Notice of Privacy Practices
The Princeton Eye Group
Felton, Wong, Wong, and Reynolds, P.A.
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. Please review it carefully.
If you have any questions about this
Notice, please contact:
our Privacy Contact, Diane Wronko
This Notice of Privacy Practices describes
how we may use and disclose your protected health information
to carry out treatment, payment or health care operations and
for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected
health information. "Protected health information"
is information about you, including demographic information,
that may identify you and that relates to your past, present
or future physical or mental health or condition and related
health care services.
We are required to abide by the terms of this
Notice of Privacy Practices. We may change the terms of our notice,
at any time. The new notice will be effective for all protected
health information that we maintain at that time. Upon your request,
we will provide you with any revised Notice of Privacy Practices
by accessing our website www.willslaservision.com, calling the
office and requesting that a revised copy be sent to you in the
mail or asking for one at the time of your next appointment.
1. Uses and Disclosures of Protected
Health Information
Uses and Disclosures of Protected Health
Information
You will be asked to provide written acknowledgment
that you have reviewed this Notice of Privacy Practices (for
treatment, payment and health care operations). Your physician
may use or disclose your protected health information as described
in this Section 1. Your protected health information may be used
and disclosed by your physician, our office staff and others
outside of our office that are involved in your care and treatment
for the purpose of providing health care services to you. Your
protected health information may also be used and disclosed to
pay your health care bills and to support the operation of the
physician's practice.
Following are examples of the types of uses
and disclosures of your protected health care information that
the physician's office is permitted to make. These examples are
not meant to be exhaustive, but to describe the types of uses
and disclosures that may be made by our office.
Treatment:
We will use and disclose your protected health information to
provide, coordinate, or manage your health care and any related
services. This includes the coordination or management of your
health care with a third party that has already obtained your
permission to have access to your protected health information.
For example, we would disclose your protected health information,
as necessary, to a home health agency that provides care to you.
We will also disclose protected health information to other physicians
who may be treating you when we have the necessary permission
from you to disclose your protected health information. For example,
your protected health information may be provided to a physician
to whom you have been referred to ensure that the physician has
the necessary information to diagnose or treat you.
In addition, we may disclose your protected
health information from time-to-time to another physician or
health care provider (e.g., a specialist or laboratory) who,
at the request of your physician, becomes involved in your care
by providing assistance with your health care diagnosis or treatment
to your physician.
Payment:
Your protected health information will be used, as needed, to
obtain payment for your health care services. This may include
certain activities that your health insurance plan may undertake
before it approves or pays for the health care services we recommend
for you such as: making a determination of eligibility or coverage
for insurance benefits, reviewing services provided to you for
medical necessity, and undertaking utilization review activities.
For example, obtaining approval for a hospital stay may require
that your relevant protected health information be disclosed
to the health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as-needed, your protected
health information in order to support the business activities
of your physician's practice. These activities include, but are
not limited to, quality assessment activities, employee review
activities, training of medical students, licensing, marketing
and fundraising activities, and conducting or arranging for other
business activities.
For example, we may disclose your protected health information
to medical school students that see patients at our office. In
addition, we may use a sign-in sheet at the registration desk
where you will be asked to sign your name and indicate your physician.
We may also call you by name in the waiting room when your physician
is ready to see you. We may use or disclose your protected health
information, as necessary, to contact you to remind you of your
appointment.
We will share your protected health information
with third party "business associates" that perform
various activities (e.g., billing, transcription services) for
the practice. Whenever an arrangement between our office and
a business associate involves the use or disclosure of your protected
health information, we will have a written contract that contains
terms that will protect the privacy of your protected health
information.
We may use or disclose your protected health
information, as necessary, to provide you with information about
treatment alternatives or other health-related benefits and services
that may be of interest to you. We may also use and disclose
your protected health information for other marketing activities.
For example, your name and address may be used to send you a
newsletter about our practice and the services we offer. We may
also send you information about products or services that we
believe may be beneficial to you. You may contact our Privacy
Contact to request that these materials not be sent to you.
We may use or disclose your demographic information
and the dates that you received treatment from your physician,
as necessary, in order to contact you for fundraising activities
supported by our office. If you do not want to receive these
materials, please contact our Privacy Contact and request that
these fundraising materials not be sent to you.
Uses and Disclosures of Protected Health
Information Based upon Your Written Authorization
Other uses and disclosures of your protected
health information will be made only with your written authorization,
unless otherwise permitted or required by law as described below.
You may revoke this authorization, at any time, in writing, except
to the extent that your physician or the physician's practice
has taken an action in reliance on the use or disclosure indicated
in the authorization.
