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HIPAA PRIVACY
PATIENT PRIVACY & PRIVACY PRACTICES
of the
DR.
STERN’S VISUAL HEALTH CENTERS
The Information Provided Here
Will Describe How Medical Information about Patients Examined and/or
Served at a DR. STERN’S VISUAL HEALTH CENTERS Office May Be
Used and Disclosed, and How a DR. STERN’S Patient Can Get
Access to That Information. Please Review This Information Carefully.
AN OBLIGATION TO OUR
PATIENTS
DR. STERN’S VISUAL HEALTH CENTERS
are sincerely and genuinely committed to protecting the privacy
of our patients and their medical information. We are required by
law to maintain the confidentiality of all information which may
identify a patient and any health-care services he or she has received
in the past or is now receiving, as well as all information regarding
payments for those services and other financial information. We
are also required to give patients notice of our privacy practices
and our legal responsibilities regarding their rights. We disclose
information only when absolutely necessary — and
then, only to appropriate persons or companies involved
in the delivery or administration of those services and related
matters — and those other persons or companies are bound by
the same patient-privacy rules as we are. We require those other
persons and companies to protect our patients privacy, too.
HOW WE USE
& DISCLOSE INFORMATION
FOR TREATMENT:
We may receive information, for example, about a patient from Medicaid
or Medicare, the patient’s primary-care physician or the patient
him- or herself. In order to provide the services called for, we
may share this information among our various departments to conduct
the “business of our business” — that is, to schedule
and perform comprehensive eye examinations, to evaluate the findings
of those exams and recommend appropriate care and treatment, to
produce and/or dispense corrective lenses called for (eyeglasses
and/or contact lenses) and, when appropriate, to refer patients
to another practice for follow-up care and treatment.
FOR PAYMENT:
We provide appropriate coverage information to our Network physicians
when Health Plan members or another party representing them calls
to schedule an exam. We may contact the Department of Health or
the Health Plan itself to confirm member eligibility for services.
DR. STERN’S VISUAL HEALTH CENTERS will share information among
its offices or departments for the purpose of determining eligibility,
pre-authorization, payment, enrollment data or providing services
to a patient, and we may also use or disclose information to obtain
payment from third parties who may be responsible for payment, such
as Health Plans or other insurance companies.
FOR HEALTH-CARE OPERATIONS:
We conduct quality assessment and improvement activities, for example,
in order to improve the performance of DR. STERN’S VISUAL
HEALTH CENTERS overall. We also use information for facility management
and strategic planning.
TO OTHER PROVIDERS:
For example, for their treatment, payment and/or operations support
as those activities relate to a patient’s evaluation, care
and treatment.
TO INDIVIDUALS:
To individuals involved in a patient’s care if the
patient or legal guardian has given us the name of such person in
writing at some point since enrolling in a Health Plan we support.
We will also give information about a child to the child’s
parent or legal guardian, and we may disclose information to Disaster
Relief Organizations such as the Red Cross, when appropriate, so
that they can contact the patient’s family if that is necessary.
FOR APPOINTMENTS AND
SERVICES: To remind a patient of an appointment, for example,
or tell a patient about treatment alternatives or health-related
benefits available through DR. STERN’S VISUAL HEALTH CENTERS
or a Health Plan we are supporting.
WITH A PATIENT’S
WRITTEN AUTHORIZATION: We may use or disclose medical information
for purposes not described in this notice only with
a patient’s written authorization. The patient may revoke
any authorization at any time, in writing, but only as to future
disclosures or uses — not disclosures we have already made
which relied on an authorization previously given to us.
USES
& DISCLOSURES WE MAY MAKE
WITHOUT YOUR
AUTHORIZATION
AS REQUIRED BY LAW:
However, we will only do that to the extent and under the specific
circumstances provided for by such law.
TO PUBLIC HEALTH AUTHORITIES:
For activities such as tracking communicable disease, reporting
child abuse or for public-health investigations.
TO REPORT ABUSE, DOMESTIC
VIOLENCE OR NEGLECT: If, for example, we believe a patient
is a victim, we may disclose that patient’s information as
permitted by law unless we think that would place the patient at
risk of serious harm. We will not inform the patient’s personal
representative if we believe that would put the patient at risk
of serious harm.
FOR HEALTH OVERSIGHT
ACTIVITIES: We may disclose to health oversight agencies,
such as a state Department of Health or Department of Health &
Human Services, for activities authorized by law, including audits,
civil, administrative or criminal investigations, licensure or disciplinary
actions, and monitoring of compliance with law.
