Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
This Notice of Privacy Practices describes how we may use and disclose your medical information to carry out treatment, payment or health care operations and for other purposes permitted or required by law. It also describes your rights with respect to your medical information. For these purposes, “medical information” is information about you, including demographic information, that may identify you and that relates to your past, present or future health and related health care services.
We are required by law, including the Health Insurance Portability & Accountability Act of 1996 (“HIPAA”), to maintain the privacy of your medical information, to provide you with this Notice of Privacy Practices and to abide by its terms. We may change the terms of our notice, at any time. The updated notice will be effective for all medical information that we maintain at that time and will be available at our office and on this website.
1. USES & DISCLOSURES OF MEDICAL INFORMATION:
A. Permitted Uses & Disclosures of Your Medical Information: Following are examples of the types of uses and disclosures of your medical information that we, as your physician’s office, are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made.
Treatment: We will use and disclose your medical information, as needed, to provide or, coordinate your health care and related services. For example, your medical information may be provided to a physician to whom you have been referred so that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your medical information from time-to-time to another physician or health care provider (e.g., a specialist, laboratory, nurse, medical student) who, at the request of your doctor, becomes involved in your care or we may disclose your medical information to a pharmacy or contact lens provider so they may fulfill a prescription you need.
Payment: Your medical information will be used, as needed, to obtain payment for your health care services. This may include activities that your health insurance plan requires before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility for insurance benefits or reviewing services provided to you for medical necessity. For example, we may be required to disclose your medical information to a health plan to obtain such a plan’s approval for a hospital stay. If you pay for a health treatment personally and in full, however, you may request that we not share information about that treatment with your health insurance plan, and we will accommodate your request, except if required by law to make a disclosure.
Healthcare Operations: We may use or disclose, as-needed, your medical information in order to support the business activities of the practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, patient education, and conducting other necessary business activities, including without limitation, the transfer of all or part of the practice to another physician or physician entity. For example, we may share your medical information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice, or to the extent, a health oversight agency requires such disclosures (e.g., for an audit or inspection). In addition, we may use a sign-in sheet at the front desk where you will be asked to sign your name. 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 medical information, as necessary, to contact you to remind you of your appointment. We may use your medical information as necessary to provide you with information about treatment alternatives or other health-related benefits that may be of interest to you. For example, we may use your name and address to send you a newsletter about our practice and health-related services we offer that we believe may be beneficial to you.
B. Uses of Medical Information Based upon Your Written Authorization: Certain uses and disclosures of your medical information will be made only with your written authorization, unless, as described below, either (1) emergency conditions require such disclosure or (2) such disclosure is otherwise permitted or required by law. We will not use your medical information without a separate written authorization from you for the following uses:
- Most uses and disclosures of psychotherapy notes;
- Uses and disclosures of your medical information for the third-party subsidized marketing purposes;
- Disclosures that would constitute a separate sale of your medical information under HIPAA;
- Other uses and disclosures not covered by this notice.
You may revoke such an 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.
C. Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object: You may agree or object to the use or disclosure of all or part of your medical information in the instances described below in this Section C. However, if you are not present or able to agree to such use of your medical information, then your doctor, using professional judgment, will determine whether such use is in your best interest. In this case, only the medical information that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare: In the event of an emergency, if you are unable to agree, we may disclose your medical information, as necessary, to a family member, a close friend or any other person you have identified, if, in our professional judgment, it is in your best interest. For example, we may disclose medical information to notify a family member, personal representative or any other person that is responsible for the care of your location, general condition or death. Similarly, we may disclose your medical information to an authorized public or private entity to assist in disaster relief efforts and to coordinate disclosures to family or other individuals involved in your health care.
Emergencies: We may use or disclose your medical information in an emergency treatment situation. If this happens, your physician will try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If the physician is required by law to treat you and has attempted to obtain your consent but is unable to do so, he or she may still use or disclose your medical information to treat you.