Other Permitted and Required Uses and Disclosures
That May Be Made With Your Consent, Authorization or Opportunity
to Object
We may use and disclose your protected health
information in the following instances. You have the opportunity
to agree or object to the use or disclosure of all or part of
your protected health information. If you are not present or
able to agree or object to the use or disclosure of the protected
health information, then your physician may, using professional
judgment, determine whether the disclosure is in your best interest.
In this case, only the protected health information that is relevant
to your health care will be disclosed.
Others Involved in Your Healthcare: Unless you object, we may disclose to a member of
your family, a relative, a close friend or any other person you
identify, your protected health information that directly relates
to that person's involvement in your health care. If you are
unable to agree or object to such a disclosure, we may disclose
such information as necessary if we determine that it is in your
best interest based on our professional judgment. We may use
or disclose protected health information to notify or assist
in notifying a family member, personal representative or any
other person that is responsible for your care of your location,
general condition or death. Finally, we may use or disclose your
protected health information to an authorized public or private
entity to assist in disaster relief efforts and to coordinate
uses and disclosures to family or other individuals involved
in your health care.
Emergencies:
We may use or disclose your protected health information in an
emergency treatment situation. If this happens, your physician
shall try to obtain your consent as soon as reasonably practicable
after the delivery of treatment. If your physician or another
physician in the practice is required by law to treat you and
the physician has attempted to obtain your consent but is unable
to obtain your consent, he or she may still use or disclose your
protected health information to treat you.
Communication Barriers: We may use and disclose your protected health information
if your physician or another physician in the practice attempts
to obtain consent from you but is unable to do so due to substantial
communication barriers and the physician determines, using professional
judgment, that you intend to consent to use or disclosure under
the circumstances.
Other Permitted and Required Uses and Disclosures
That May Be Made Without Your Consent, Authorization or Opportunity
to Object
We may use or disclose your protected health
information in the following situations without your consent
or authorization. These situations include:
Required By Law: We may use or disclose your protected health information
to the extent that the use or disclosure is required by law.
The use or disclosure will be made in compliance with the law
and will be limited to the relevant requirements of the law.
You will be notified, as required by law, of any such uses or
disclosures.
Public Health:
We may disclose your protected health information for public
health activities and purposes to a public health authority that
is permitted by law to collect or receive the information. The
disclosure will be made for the purpose of controlling disease,
injury or disability. We may also disclose your protected health
information, if directed by the public health authority, to a
foreign government agency that is collaborating with the public
health authority.
Communicable Diseases: We may disclose your protected health information,
if authorized by law, to a person who may have been exposed to
a communicable disease or may otherwise be at risk of contracting
or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a
health oversight agency for activities authorized by law, such
as audits, investigations, and inspections. Oversight agencies
seeking this information include government agencies that oversee
the health care system, government benefit programs, other government
regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information
to a public health authority that is authorized by law to receive
reports of child abuse or neglect. In addition, we may disclose
your protected health information if we believe that you have
been a victim of abuse, neglect or domestic violence to the governmental
entity or agency authorized to receive such information. In this
case, the disclosure will be made consistent with the requirements
of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information
to a person or company required by the Food and Drug Administration
to report adverse events, product defects or problems, biologic
product deviations, track products; to enable product recalls;
to make repairs or replacements, or to conduct post marketing
surveillance, as required.
Legal Proceedings: We may disclose protected health information in the
course of any judicial or administrative proceeding, in response
to an order of a court or administrative tribunal (to the extent
such disclosure is expressly authorized), in certain conditions
in response to a subpoena, discovery request or other lawful
process.
Law Enforcement: We may also disclose protected health information,
so long as applicable legal requirements are met, for law enforcement
purposes. These law enforcement purposes include (1) legal processes
and otherwise required by law, (2) limited information requests
for identification and location purposes, (3) pertaining to victims
of a crime, (4) suspicion that death has occurred as a result
of criminal conduct, (5) in the event that a crime occurs on
the premises of the practice, and (6) medical emergency (not
on the Practice's premises) and it is likely that a crime has
occurred.
Coroners, Funeral Directors, and Organ
Donation: We may disclose protected
health information to a coroner or medical examiner for identification
purposes, determining cause of death or for the coroner or medical
examiner to perform other duties authorized by law. We may also
disclose protected health information to a funeral director,
as authorized by law, in order to permit the funeral director
to carry out their duties. We may disclose such information in
reasonable anticipation of death. Protected health information
may be used and disclosed for cadaveric organ, eye or tissue
donation purposes.
Research:
We may disclose your protected health information to researchers
when their research has been approved by an institutional review
board that has reviewed the research proposal and established
protocols to ensure the privacy of your protected health information.
