NOTICE OF PRIVACY
PRACTICES
Robert
S. Martorano, O.D.
13860-3
Telephone (561) 795-1268 Fax (561) 333-9559 Contact Person: Jonathan
_________________________________________________________________________________________________________________________________________________________________________________
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.
_________________________________________________________________________________________________________________________________________________________________________________
We respect our legal obligation to keep health
information that identifies you private. We are obligated by law to give you
notice of our privacy practices. This Notice describes how we protect your
health information and what rights you have regarding it.
TREATMENT, PAYMENT,
AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your
health information is for treatment, payment or health care operations.
Examples of how we use or disclose information for treatment purposes are:
setting up an appointment for you; testing or examining your eyes; prescribing
glasses, contact lenses, or eye medications and faxing them to be filled;
showing you low vision aids; referring you to another doctor or clinic for
eye care or low vision aids or services; or getting copies
of your health information from another professional that you may have seen
before us.
Examples of how we use or disclose your health
information for payment purposes are: asking you about your health or vision
care plans, or other sources of payment; preparing and sending bills or claims;
and collecting unpaid amounts (either ourselves or through a collection agency
or attorney). “Health care operations” mean those administrative and managerial
functions that we have to do in order to run our office.
Examples of how we use or disclose your health
information for health care operations are: financial or billing audits;
internal quality assurance; personnel decisions; participation in managed care
plans; defense of legal matters; business planning; and outside storage of our
records. We routinely use your health information inside our office for these
purposes without any special permission. If we need to disclose your health
information outside of our office for these reasons, we usually will not ask
you for special written permission.
USES AND DISCLOSURES
FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires
us to use or disclose your health information without your permission. Not all
of these situations will apply to us; some may never come up at our office at
all. Such uses or disclosures are:
• When a
state or federal law mandates that certain health information be reported for a
specific purpose;
• for
public health purposes, such as contagious disease reporting, investigation or
surveillance; and notices to and from the federal Food and Drug Administration
regarding drugs or medical devices;
• Disclosures
to governmental authorities about victims of suspected abuse, neglect or
domestic violence;
• Uses and
disclosures for health oversight activities, such as for the licensing of
doctors; for audits by Medicare or Medicaid; or for investigation of possible
violations of health care laws;
• Disclosures
for judicial and administrative proceedings, such as in response to subpoenas
or orders of courts or administrative agencies;
• Disclosures
for law enforcement purposes, such as to provide information about someone who
is or is suspected to be a victim of a crime; to provide information about a
crime at our office; or to report a crime that happened somewhere else;
• Disclosure
to a medical examiner to identify a dead person or to determine the cause of
death; or to funeral directors to aid in burial; or to organizations that
handle organ or tissue donations;
• Uses or
disclosures for health related research;
• Uses and
disclosures to prevent a serious threat to health or safety;
• Uses or
disclosures for specialized government functions, such as for the protection of
the president or high ranking government officials; for lawful national
intelligence activities; for military purposes; or for the evaluation and
health of members of the Foreign Service;
• Disclosures
of de-identified information;
• Disclosures
relating to worker’s compensation programs;
• Disclosures
of a “limited data set” for research, public health, or health care operations;
• Incidental
disclosures that are an unavoidable by-product of permitted uses or
disclosures;
• Disclosures
to “business associates” who perform health care operations for us and who
commit to respect the privacy of your health information.
Unless you object, we will also share relevant
information about your care with your family or friends who are helping you
with your eye care.
APPOINTMENT
REMINDERS
We may call or write/email to remind you of scheduled
appointments, or that it is time to make a routine appointment. We may also
call or write/email to notify you of other treatments or services available at
our office that might help you. Unless you tell us otherwise, we will mail/email
you an appointment reminder or a reminder to pickup contact lenses or glasses
on a post card, and/or leave you a reminder message on your home
answering machine or with someone who answers your phone if you
are not home, or at your place of work.
