DAVIS EYECARE ASSOCIATES
NOTICE OF PRIVACY PRACTICE
RIGHT TO NOTICE AS A PATIENT: You have the right to adequate notice of the uses and disclosures of your protected health information. Under the Health Insurance Portability and Accessibility Act (HIPAA), Davis EyeCare Associates can use your protected health information for treatment, payment and health care operations.
1. Treatment – We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
2. Payment – We may use and disclose your health information to obtain payment for services we provide you in connection with our healthcare
operations. Healthcare operations include quality assessment and improvement activities, reviewing the competency or qualification of
healthcare professionals, evaluating provider performance, conduct training programs, accreditation, certification licensing or credentialing.
YOUR AUTHORIZATION: Most uses and disclosures that do not fall under treatment, payment, healthcare operations will require your written authorization. Upon signing, you may revoke your authorization (in writing) through our practice at any time.
EMERGENCY SITUATIONS: In the event of your incapacity or an emergency situation we will disclose health information to a family member or another person responsible for your care, using our professional judgment. We will only disclose health information that is directly relevant to the person’s involvement in your healthcare.
MARKETING: We will not use your health information for marketing communications without your written authorization.
REQUIRED BY LAW: We may also use or disclose your health information when we are required to do so by law.
ABUSE OR NEGLECT: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your or other people’s health or safety.
NATIONAL SECURITY: We may disclose the health information of Armed Forces personnel to military authorities under certain circumstances. We may disclose health information to authorized federal officials required for lawful intelligence counterintelligence and other national security activities. We may disclose health information of inmates or patients to the appropriate authorities under certain circumstances.
APPOINTMENT REMINDERS: We may use or disclose your health information to provide you with appointment reminders via phone, e-mail or letter.
YOUR RIGHTS AS A PATIENT: You have the right to restrict the disclosure of your protected health information (in writing). The request for restriction may be denied if the information is required for treatment, payment or healthcare operations. You have the right to receive confidential communications regarding your protected health information. You have the right to inspect and copy your protected health information. You have the right to amend your protected health information. You have the right to receive an account of disclosures of your protected health information. You have the right to a paper copy of this notice of privacy practices.
COMPLAINTS: If you have complaints regarding the way your protected health information was handled, you may submit a complaint in writing to our office. You will not be retaliated against in any manner for a complaint. For our Medicare and Medicaid patients, your complaints may be filed by internet using the Administrative Simplification Enforcement Tool at http://htct.hhs.gov/. or by mail at: The Centers for Medicare & Medicaid Services, HIPAA TCS Enforcement Activities, P.O. Box 8030, Baltimore, MD. 21244-8030. You will not be retaliated against in any manner for a complaint.
CONTACT INFORMATION: For further information about Davis EyeCare Associates privacy policies, please contact Drs. Harold E. Davis, Robert L. Davis or Bradley Cogswell at the following address or phone number: Davis EyeCare Associates, 4663 West 95th. Street, Oak Lawn, IL. 60453 – 708-636-0600