Criminal Activity:
Consistent with applicable federal
and state laws, we may disclose your protected health information,
if we believe that the use or disclosure is necessary to prevent
or lessen a serious and imminent threat to the health or safety
of a person or the public. We may also disclose protected health
information if it is necessary for law enforcement authorities
to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use
or disclose protected health information of individuals who are
Armed Forces personnel (1) for activities deemed necessary by
appropriate military command authorities; (2) for the purpose
of a determination by the Department of Veterans Affairs of your
eligibility for benefits, or (3) to foreign military authority
if you are a member of that foreign military services. We may
also disclose your protected health information to authorized
federal officials for conducting national security and intelligence
activities, including for the provision of protective services
to the President or others legally authorized.
Workers' Compensation: Your protected health information may be disclosed
by us as authorized to comply with workers' compensation laws
and other similar legally-established programs.
Inmates:
We may use or disclose your protected health information if you
are an inmate of a correctional facility and your physician created
or received your protected health information in the course of
providing care to you.
Required Uses and Disclosures: Under the law, we must make disclosures to you and
when required by the Secretary of the Department of Health and
Human Services to investigate or determine our compliance with
the requirements of Section 164.500 et. seq.
2. Your Rights
Following is a statement of your rights with
respect to your protected health information and a brief description
of how you may exercise these rights.
You have the right to inspect and copy
your protected health information.
This means you may inspect and obtain a copy of protected health
information about you that is contained in a designated record
set for as long as we maintain the protected health information.
A "designated record set" contains medical and billing
records and any other records that your physician and the practice
uses for making decisions about you. A nominal fee is charged
for this service.
Under federal law, however, you may not inspect
or copy the following records; psychotherapy notes; information
compiled in reasonable anticipation of, or use in, a civil, criminal,
or administrative action or proceeding, and protected health
information that is subject to law that prohibits access to protected
health information. Depending on the circumstances, a decision
to deny access may be reviewable. In some circumstances, you
may have a right to have this decision reviewed. Please contact
our Privacy Contact if you have questions about access to your
medical record.
You have the right to request a restriction
of your protected health information.
This means you may ask us not to use or disclose any part of
your protected health information for the purposes of treatment,
payment or healthcare operations. You may also request that any
part of your protected health information not be disclosed to
family members or friends who may be involved in your care or
for notification purposes as described in this Notice of Privacy
Practices. Your request must state the specific restriction requested
and to whom you want the restriction to apply.
Your physician is not required to agree to
a restriction that you may request. If physician believes it
is in your best interest to permit use and disclosure of your
protected health information, your protected health information
will not be restricted. If your physician does agree to the requested
restriction, we may not use or disclose your protected health
information in violation of that restriction unless it is needed
to provide emergency treatment. With this in mind, please discuss
any restriction you wish to request with your physician. You
may request a restriction by submitting such a request in writing
to our Privacy Contact. You will be notified if your request
will be honored or denied.
You have the right to request to receive
confidential communications from us by alternative means or at
an alternative location. We will
accommodate reasonable requests. We may also condition this accommodation
by asking you for information as to how payment will be handled
or specification of an alternative address or other method of
contact. We will not request an explanation from you as to the
basis for the request. Please make this request in writing to
our Privacy Contact.
You may have the right to have your
physician amend your protected health information. This means you may request an amendment of protected
health information about you in a designated record set for as
long as we maintain this information. In certain cases, we may
deny your request for an amendment. If we deny your request for
amendment, you have the right to file a statement of disagreement
with us and we may prepare a rebuttal to your statement and will
provide you with a copy of any such rebuttal. Please contact
our Privacy Contact to determine if you have questions about
amending your medical record.
You have the right to receive an accounting
of certain disclosures we have made, if any, of your protected
health information. This right
applies to disclosures for purposes other than treatment, payment
or healthcare operations as described in this Notice of Privacy
Practices. It excludes disclosures we may have made to you, for
a facility directory, to family members or friends involved in
your care, or for notification purposes. You have the right to
receive specific information regarding these disclosures that
occurred after April 14, 2003. You may request a shorter timeframe.
The right to receive this information is subject to certain exceptions,
restrictions and limitations.
You have the right to obtain a paper
copy of this notice from us, upon
request, even if you have agreed to accept this notice electronically.
3. Complaints
You may complain to us or to the Secretary
of Health and Human Services if you believe your privacy rights
have been violated by us. You may file a complaint with us by
notifying our Privacy Contact of your complaint. We will not
retaliate against you for filing a complaint.
You may contact our Privacy Contact, Diane
Wronko, at 609-921-9437 for further information about the complaint
process.
This notice was published and becomes effective
on February 1, 2003.
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