TIFFIN EYE CENTER

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.

 

Each time you visit Tiffin Eye Center, we make a record of the information gathered during your visit.  This information is used for a number of purposes.  These uses are set forth below.  You have certain rights regarding this information.  Your rights regarding this information are set forth below.  Finally, we have certain responsibilities regarding our use of your information.  Our responsibilities are set forth below.

 

USES AND DISCLOSURE OF HEALTH INFORMATION

 

We are permitted by law to use your health information to provide treatment to you.  For example, we will provide your physician and our other clinicians involved with your care and treatment with the information in our records to assist the physician in providing proper care to you.  We will also provide this information to subsequent health care providers.  These individuals may create additional information related to the care and treatment they provide you.

 

We are permitted by law to use your health information to obtain payment for our services.  For example, we may send your insurance company or other payer a bill that may include your health information.

 

We are permitted by law to use your health information to perform our regular health care operations.  For example, we may use your health information to assess the quality of care we provide in order to maintain our standards.

 

We may use a sign-in sheet at the registration desk where you may be asked to sign your name.  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 to contact you to remind you to schedule or keep an appointment or to mail to you an office newsletter or information regarding your eye care.

 

We are permitted, and in some cases required, by law to make certain other disclosures of health information without your consent.  We may disclose your health information, if appropriate, to the following entities under the following circumstances:

 

-         to public health agencies to satisfy certain reporting requirements, such as births and deaths, certain communicable diseases, child abuse, and other public health issues

-         to health oversight agencies, such as governmental auditors, the Ohio Department of Health, and other agencies when required

-         to any individual when ordered by a court or other legal process to do so

-         to law enforcement officials when necessary for law enforcement purposes and required by law

-         to a coroner or medical examiner when necessary to enable them to perform their duties

-         to organ procurement organization, to enable them to make suitability determinations

-         in cases of emergency

-         to researchers if their research has been approved by an institutional review board and they take certain steps to protect your privacy

 

We will not use your information for any other purpose without your written authorization.  You have the right to revoke any authorization you provide us.

 

    

    YOUR INDIVIDUAL RIGHTS

 

       You have certain rights regarding your health information.  These rights include:

-         the right to a paper copy of this notice

-         the right to inspect and copy your health information (copies are available for a fee)

-         the right to request amendments to your health information you believe to be inaccurate

-         the right to obtain an accounting of our uses and disclosures of your health information, subject to certain exceptions

-         the right to request restrictions on our permitted uses and disclosures of your information (although we are not legally obligated to honor this request)

-         the right to request that communications regarding your health information be sent by alternative means or at alternative locations

 

OUR RESPONSIBILITIES

We are required by law to maintain the privacy of your information in accordance with this notice.  We are also required to provide you with this notice explaining our duties and practices regarding your health information.  We are required to abide by the terms of this notice.

We reserve the right to change the content of this notice and to make new provisions regarding your protected health information.  We will provide you a revised notice during your first visit after the revisions are effective.

 If you have any questions regarding this notice or wish to exercise any of your rights as described herein, you may contact Shelly or Denise at Tiffin Eye Center.  You can file a complaint with Dr. Young, the Privacy Officer of Tiffin Eye Center by written notice.  Finally, you can submit a complaint to the Secretary of Health and Human Services.  We will not retaliate against you for filing a complaint.