NOTICE OF PRIVACY PRACTICES

 

HARTFORD EYE PHYSICIANS, P.C.

 

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.

 

Understanding Your Health Record/Information

 

Each time you visit Hartford Eye Physicians a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your "protected health information" or "medical record", serves as an:

  • Basis for planning your care and treatment

  • Means of communication among the many health professionals who contribute to your care

  • Legal document describing the care you received

  • Means by which you or a third-party payer can verify that services billed were actually provided

  • A tool in educating health professionals

  • A source of information for public health officials charged with improving the health of the nation

  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

  • Understanding of what is in your record and how your protected health information is used to help you to:

  • Ensure its accuracy

  • Better understand who, what, when, where and why others may access your protected health information

  • Make more informed decisions when authorizing disclosure to others

Your Protected Health Information Rights

 

Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. You have a right to:

  • Request a restriction on certain uses and disclosures of your information

  • Obtain a paper copy of this Notice of Private Practices upon request

  • Inspect and copy your health record

  • Amend your health record

  • Obtain an accounting of disclosures of your protected health information

  • Requested communications of your protected health information by alternative means or at alternative locations

  • Revoke your authorization to use or disclose protected health information except to the extent that action has already been taken

Our Responsibilities

 

This organization is required to:

  • Maintain the privacy of your protected health information

  • Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you

  • Abide by the terms of this notice

  • Notify you if we are unable to agree to a requested restriction

  • Accommodate reasonable requests you may have to communicate protected health information by alternative means or at alternative locations

We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice, upon request.

 

We will not disclose your protected health information without your authorization, except as described in this notice.

 

Uses and Disclosures of Protected Health Information Based Upon Your Written Consent

 

You will be asked by your physician to sign a consent form. Once you have consented to use and disclosure of your protected health information for treatment, payment and health care operations by signing the consent form, your physician will use or disclose your 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 purpose of providing health care services to you.

 

Examples of Disclosures for Treatment, Payment, and Health Operations

 

We will use your protected health information for treatment.

 

For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you.

 

We will use your protected health information for payment.

 

For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

 

We will use your protected health information for regular health operations.

 

For example: Members of the medical staff, the risk or quality improvement manager may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

 

Workers compensation: We may disclose protected health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

 

Public health: As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

 

Law enforcement: We may disclose protected health information for law enforcement purposes as required by law or in response to a valid subpoena.

 

This notice was published and becomes effective on April 14, 2003.

 

 

For More Information or to Report a Problem

 

If you have any questions about this notice please contact: our Privacy Officer. If you believe your privacy rights have been violated, you can file a complaint with the director of health information management or with the Secretary of Health and Human Services.

 

Privacy Officer: Susan Gillanders

Telephone: (860) 633-6634

Fax: (860) 652-3291

 

Address:

Hartford Eye Physicians, P.C.

55 Nye Road, Suite 104

Glastonbury, CT 06033

 

E-mail: Susan@hartfordeye.net