|
SOUTH
TEXAS EYE CONSULTANTS, P.L.L.C.
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.
Treatment
The physician in this practice is a specialist. When we provide
treatment, we may request that your primary care physician share
your medical information with us. Also, we may provide your primary
care physician information about your particular condition so
that he or she can appropriately treat you for other medical conditions,
if any.
Payment
We are permitted to use and disclose your medical information
to bill and collect payment for the services provided to you.
For example, we may complete a claim form to obtain payment from
your insurer or HMO. The form will contain medical information,
such as a description of the medical service provided to you,
that your insurer or HMO needs to approve payment to us.
Health Care Operations
We are permitted to use or disclose your medical information for
the purpose of health care operations. For example, we may engage
the services of a professional to aid this practice in its compliance
programs. This person will review billing and medical files to
ensure we maintain our compliance with regulations and the law.
Legal Proceedings and Law Enforcement
We may disclose your medical information in the course of judicial
or administrative proceedings in response to an order of the court
or other appropriate legal process. Certain requirements must
be met before the information is disclosed.
Public Health, Abuse or Neglect, and Health Oversight
Your health information may be disclosed to public health agencies
as required by law. For example, we are required to report certain
communicable diseases to the state's public health
department.
Requested Restrictions
You may request that we restrict or limit how your protected health
information is used or disclosed to treatment, payment, or healthcare
operation. We do NOT have to agree to this restriction, but if
we do agree, we will comply with your request except under emergency
circumstances.
Required by Law
We may release your medical information where the disclosure is
required by law.
Appointments Reminders, Treatment Alternatives, and other
Health-related Benefits
We may contact you by telephone, mail, or both to provide appointment
reminders.
Your Rights Under Federal Privacy Regulations
You have certain rights under the federal privacy standards. These
include:
- The right to receive a printed copy of this notice.
- The right to receive an accounting of how and to whom your
protected health information has been disclosed.
- The right to request restrictions on the use and disclosure
of your protected health information.
- The right to receive confidential communications concerning
your medical condition and treatment.
- The right to inspect and copy your protected health information.
There may be a fee for copies.
- The right to amend or submit corrections to your protected
health information.
Requests to Inspect Protected Health Information
You may generally inspect or copy the protected health information
that we maintain. As permitted by federal regulation, we require
that requests to inspect or copy protected health information
be submitted in writing. You may obtain a form to request access
to your records by contacting the person listed below. Your request
will generally be approved unless there are legal or medical reasons
to deny the request.
Complaints
If you are concerned that your privacy rights have been violated,
you may contact the person listed below. We will not retaliate
against you for filing a complaint with the government or us.
You may also send a written complaint to:
U.S. Department of Health and Human Services
HIPAA Complaint
7500 Security Blvd., C5-24-04
Baltimore, MD 21244
Our Promise to You
We are required by law and regulation to protect the privacy of
your medical information, to provide you with this notice of our
privacy practices with respect to protected health information,
and to abide by the terms of the notice of privacy practices in
effect.
Questions and Contact Persons for Requests
If you have any questions or want to make a request pursuant to
the rights described above, please contact:
Lisa Mendoza
5402 South Staples, Suite 100
Corpus Christi, TX 78411
(361) 992-9400 Fax (361) 992-3907
This notice is effective on the following date: April 14, 2003
We may change our policies and this notice at any time and have
those revised policies apply to all the protected health information
we maintain. If or when we change our notice, we will post the
new notice in the office where it can be seen.
|