OTHER USES AND
DISCLOSURES
We will not make any other uses or disclosures of your
health information unless you sign a written “authorization form.” The content
of an “authorization form” is determined by federal law. Sometimes, we may
initiate the authorization process if the use or disclosure is our idea.
Sometimes, you may initiate the process if it’s your
idea for us to send your information to someone else. Typically, in this
situation you will give us a properly completed authorization form, or you can
use one of ours. If we initiate the process and ask you to sign an
authorization form, you do not have to sign it. If you do not sign the
authorization, we cannot make the use or disclosure. If you do sign one, you
may revoke it at any time unless we have already acted in reliance upon it.
Revocations must be in writing. Send them to the office contact person named at
the beginning of this Notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding your health
information. You can:
• Ask us to restrict our uses and disclosures for
purposes of treatment (except emergency treatment), payment or health care
operations. We do not have to agree to do this, but if we agree, we must honor
the restrictions that you want. To ask for a restriction, send a written request
or fax to the office contact person at the address or fax number shown at the
beginning of this Notice.
• Ask us to communicate with you in a confidential way,
such as by phoning you at work rather than at home, or by mailing health information
to a different address. We will accommodate these requests if they are
reasonable, and if you pay us for any extra cost. If you want to ask for
confidential communications, send a written request or fax to the office
contact person at the address or fax number at the beginning of this Notice.
• Ask to see or to get photocopies of your health
information. By law, there are a few limited situations in which we can refuse
to permit access or copying. For the most part, however, you will be able to
review or have a copy of your health information within 30 days of asking us
(or sixty days if the information is stored off-site). You may have to pay for
photocopies in advance. If we deny your request, we will send you a written
explanation, and instructions about how to get an impartial review of our
denial if one is legally available. By law, we can have one 30 day extension of
the time for us to give you access or photocopies if we send you a written notice
of the extension. If you want to review or get photocopies of your health
information, send a written request or fax to the office contact person at the
address or fax number shown at the beginning of this Notice.
• Ask us to amend your health information if you think
that it is incorrect or incomplete. If we agree, we will amend the information within
60 days from when you ask us. We will send the corrected information to persons
who we know got the wrong information, and others that you specify. If we do
not agree, you can write a statement of your position, and we will include it
with your health information along with any rebuttal statement that we may
write. Once your statement of position and/or our rebuttal is included in your
health information, we will send it along whenever we make a permitted
disclosure of your health information. By law, we can have one 30 day extension
of time to consider a request for amendment if we notify you in writing of the
extension. If you want to ask us to amend your health information, send a
written request, including your reasons for the amendment, to the office
contact person at the address or fax number shown at the beginning of this
Notice.
• Get a list of the disclosures that we have made of your
health information within the past six years (or a shorter period if you want).
By law, the list will not include: disclosures for purposes of treatment,
payment or health care operations; disclosures with your authorization;
incidental disclosures; disclosures required by law; and some other limited
disclosures. You are entitled to one such list per year without charge. If you
want more frequent lists, you will have to pay for them in advance. We will
usually respond to your request within 60 days of receiving it, but by law we
can have one 30 day extension of time if we notify you of the extension in
writing. If you want a list, send a written request to the office contact
person at the address or fax number shown at the beginning of this Notice.
• Get additional paper copies of this Notice of Privacy
Practices upon request. If you want additional paper copies, send a written
request to the office contact person at the address or fax number shown at the
beginning of this Notice.
OUR NOTICE OF
PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of
Privacy Practices until we choose to change it. We reserve the right to change
this notice at any time as allowed by law. If we change this Notice, the new
privacy practices will apply to your health information that we already have as
well as to such information that we may generate in the future. If we change
our Notice of Privacy Practices, we will post the new notice in our office or
have copies available in our office.
COMPLAINTS
If you think that we have not properly respected the
privacy of your health information, you are free to complain to us or the
FOR MORE INFORMATION
If you want more information about our privacy practices, call or visit the office contact person at the address or phone number shown at the beginning of this Notice.