HIPAA Notice of Privacy Practices
Texas State Optical of Lufkin
905 South John Redditt
Lufkin, TX 75904
(936) 632-1119
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.
This Notice of Privacy
Practices describes how we may use and disclose your protected health
information (PHI) to carry out treatment, payment or health care operations
(TPO) and for other purposes that are permitted or required by law. It also
describes your rights to access and control your protected health information.
“Protected health information” is information about you, including demographic
information, that may identify you and that relates to your past, present or
future physical or mental health or condition and related health care services.
Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information
Your protected health
information may be used and disclosed by your physician, our office staff and
others outside of our office that are involved in your care and treatment for
the purpose of providing health care services to you, to pay your health care
bills, to support the operation of the physician’s practice, and any other use
required by law.
Treatment:
We will use and disclose your protected health
information to provide, coordinate, or manage your health care and any related
services. This includes the coordination or management of your health care with
a third party. For example, we would disclose your protected health information,
as necessary, to a home health agency that provides care to you. For example,
your protected health information may be provided to a physician to whom you
have been referred to ensure that the physician has the necessary information to
diagnose or treat you.
Payment :
Your protected health information will be used,
as needed, to obtain payment for your health care services. For example,
obtaining approval for a hospital stay may require that your relevant protected
health information be disclosed to the health plan to obtain approval for the
hospital admission.
Healthcare Operations:
We may use or disclose, as-needed, your protected
health information in order to support the business activities of your
physician’s practice. These activities include, but are not limited to, quality
assessment activities, employee review activities, training of medical students,
licensing, and conducting or arranging for other business activities. For
example, we may disclose your protected health information to medical school
students that see patients at our office. In addition, we may use a sign-in
sheet at the registration desk where you will be asked to sign your name and
indicate your physician. We may also call you by name in the waiting room when
your physician is ready to see you. We may use or disclose your protected health
information, as necessary, to contact you to remind you of your appointment.
We may use or disclose your protected health information in the following
situations without your authorization. These situations include: as Required By
Law, Public Health issues as required by law, Communicable Diseases: Health
Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal
Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation:
Research: Criminal Activity: Military Activity and National Security: Workers’
Compensation: Inmates: Required Uses and Disclosures: Under the law, we must
make disclosures to you and when required by the Secretary of the Department of
Health and Human Services to investigate or determine our compliance with the
requirements of Section 164.500.
Other Permitted and Required Uses and
Disclosures Will Be Made Only With
Your Consent, Authorization or Opportunity to Object unless required by law.
You may revoke this authorization,
at any time, in writing, except to the extent
that your physician or the physician’s practice has taken an action in reliance
on the use or disclosure indicated in the authorization.
Your Rights
Following is a statement of
your rights with respect to your protected health information.
You have the right to inspect and copy
your protected health information .
Under federal law, however, you may not inspect or copy the following records;
psychotherapy notes; information compiled in reasonable anticipation of, or use
in, a civil, criminal, or administrative action or proceeding, and protected
health information that is subject to law that prohibits access to protected
health information.
You have the right to request a
restriction of your protected health information.
This means you may ask us not to use or disclose
any part of your protected health information for the purposes of treatment,
payment or healthcare operations. You may also request that any part of your
protected health information not be disclosed to family members or friends who
may be involved in your care or for notification purposes as described in this
Notice of Privacy Practices. Your request must state the specific restriction
requested and to whom you want the restriction to apply.
Your physician is not required to agree to a
restriction that you may request. If physician believes it is in your best
interest to permit use and disclosure of your protected health information, your
protected health information will not be restricted. You then have the right to
use another Healthcare Professional.
You have the right to request to receive
confidential communications from us by alternative means or at an alternative
location. You have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice alternatively i.e.
electronically.
You may have the right to have your
physician amend your protected health information.
If we deny your request for amendment, you have the right to file a statement of
disagreement with us and we may prepare a rebuttal to your statement and will
provide you with a copy of any such rebuttal.
You have the right to receive an
accounting of certain disclosures we have made, if any, of your protected health
information.
We reserve the right to change the terms of this
notice and will inform you by mail of any changes. You then have the right to
object or withdraw as provided in this notice.
Complaints
You may complain to us or to
the Secretary of Health and Human Services if you believe your privacy rights
have been violated by us. You may file a complaint with us by notifying our
privacy contact of your complaint. We will not retaliate against you for
filing a complaint.
This notice was published and becomes
effective on/or before April 14, 2003.
We are required by law to maintain the privacy
of, and provide individuals with, this notice of our legal duties and privacy
practices with respect to protected health information. If you have any
objections to this form, please ask to speak with our HIPAA Compliance Officer
in person or by phone at our Main Phone Number.
