Notice of
Privacy Practices
This
notice describes how medical information about you may be used and disclosed
and how you can get access to this information.
Uses and Disclosures
Treatment: Your health information
may be used by our physicians and staff members or communicated to other
health care professionals for the purpose of evaluating your health,
diagnosing medical conditions, and providing you with treatment.
Payment: Your health information
may be used to obtain payment from your health plan, other sources of
coverage such as an automobile insurer, or credit card companies that
you may use to pay for services. For
example, your health plan may request and receive information on dates
of service, the services provided, and the medical condition for which
you are being treated.
Health care operations: Your health
information may be used to support the day-to-day activities and management
of Canton Ophthalmology Associates.
For example, information on the services you received may be
used to support internal budgeting and financial reporting.
Law enforcement: Your health information
may be given to law enforcement agencies, without your permission, to
support government audits and inspections, to assist in law enforcement
investigations, and to comply with government mandated reporting.
Public health reporting: Your health
information may be disclosed to public health agencies as required by
law. For example, our practice is required to report
certain communicable diseases to the State of Ohio Department of Health.
Business associates: There are some
services provided by Canton Ophthalmology Associates through our business
associates (accountant, telephone confirmation service, etc.) which
require us to disclose your health information so that they can perform
the job that we have asked them to do.
However, we require such businesses to sign an agreement with
our office to not disclose this information.
Notification/communication with family:
We may use information to notify or assist us in notifying a family
member, personal representative or other person responsible for your
care.
Research: Based on applicable law,
we may disclose information to researchers when their research has been
approved to ensure the privacy of your health information.
Funeral directors, coroner and medical
examiner: Consistent with applicable law, we may disclose health
information to the above to help them carry out their duties.
Organ procurement organizations: We
may disclose health information to organ procurement organizations or
other entities obtaining, banking or transporting of organs for the
purpose of tissue donations and transplants.
Other used and disclosures require your
authorization: Disclosure of your health information or its
use for any purpose other than those listed above requires your written
authorization. If you change
your mind after authorizing a use or release of your information, you
may submit a written request to change your authorization.
However, your decision to change the authorization will not affect
or undo any information that was given out before you notified us of
this decision.
Additional Uses of Information
Appointment reminders: Canton Ophthalmology
Associates utilizes an automated telephone system using your name, address,
and phone number; the name of your scheduled treating physician; and
the time and place of your scheduled appointment(s), for the limited
purpose of contacting you to notify you of a pending appointment or
other healthcare related communication.
Canton Ophthalmology Associates may disclose to third parties
who answer your phone limited protected health information regarding
pending appointments and/or leave a reminder message on your voice mail
system or answering machine.
In addition, Canton Ophthalmology Associates
mails postcards to you to remind you of upcoming appointments or an
appointment that you need to make. These
postcards include your name, your appointment date or a reminder to
make an appointment, and the name of the doctor you will be seeing.
Information about treatments: Your
health information may be used to send you information on the treatment
and management of your medical condition that you may find to be of
interest. We may also send you information describing
other health-related goods and services that we believe may interest
you.
Individual rights: You have certain
rights under the federal privacy standards.
These include:
·
the right
to request restrictions on the use and disclosure of our protected health
information.
·
the right
to receive confidential communications concerning your medical condition
and treatment.
·
the right
to inspect and copy your protected health information.
·
the right
to request an amendment or submit corrections to your protected health
information.
·
the right
to receive an accounting of how and to whom your protected health information
has been disclosed.
·
the right
to receive a printed copy of this notice.
Canton Ophthalmology Associates’ duties:
We are required by law to protect your health information and to provide
you with this notice of privacy practices.
Right to revise privacy practices:
As permitted by law, we reserve the right to change or modify our privacy
policies and practices. These
changes in our policies and practices may be required by changes in
federal and state laws and regulations.
We will provide you with a notice on your next office visit of
any changes.
Requests to inspect protected health
information: As permitted by federal regulation, we require that
requests to inspect or copy protected health information be submitted
in writing. You may obtain a form to request access to your
records by contacting our Privacy Officer.
Contact person for questions, requests,
complaints: If you would like to submit a question, request or complaint
about our privacy practices, or obtain additional information about
our privacy practices, you can do so by sending a letter with your concerns
to the person listed below. There
will be no type of penalty for filing a request or complaint.
Privacy Officer
Canton Ophthalmology Associates, Inc.
2600 Tuscarawas St. W Suite 200
Canton OH 44708-4693
Phone: 330-456-0047
Effective date: This notice is effective
on or after April 14, 2003.
