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Eye Physicians and Surgeons of Augusta, P.C.
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW PERSONAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical
information. For each category of uses or disclosures, we will elaborate on the
meaning and provide specific examples. Not every use or disclosure in a category
will be listed. However, all of the ways we are permitted to use and disclose
information will fall within one of the categories.
- For Payment. We may use and disclose medical information
about you so that the treatment and services you receive at the practice may be
billed to and payment may be collected from you, an insurance company or a third
party. For example, it may be essential that you provide us with your health plan
information regarding care you receive at the practice so that your health plan
will pay us or reimburse you for those services. In addition, we may tell your health
plan about a treatment you are going to receive in order to obtain necessary
approval or to determine whether your plan will cover the treatment.
- For Treatment. We may use medical information about you to
provide you with medical treatment or services. We may disclose medical
information about you to doctors, nurses, technicians, medical students, or other
practice personnel who are involved in taking care of you at the practice. For
example, a doctor treating you for a broken leg may need to know if you have
diabetes so that he/she can arrange for an appropriate diet. Different departments
of the practice also may share medical information about you in order to coordinate
the different services you need, such as prescriptions, lab work and x-rays. We
also may disclose medical information about you to people outside the practice who
may be involved in your medical care after you leave the practice, such as family
members, clergy or other persons that are part of your care.
- For Health Care Operations. We may use and disclose medical
information about you for practice operations. These uses and disclosures are
necessary to run the practice and ensure that all of our patients receive quality
care. For example, we may combine medical information about a variety of practice
patients to decide what additional services the practice should offer, what services
are not needed, and whether certain new treatments are effective. We may also
disclose information to doctors, nurses, technicians, medical students, and other
practice personnel for review and learning purposes. We may combine the medical
information we have along with medical information from other practices to compare
how we are doing and thus, evaluate where we can make improvements in the
care and services we provide. We may remove information that identifies you from
this set of medical information so that others may use it to study health care and
health care delivery, without learning the identity of the patients.
WHO WILL FOLLOW THIS NOTICE.
This notice describes our organization's practices and that of:
- Any health care professional authorized to enter information into your chart.
- All departments and units of the practice.
- All employees, staff and other practice personnel.
- All of these entities, sites and locations follow the terms of this notice. In
addition, these entities, sites and locations may share medical information with
each other for treatment, payment or practice operations purposes described in
POLICY REGARDING THE PROTECTION OF PERSONAL INFORMATION:
We understand that medical information pertaining to you and your health is
personal. We are committed to protecting your medical information. We create a
record of the care and services you receive at the practice. We need this record in
order to provide you with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated by the practice,
whether made by practice personnel or by your personal doctor. Your personal
doctor may have different policies or notices regarding the doctor's use and disclosure
of your medical information created in the doctor's office or clinic.
This notice will inform you about the different ways in which we may use and
disclose medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical information.
The law requires us to:
- Make sure that medical information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect to
medical information about you; and
- Follow the terms of the notice that is currently in effect.
OTHER CATEGORIES OF OUR INFORMATION USES AND DISCLOSURES INCLUDE:
- Appointment Reminders. We may use and disclose medical
information to contact you as a reminder that you have an appointment for
treatment or medical care at the practice.
- As Required By Law. We will disclose medical information
about you when required to do so by federal, state or local law.
- Health-Related Benefits and Services. We may use and disclose
medical information to tell you about health-related benefits or services that
may be of interests to you.
- Practice Directory. We may include certain limited information about you
in the practice directory while you are a patient at the practice. This information
may include your name, location in the practice, your general condition (e.g. fair,
stable, etc.) and your religious affiliation. The directory information, except for
your religious affiliation, may also be released to people who ask for you by
name. Your religious affiliation may be given to a member of the clergy, such
as a priest or rabbi, even if they do not ask for you by name. This is so your family,
friends and clergy can call the practice about you and generally know how you are
- Individual Involved in Your Care or Payment for Your Care. We may
release medical information about you to a friend or family member who is
involved in your medical care. We may also give information to someone who
helps pay for your care. We may also inform your family or friends about your
condition. In addition, we may disclose medical information about you to an
entity assisting in a disaster relief effort so that your family can be notified about
your condition, status and location.
- To Avert a Serious Threat to Health or Safety. We may use and disclose
medical information about you when necessary to prevent a serious threat to your
health and safety or the health and safety of the public or another person. Any
disclosure, however, would only be to someone able to help prevent the threat.
- Treatment Alternatives. We may use and disclose medical information to
inform you about, recommend possible treatment options or alternatives that
may be of interest to you.
LESS FREQUENT USES AND DISCLOSURES OF YOUR PERSONAL INFORMATION
INVOLVING THOSE NOT DIRECTLY INVOLVED IN YOUR CARE COULD INCLUDE:
- Coroners, Medical Examiners and Funeral Directors. We may release
medical information to a coroner or medical examiner, in order to identify a
deceased person or determine the cause of death. We may also release medical
information about patients of the practice to funeral directors as necessary to carry
out their services.
- Health Oversight Activities. We may disclose medical information to a
health oversight agency for activities authorized by law. These oversight activities
include, for example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
- 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.