Communication Barriers: We may use your medical information if your doctor or another doctor in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the doctor determines, using professional judgment, that you intend to consent to such use under the circumstances.
D. Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object: We may use or disclose your medical information in the following situations without your consent, authorization or opportunity to object. These situations include:
Abuse, Neglect or Criminal Activity: We may disclose your medical information to an appropriate authority if we believe that you have been a victim of abuse, neglect, domestic violence or other crimes. Similarly, we may disclose your medical information if we believe that such disclosure is necessary to avert a serious and imminent threat to your safety or the health or safety of the public. In all such cases, any disclosure will be made consistent with the requirements of applicable federal and state laws.
Law Enforcement: We may also disclose medical information, so long as applicable legal requirements are met, for law enforcement purposes. Such purposes include: legal processes and as otherwise required by law, limited information requests for identification and location purposes; requests pertaining to victims of a crime; suspicion that death has occurred as a result of criminal conduct; in the event a crime occurs on the premises of the practice; or a medical emergency in which it is likely that a crime has occurred.
Required By Law: We may disclose your medical information if such disclosure is required by law, including workers’ compensation laws, public health laws or by public health agencies. For example, we may disclose your medical information if the FDA requires such disclosure for the purpose of controlling disease or injury. Any such use will be made in compliance with the law and will be limited to the relevant requirements of the law. We may also disclose medical information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or another lawful process.
Research, Death, and Organ Donations: In limited circumstances, we may disclose your medical information for research purposes or to a coroner, medical examiner, funeral director or organ procurement center. If information is disclosed for research uses, such research must be independently approved by an institutional review board that has reviewed the research plan and set protocols to ensure the privacy of your medical information.
Specialized Governmental Functions: When the appropriate conditions apply, we may use or disclose medical information for activities related to national defense or security.
2. YOUR RIGHTS
Following is a statement of your rights with respect to your medical information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your medical information. You may review and obtain a copy of your medical information that is contained in a designated record set for as long as we maintain the medical information. You must make your request in writing and if you request copies, we may charge you a reasonable amount, not to exceed $0.75 for each page, and postage if you want the copies mailed. You may also request an electronic copy of your record. We will send such copies to you within a reasonable amount of time, not to exceed 30 days.
Please note, however, that under federal law, you may not inspect or copy information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and medical information that is subject to law that prohibits access to medical information. Depending on the circumstances, a decision to deny access may be reviewable.
You have the right to request additional restrictions on the use of your medical information. You may also request that any part of your medical 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 be in writing, state the specific restriction requested and to whom you want the restriction to apply. Such a request should be submitted to the Privacy Contact identified at the end of this notice. Please note that we are not required to agree to additional restrictions, but if we do, we will abide by our agreement, except in the case of an emergency or as required by law.
You have the right to request that we communicate with you about your medical information by different means or to a different location. We will accommodate reasonable requests although we may also condition this accommodation by requiring specification of an alternative address or another method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Contact.
You have the right to request that your physician amend your medical information. This means you may request an amendment of medical information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. 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. Please contact our Privacy Contact if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your medical information. This right generally applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices and excludes certain disclosures (such as ones we may have made to you) . The right to receive this information is also subject to certain time limitations.
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 electronically.
You have the right to be advised if your unprotected medical information is intentionally or unintentionally disclosed, contrary to this Notice of Privacy Policies.
You may complain to us if you believe your privacy rights have been violated by us by notifying our privacy contact. Complaints must be in writing. Please note that you may also complain to the Department of Health and Human Services if you believe we, or any health care provider, has violated your privacy rights. We will not retaliate against you for filing a complaint against us. You may contact our Privacy Contact, Sarabjit Kaur at NY Vision Group, 37-39 Murray Street, Unit B, New York, NY 10007, phone (212) 243-2300, e-mail firstname.lastname@example.org, for further information about this policy or the complaint process. This notice first became effective on April 14, 2003, and was last updated on July 15, 2018.