IN JUDICIAL PROCEEDINGS:
In response to court or administrative orders; with subpoenas, discovery
requests or other process, after reasonable efforts to notify you
or obtain a protective order.
TO LAW ENFORCEMENT:
To identify or locate suspects, fugitives or witnesses, or victims
of crime (with your consent in some circumstances), to report crimes
on our premises or in emergencies, or the commission of a crime.
TO CORONERS, MEDICAL
EXAMINERS AND FUNERAL DIRECTORS: If required by the appropriate
authorities, we may disclose information to coroners, medical examiners
and funeral directors to help them (1) identify a deceased person,
(2) determine cause of death, or (3) as reasonably necessary to
permit them to carry out their duties.
MILITARY AND VETERANS:
If a patient is a member of the armed forces, as required by command
authorities.
FOR NATIONAL SECURITY,
INTELLIGENCE ACTIVITIES, PROTECTIVE SERVICES FOR THE PRESIDENT AND
OTHERS, AND STATE DEPARTMENT PURPOSES: To officials as
authorized by law to perform their duties and conduct investigations
or make medical suitability determinations for foreign service.
TO CORRECTIONAL INSTITUTIONS:
We may disclose information for the health and safety of inmates
and others.
FOR WORKERS COMPENSATION:
We may disclose to Workers Compensation or similar programs,
as required by the federal and state applicable laws.
PATIENTS
HAVE THE FOLLOWING RIGHTS
To exercise these rights,
see the contact information below.
To Obtain a Copy of
This Notice, On Request: To request a copy of this Patient
Privacy & Privacy Practices notice, a patient must send a formal
request in writing. That request may be either typed or, if the
patient’s handwriting is legible, hand-written.
To Inspect and Request
a Copy of Your Health Record: A patient may inspect and
request a copy of his or her health record except in limited circumstances
defined by federal and state regulations. The copy may be requested
by the patient or his or her legal guardian. The request must be
made in writing, and it may be either typed or hand-written if the
handwriting is legible. If the request is being made by the patient,
a copy of the patient’s photo-identification confirming his/her
identity and signature must accompany the written request. If the
request is being made by the patient’s legal guardian, then
a copy of the document giving the guardian legal authority for the
patient must also accompany the request as well as the guardian’s
photo-identification confirming his/her identity and signature.
A nominal fee will be charged to copy your record. The actual cost
will depend on how many years back the file goes and the number
of pages being copied. If a patient is denied access to his/her
record for certain reasons, we will tell the patient why and what
his/her rights are to challenge that denial.
To Request An Amendment
To a Patient’s Record: The request must be in writing
and give a reason. We may deny that request if the information was
not created by us, not a part of the information that the patient
would be permitted to inspect and copy, or if the information is
accurate and complete. If we agree with the patient’s request,
we will not delete any information already in the patient’s
record. We will add the patient’s correction to the record.
To an Accounting of
Disclosures of a Patient’s Health Information: For
purposes other than treatment, payment for health operations; disclosures
to you or authorized by you; disclosures incidental to permitted
disclosure and certain other disclosures excluded by regulation.
To Request a Restriction
on Certain Uses and Disclosures: We are not required to
agree with your request. If we do agree with the request, we will
comply with your request except to the extent that the disclosure
has already occurred or if you are in need of emergency treatment
and the information is needed to provide the emergency treatment.
To Request That We
Contact You by Alternate Means: You may request that we
contact you by alternate means, (e.g., fax versus mail) or at alternate
locations (alternate address or phone number). Your request must
be in writing. We must honor your request if it is reasonable.
CONTACT INFORMATION:
To exercise any of the above rights,
or if you have any questions, contact the DR. STERN’S VISUAL
HEALTH CENTERS at: 7352 N.W. 34 th Street; Miami, FL 33122; (305)
418-2025; FAX (305) 418-7627 . If you believe your privacy rights
have been violated, you may file a complaint in writing addressed
to the PRIVACY OFFICER, DR. STERN’S VISUAL HEALTH CENTERS
at 7352 N.W. 34 th Street; Miami, FL 33122 . There will be no retaliation
for filing a complaint. You also have a right to complain to the
appropriate federal and state Department.
CHANGES TO THIS NOTICE: We
reserve the right to change this notice. We reserve the right to
make the revised or changed notice effective for information we
already have about a patient as well as information we may receive
in the future. We post a copy of the current notice in our offices
and on our website. A copy of the current notice in effect will
be available at our offices upon request.
EFFECTIVE DATE September 1,
2004 .
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