Privacy Notice
Barton Eye Associates, P.A.
Notice of Privacy Practices
Please read this notice carefully. This notice is being provided to you, as mandated by the Health Insurance Portability and Accountability Act (HIPAA).
Introduction
At Barton Eye Associates, P.A. we are committed to treating and using protected health information about you responsibly. This Notice describes the personal information we collect, how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 14, 2003 and applies to all protected health information as defined by federal and state regulations.
Understanding Your Medical Record/Health Information
Each time you visit Barton Eye Associates, P.A. a record of your visit is made. Typically, this record contains information about your visit, including your examination, diagnoses, test results and treatment plan, as well as other pertinent healthcare data. Understanding what is in your record and how your health information is used helps to ensure accuracy, determine who has access to your health information, and make an informed decision when authorizing the disclosure of this information to other entities.
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 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. ?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 all. Such uses or disclosures are:
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 to remind you of scheduled appointments, or that it is time to make routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you an appointment reminder on a post card, and/or leave a reminder message on your home answering machine or with someone who answers your phone if you are not home.
Other Uses And Disclosures
We will not make any other uses or disclosures of your health information unless you sign a written ?authorization form.? Content of a? authorization form ? is determined by federal law. Sometimes, we may initiate the authorization process of 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. 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 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 person named at the end of this notice.
Your Rights Under Federal Law
You have certain rights under (HIPAA) Health Insurance Portability and Accountability Act. These regulations create several privileges that patients may exercise. We will not retaliate against patients who exercise their HIPAA rights.
These Privileges include:
For More Information, Copies of Revisions Or To Report A Complaint
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal, state laws and regulations. Whatever the reason for these revisions, we will post any revised notice in the office where it can be seen. You can request a paper copy at any time. The revised policies and practices will be applied to all protected health information that we maintain.
If you have any complaints, questions or would like additional information regarding this notice or the privacy practices of Barton Eye Associates, P.A. Please contact:
Brian Barton, O.D.
Barton Eye Associates
3930 Glade Rd. #122
Colleyville, Texas 76034
817-283-3393
If you believe that your privacy rights have been violated, please contact the aforementioned practice Privacy Official, or you may file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the practice?s Privacy Official or with the Office for Civil Rights.
The address for the Civil Rights is listed below:
U.S. Department of Health and Human Services
HIPAA Compliant
7500 Security Boulevard, C5-24-04
Baltimore, MD 21244
Notice of Privacy Practices
Please read this notice carefully. This notice is being provided to you, as mandated by the Health Insurance Portability and Accountability Act (HIPAA).
Introduction
At Barton Eye Associates, P.A. we are committed to treating and using protected health information about you responsibly. This Notice describes the personal information we collect, how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 14, 2003 and applies to all protected health information as defined by federal and state regulations.
Understanding Your Medical Record/Health Information
Each time you visit Barton Eye Associates, P.A. a record of your visit is made. Typically, this record contains information about your visit, including your examination, diagnoses, test results and treatment plan, as well as other pertinent healthcare data. Understanding what is in your record and how your health information is used helps to ensure accuracy, determine who has access to your health information, and make an informed decision when authorizing the disclosure of this information to other entities.
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 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. ?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 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 a 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 that 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 and safety
- Disclosures relating to worker?s compensation programs.
- Incidental disclosures that are unavoidable by-product of permitted uses or disclosures
- Disclosures to ?business associates? who perform health care operations with respect to 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 to remind you of scheduled appointments, or that it is time to make routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you an appointment reminder on a post card, and/or leave a reminder message on your home answering machine or with someone who answers your phone if you are not home.
Other Uses And Disclosures
We will not make any other uses or disclosures of your health information unless you sign a written ?authorization form.? Content of a? authorization form ? is determined by federal law. Sometimes, we may initiate the authorization process of 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. 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 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 person named at the end of this notice.
Your Rights Under Federal Law
You have certain rights under (HIPAA) Health Insurance Portability and Accountability Act. These regulations create several privileges that patients may exercise. We will not retaliate against patients who exercise their HIPAA rights.
These Privileges include:
- The right to request restrictions on the use and disclosures of your protected health information. In regard to you right to request a restriction or limit on how your health information is disclosed for treatment, payment, or healthcare operations, we do NOT have to agree to this restriction, but if we agree, we will comply with your request, except under emergency circumstances. You may also request that we limit disclosure to a family member, other relatives, or close personal friends who may or may not be involved in your care. Please submit the following in writing:
- The information to be restricted.
- What kind of restrictions you are requesting.
- To whom these limits apply.
- The right to receive confidential communications by alternative means or to an alternative location concerning your medical condition and treatment. If you want to request that we communicate with you via an alternative means and/or an alternative location, please specify in your correspondence exactly how you want us to communicate with and, if you are directing us to send it to a particular place, the contact/address information.
- The right to inspect and copy your protected health information. If you request to inspect or copy your health information, Texas law requires the request be made in writing and that you allow 15 days from the date of your request to provide the copies at a reasonable cost-base fee. We will inform you when the records are ready or if we believe that access should be limited. We may ask that a narrative of that information be provided rather than copies. However, if you do not agree to our request, we will provide copies. We can refuse to provide some information based on certain criteria (please contact the person noted at the end of this document for further information).
- The right to amend or submit corrections to your protected health information. If you request an amendment to your health information you will allow us 60 days from the date of your written request. We can refuse to allow your request for an amendment based on certain criteria (please contact the person noted at the end of this document for further information). We will inform you in writing of approval or refusal to an amendment. If we refuse to allow an amendment, you are permitted to include a patient statement about the information at issue in your medical record.
- The right to receive an accounting of how and to whom your protected health information has been disclosed. Your first request for an accounting of disclosures (within a 12 month period) will be at no charge. For additional requests within that period we are permitted to charge for the cost of creating that list.
- The right to receive a printed copy of this notice.
For More Information, Copies of Revisions Or To Report A Complaint
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal, state laws and regulations. Whatever the reason for these revisions, we will post any revised notice in the office where it can be seen. You can request a paper copy at any time. The revised policies and practices will be applied to all protected health information that we maintain.
If you have any complaints, questions or would like additional information regarding this notice or the privacy practices of Barton Eye Associates, P.A. Please contact:
Brian Barton, O.D.
Barton Eye Associates
3930 Glade Rd. #122
Colleyville, Texas 76034
817-283-3393
If you believe that your privacy rights have been violated, please contact the aforementioned practice Privacy Official, or you may file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the practice?s Privacy Official or with the Office for Civil Rights.
The address for the Civil Rights is listed below:
U.S. Department of Health and Human Services
HIPAA Compliant
7500 Security Boulevard, C5-24-04
Baltimore, MD 21244
