crimes in emergencies.
Inmates: If you are an inmate of a correctional
institution or under the custody of a law enforcement official, we may release
health 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.
Threats to Public Health or Safety: We may disclose or use
health information when it is our good faith belief, consistent with ethical
and legal standards, that it is necessary to prevent or lessen a serious and
imminent threat or is necessary to identify or apprehend an individual.
Specialized Government Functions: Subject to certain
requirements, we may disclose or use health information for military personnel
and veterans, for national security and intelligence activities, for protective
services for the President and others, for medical suitability determinations
for the Department of State, for correctional institutions and other law
enforcement custodial situations, and for government programs providing public
benefits.
Workers Compensation: We may disclose health
information when authorized and necessary to comply with laws relating to
workers compensation or other similar programs.
Other Uses: We may also use and
disclose your personal health information for the following purposes:
¥ To contact you to remind you of an appointment
for treatment;
¥ To describe or recommend treatment
alternatives to you;
¥ To furnish information about health-related
benefits and services that may be of interest to you; or
¥ For certain charitable fundraising purposes.
Prohibition on Other Uses or Disclosures We may not make
any other use or disclosure of your personal health information without your
written authorization. Once given, you may revoke the authorization by writing
to the contact person listed below. Understandably, we are unable to take back
any disclosure we have already made with your permission.
Individual Rights You have many
rights concerning the confidentiality of your health information. You have the
right:
¥ To request restrictions on the health
information we may use and disclose for treatment, payment, and health care
operations. We are not required to agree to these requests. To request restrictions,
please send a written request to the address below.
¥ To receive confidential communications of
health information about you in a certain manner or at a certain location. For
instance, you may request that we only contact you at work or by mail. To make
such a request, you must write to us at the address below, and tell us how or
where you wish to be contacted.
¥ To inspect or copy your health information.
You must submit your request in writing to the address below. If you request a
copy of your health information we may charge you a fee for the cost of
copying, mailing or other supplies. In certain circumstances we may deny your
request to inspect or copy your health information. If you are denied access to
your health information, you may request that the denial be reviewed. Another
licensed health care professional will then review your request and the denial.
The person conducting the review will not be the person who denied your
request. We will comply with the outcome of the review.
¥ To amend health information. If you feel that
health information we have about you is incorrect or incomplete, you may ask us
to amend the information. To request an amendment, you must write to us at the
address below. You must also give us a reason to support your request. We may
deny your request to amend your health information if it is not in writing or
does not provide a reason to support your request. We may also deny your
request if:
The information was not created by us, unless
the person that created the information is no longer available to make the
amendment,
The information is not part of the health information kept by or for us,
Is not part of the information you would be permitted to inspect or copy, or
Is accurate and complete.
¥ To receive an accounting of disclosures of
your health information. You must submit a request in writing to the address
below. Not all health information is subject to this request. Your request must
state a time period, no longer than 6 years and may not include dates before
April 14, 2003. Your request must state how you would like to receive the
report (paper, electronically). The first accounting you request within a
12-month period is free. For additional accountings, we may charge you the cost
of providing the accounting. We will notify you of this cost and you may choose
to withdraw or modify your request before charges are incurred.
¥ To receive a paper copy of this Notice upon
request, even if you have agreed to receive the Notice electronically. You may
also obtain a copy of this notice at our website, www.onlinemep.com. You must
submit a request for a paper notice in writing to the address below. All
requests to restrict use of your health information for treatment, payment, and
health care operations, to inspect and copy health information, to amend your
health information, or to receive an accounting of disclosures of health
information must be made in writing to the contact person listed below.
Fees for copying of medical records are as
follows:
$5.00 administrative charge
$1.00 per page of the first 25 pages
$0.50 per page above that.
Complaints If you believe that your privacy
rights have been violated, a complaint may be made to our privacy officer at
1.334.271.3804 or the address listed below. You may also submit a complaint to
the Secretary of the Department of Health and Human Services at The Office of
Civil Rights, The U.S. Department of Health and Human Services, 200
Independence Avenue, S.W., Washington, D.C. 20201, 1.202.619.0257 or toll free
1.877.696.6775. We will not retaliate against you for filing a complaint.
Contact Person Our contact person
for all questions, requests or for further information related to the privacy
of your health information is: Stephen W. Gilkeson, Privacy Officer, 4214 W.
Lee Boulevard, Lawton, OK 73505, (580)353-5860.
Changes to This Notice We reserve the
right to change our privacy practices and to apply the revised practices to
health information about you that we already have. Any revision to our privacy
practices will be described in a revised Notice that will be posted prominently
in our facility.
Notice Effective Date: April 14, 2003