- Law Enforcement. We may release medical information if asked to do
so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar
- To identify or locate a suspect, fugitive, material witness, or missing
- About the victim of a crime if, under certain limited circumstances, we
are unable to obtain the person�s agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the practice; and
- In emergency circumstances to report a crime; the location of the crime or
victims; or to identify, description or location of the person who committed
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute,
we may disclose medical information about you in response to a court or
administrative order. We may also disclose medical information about you
in response to a subpoena, discovery request, or other lawful process by someone
else involved in the dispute, but only if efforts have been made to tell you about
the request or to obtain an order protecting the information requested.
- Military and Veterans. If you are a member of the armed forces, we
may release medical information about you as required by military command
authorities. We may also release medical information about foreign military
personnel to the appropriate foreign military authority.
- National Security and Intelligence Activities. We may release medical
information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.
- Organ and Tissue Donation. If you are an organ donor, we may release
medical information to organizations that handle organ procurement or organ,
eye or tissue transplantation or to an organ donation bank, as necessary, to
facilitate organ or tissue donation and transplantation.
- Protective Services for the President and Others. We may disclose
medical information about you to authorized federal officials so they may provide
protection to the President, other authorized persons, and foreign heads of
state or conduct special investigations.
- Public Health Risks. We may disclose medical information about you for
public health activities. These activities generally include the following, but are
not limited to:
- Preventing or controlling disease, injury or disability;
- Reporting births and deaths;
- Reporting child abuse or neglect;
- Reporting reactions to medications or problems with products;
- Notifying people of recalls of products they may be using;
- Notifying a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition;
- Notifying the appropriate government authority if we believe a patient has been a
victim of abuse, neglect or domestic violence. We will only make this disclosure if
you agree or when required or authorized by law.
- Worker�s Compensation. We may release medical information about
you for worker's compensation or similar programs. These programs provide benefits for
work-related injuries or illness.
NOTICE OF INDIVIDUAL RIGHTS
You have the following rights regarding medical information we maintain about you:
- 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. To request this list or accounting of disclosures, you must submit
your request in writing to Barbara McLaughlin at 1330 Interstate Parkway,
Augusta, GA 30909. Your request must state a time period, which may
not be longer than six years and may not include dates before February 26, 2003.
Your request should indicate in what form you want the list (for example, on paper,
electronically). The first list you request within a 12-month period will be free. For
additional lists, we may charge you for the cost 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 Amend. If you feel that medical 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 for as long as the information is kept by or for the
practice. To request an amendment, your request must be made in writing and submitted
to Barbara McLaughlin. In addition, you must provide a reason that supports your request.
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:
- Was not created by us, unless the person or entity that created the information is
no longer available to make the amendment;
- Is not part of the medical information kept by or for the practice;
- Is not part of information which you would be permitted to inspect and copy; or
- Is accurate and complete.
- Right to Inspect and Copy. You have the right to insect
and copy medical information that may be used to make decisions about your
care. Usually, this includes medical and billing records, but does not include
psychotherapy notes. To inspect and copy medical information that may be used to make decisions about
you, you must submit your request in writing to Barbara McLaughlin. If you request a
copy of the information, we are entitled to charge a fee for the costs of copying, mailing
or other supplies associated with your request. We may deny your request to inspect and
copy in certain very limited circumstances. If you are denied access to medical information,
you may request that the denial be reviewed. Another licensed health care professional
chosen by the practice will 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.
- 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 this notice electronically, you are still entitled to a paper copy
of this notice. You may obtain a copy of this notice at our website,
www.augustaeye.com. To obtain a paper copy
of this notice contact our Privacy Officer at 706-651-2020.
- 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 must make your request in writing to the Privacy
Officer of Eye Physicians & Surgeons of Augusta, P.C. at 1330 Interstate Parkway, Augusta,
GA 30909. We will not ask you the reason for the request and will accommodate
all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Request Restrictions. You have the right to request a restriction
or limitation on the medical 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 medical
information we disclose about you to someone who is involved in your care or the payment
for your care, 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 must make your request in writing to
Barbara McLaughlin. In your request, you must tell us (1) what information you want to limit;
(2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits
to apply, for example, disclosures to your spouse.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right 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 copy of the current notice in the practice.
The notice will contain on the first page, in the top right-hand corner, the effective date. In
addition, each time you visit the practice for treatment or health care services, we will offer
you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the
practice or with the Secretary of the Department of Health and Human Services
Office of Civil Rights, Hubert H. Humphrey Building, 200 Independence Avenue,
Washington, D.C. 20201. To file a complaint with the practice, contact: The
Privacy Officer at 706-651-2020. All complaints must be submitted in writing. You will
not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice
or the laws that apply to use will be made only with your written permission. If
you provide us permission to use or disclose medical information about you, you
may revoke that permission, in writing, at any time. If you revoke your permission,
we will no longer use or disclose medical information about you for the reasons
covered by your written authorization. You understand that we are unable to take
back any disclosures we have already made with your permission, and that we are
required to retain our records of the care that we provide to you.
If you have any questions about this notice, please contact this organization's
Effective Date: 4/14/2003
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