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We strive to deliver high quality care and make your experience in our practice the very best. We welcome your feedback to help us achieve this goal.
WHAT IS THE ICL?
The ICL, or Visian implantable collamer lens, is a new refractive surgical alternative to LASIK. Would you like to learn more?
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Effective Date: Immediately
Date of Last Revision: April 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
YOUR HEALTH INFORMATION
Whenever you visit Fishkind and Bakewell Eye Care and Surgery Center, a record of your visit is made. The record typically contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care. This notice describes the information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Policy includes:
- Any health care professional authorized to enter information into
your chart including but not limited to anesthesiologists, pain control
physicians and locum tenens physicians.
- All areas of the Practice (front desk, administration, surgery center,
billing and collection, etc.)
- All employees, staff and other personnel that work for or with our
Practice.
- Our business associates, on-call physicians, and so on.
We understand that your medical information is personal to you, and we are committed to protecting the information about you. Your record about your health is necessary to provide for your care and to comply with certain legal requirements. We are required by law to:
- Maintain the privacy of your health information.
- Provide you with a Notice of our Privacy Practices and your legal
rights with respect to protected health information about you.
- Follow the conditions of the Notice that is currently in effect.
- Notify you if we are unable to agree to a requested restriction.
- Accommodate reasonable requests you may have to communicate health information by alternative means or alternative locations.
We will not disclose your health information without your authorization, except as described in this notice.
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of Fishkind and Bakewell Eye Care and Surgery Center, the information belongs to you. You have the right to:
- Obtain a paper copy of this notice of information practices upon
request.
- Inspect and copy your health record as provided for in 45 CFR 164.524.
Upon proof of an appropriate legal relationship, records of others
related to you or under your care may also be disclosed. Requests
should be made in writing. We may charge a fee for the costs of copying,
mailing or other supplies associated with your request.
- Amend your health record as provided in 45 CFR 164.528. If you feel
that the medical information we have about you in your record is incorrect
or incomplete, then you may ask to amend the information. We may deny
your request for an amendment if it is not in writing or does not
include a reason to support the request, or if it was not created
by us or the person or entity that created the information is no longer
available to make the amendment.
- Obtain an accounting of disclosures of your health information as
provided in 45 CFR 164.528. You may request in writing, a time period
not longer than 6 years back and not before April 14, 2003.
- Request communications of your health information by alternative
means or at alternative locations. We will accommodate all reasonable
requests.
- Request a restriction on certain uses and disclosures of your information
as provided by 45 CFR 164.522. We are not required to agree to your
request and we may not be able to comply with your request.
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
The Practice provides this Notice to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1966 (HIPAA).
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following areas describe different ways that we use and disclose protected health information that we have and share with others. The explanations are general and provide some examples. Not every use or disclosure is listed or in place. The explanation is provided for your general information only.
- Medical Treatment. We most likely will disclose medical information
about you to doctors, nurses, technicians, medical students, or hospital
personnel who are involved in taking care of you. For example, a doctor
to whom we refer you for ongoing care may need your medical record.
Different areas of the Practice also may share medical information
about you including your records, prescriptions, and lab work. We
may also disclose medical information about you to people outside
the Practice who may be involved in your medical care after you leave
the Practice; this may include your family members, or other personal
representatives authorized by you.
- Payment. Your health information may be used to seek 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, services provided, and the medical condition
being treated.
- Health Care Operations. We may use and disclose medical information
about you so that we can run our Practice efficiently and make sure
that all of our patients receive quality care. For example, information
on the services you received may be used to review our treatment and
services to evaluate the performance of our staff, decide what additional
services to offer and where and whether certain new treatments are
effective. We may disclose information to other medical personnel
for review and learning purposes. We may also compare our information
with information from other Practices to compare how we are doing
and see where we can make improvements.
- Business Associates. We may disclose information to business
associates for purposes of helping us to comply with our legal requirements,
to auditors, to billing companies and the like. We shall endeavor
to advise them of their continued obligation to maintain the privacy
of your medical records.
- Appointment and Patient Recall Reminders. We may ask that
you sign in writing at the Receptionists’ Desk. We may disclose
medical information to contact you as a reminder that you have an
appointment for medical care with the Practice. We may disclose medical
information involving a medical or eyeglass prescription. This contact
may be by phone, in writing, or voice mail, or e-mail. We may contact
you to provide information about treatment alternative or other health-related
benefits and services that may be of interest to you.
- Emergency Situations. We may disclose medical information
about you to an organization assisting in a disaster relief effort
or in an emergency situation.
- Research. We may disclose medical information about you for
research purposes regarding medications, efficiency of treatment protocols
and the like. This is provided the research has been approved by the
an institutional review board with established protocols to ensure
the privacy of your health information.
- Required by Law. We will disclose health information for
law enforcement purposes as required by law or in response to a valid
subpoena. We may also use such information to defend ourselves or
any member of our Practice in any actual or threatened action.
- Law Enforcement. We may release medical information if asked
to do so by a law enforcement official.
- Organ and Tissue Donation. Consistent with applicable law,
we may disclose medical information to organizations that handle organ
procurement or organ, eye or tissue transplantation or to an organ
donation bank, as necessary to facilitate organ or tissue donation
and transplantation.
- Worker’s Compensation. We may release medical information
about you for workers’ compensation or similar programs.
- Public Health Risks. As required by law, we may disclose
your health information to public health or legal authorities charged
with preventing or controlling disease, injury, or disability.
- Investigation and Government Activities. We may disclose
medical information to a local, state, or federal agency for activities
authorized by law. These generally include audits, investigations,
inspections, and licensure.
- Coroners, Medical Examiners and Funeral Directors. We may
release medical information to a coroner or medical examiner to identify
a deceased person or determine the cause of death.
- Correctional Institution. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the institution or official.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we may receive from you in the future. The most current notice will be posted in the Practice. In addition, each time you visit the Practice for treatment or health care services you may request a copy of the current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice, you may do so by sending a letter outlining your concerns to the person listed below. All complaints must be submitted in writing, and all complaints shall be investigated, without repercussion to you.
Attention Privacy Officer:
Fishkind and Bakewell Eye Care and Surgery Center
5599 North Oracle Road
Tucson, Arizona 85704
520-293-6740