Notice of Privacy Practices

Effective date of notice: 4/5/2003

This notice describes how your medical information may be used and disclosed, and how you can obtain access to this information. Please review it carefully.

Golden Vision Clinic has always considered physician-patient confidentiality an integral part of patient care.  We respect our legal obligation to keep health information, that identifies you, private.

New legislation regarding the privacy of your protected health information will become effective April 14, 2003.  The law, known as HIPAA (Health Insurance Portability and Accountability Act), requires that all healthcare providers maintain the privacy of protected health information and provide individuals with notice of its legal duties and privacy practices with respect to protected health information.  This office is required to follow the terms of the notice currently in effect.

Uses or Disclosures of Health Information

We may use or disclose health information about you:

·         To provide treatment in our office.

·         To obtain payment for treatment.

·         To evaluate the quality of care that you receive.

·         For administrative purposes.

Continuity of care is part of treatment and your records may be shared with other healthcare providers to whom you are referred.  Information may be shared by paper mail, electronic mail, fax or other methods.  Sometimes we may request copies of your health information from another professional, which you may have seen before.

Uses or Disclosures without Authorization

In some limited situations, the law allows or requires us to use or disclose your health information without your authorization.  Examples of such uses or disclosures are:

·      Public health purposes, such as reporting of contagious disease, birth, and death.

·      Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence.

·      Uses or disclosures for health related research.

·      Uses or disclosures for auditing.

·      Disclosures for judicial and administrative proceedings, such as in response to subpoenas.

·      In emergency situations.

Appointment Reminders

We may use or disclose your health information to provide you with appointment reminders via phone, e-mail, or letter.  We may also contact you regarding other treatments or services available at our office that might be helpful to you.

Your Rights Regarding Your Health Information

·      You have the right to restrict the disclosure of your health information for purposes of treatment (except emergency treatment) payment, or healthcare operations.  This request must be submitted in writing to the address or fax at the bottom of this notice.  However, Golden Vision is not required to automatically agree to such a restriction request.

·      You have the right to receive confidential communications regarding your health information.

·      You have the right to inspect and copy all of the health information contained in your medical record.  All such requests must be submitted in writing to the address or fax at the bottom of this notice.  If you request a copy of your medical records, we will charge you only normal photocopy fees.   By law, there are a few limited situations in which we can refuse to permit access or copying.

·      You have the right to request a correction or amendment to your health information.  This request must be submitted in writing and must include a reason to support the requested amendment.  Golden Vision must act on a request for amendment within 60 days of the receipt of the request.

·      You have the right to receive a list of the disclosures that we have made of your health information within the past six years, except disclosures for purposes of treatment, payment, health care operations, disclosures made in accordance with an authorization signed by you, and some other limited disclosures. You are entitled to one such list per year without charge.  We will usually respond to your request within 60 days of receiving it.

Again, if you would like to make a request for any of the above situations, send a written request to Marilyn Baron at the address or fax shown at the bottom of this notice.

Complaints

If you have a complaint regarding the way your protected health information was handled, you may submit that complaint in writing to our office or the U.S. Department of Health and Human Services, Office for Civil Rights.    Be assured that the law prohibits retaliation in any form to any person who exercises this right.

Our Notice of Privacy Practices

We are required by law to protect the privacy of your personal health information, provide this notice about our information practices, follow the information practices that were described in this notice, and obtain your written acknowledgement that you have read this notice, been given the opportunity to ask any questions regarding the notice, and have been given a copy of the notice if you requested one.  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 in compliance with and as allowed by law.  If we change our Notice of Privacy Practices, we will post the new notice in our offices and have copies available in our office.

For More Information

If you want more information about our privacy practices, call Marilyn Baron at  303-278-20/20

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