Privacy Practices

                                                      

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NOTICE OF PRIVACY PRACTICES

Ophthalmology and Neurology Associates, P.C.

Foresight Optical,  Inc.

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.

If you have any questions about this notice, please contact our Privacy Official of our office at:

2055 Exchange Street, Suite 230, Astoria, OR  97103  503-338-3803

WHO WILL FOLLOW THIS NOTICE

This notice describes the information privacy practices followed by our employees, staff and other office personnel. 

 

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.  Your health information may include information created and received by this office, may be in the form of written or electronic records or spoken words, and may include information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, related billing activity and similar types of health-related information.

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

We may use and disclose health information for the following purposes:

·         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 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 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. 

·         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 contact you about treatment options or alternatives.

 

SPECIAL SITUATIONS

We may use or disclose health information about you with relation to the following, subject to all applicable legal requirements and limitations: to avert a serious threat to health or safety; as required by law; research purposes; organ and tissue donation; military and intelligence functions; workers’ compensation; public health risks; health oversight activities; lawsuits and disputes; and law enforcement.  We may disclose 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 a 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.

 

 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.   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.

In some instances, we may need specific, written authorization from you in order to disclose certain types of specially-protected information such as HIV, substance abuse, mental health, and genetic testing information.  

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 and billing records, that we keep and use to make decisions about your care.  We may charge a fee for the costs of copying, mailing or other associated supplies.

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. We may deny your request for an amendment if your request is not in writing or does not include a reason to support the request. 

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 purposes other than treatment, payment, health care operations, and a limited number of special circumstances involving national security, correctional institutions and law enforcement.  The list will also exclude any disclosures we have made based on your written authorization. The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list.  .

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. 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 or we are required by law to use or disclose the information.

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.

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.

 

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. 

 

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our privacy official. You will not be penalized for filing a complaint.

 

EFFECTIVE DATE

April 1, 2003