| Marcia K. Leverett, Optometrist |
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HIPAA Notice of Privacy Practices Dr. Marcia K. Leverett, OD & Associates, PC THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND 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. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information, and how we may use and disclose your health information. We may use and disclose your medical records only for each of the following purposes: treatment, payment, and health care operations: Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. We will use and disclose your protected health information only 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 physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities. Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for an authorization may require that your relevant protected health information be disclosed to the health plan in order to obtain approval. Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities and customer service. For example, we may disclose your protected health information to medical students that see patients at our office. In addition, we may use a sign-in sheet at the desk where you will be asked to sign your name upon your arrival. We may also call you by name in the waiting room when your physician is ready to see you. We may contact you to provide appointment reminders or information about treatment alternatives that may be of interest to you. 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: 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. Any other uses and disclosures will be made only with your written authorization. You may revoke this authorization, at any time, in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization. You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Compliance Officer: You have the right to inspect and copy protected health information. Under federal law, however, you 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 we have violated your privacy rights. 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.
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