Privacy Policy
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 the
Visioncare Arkansas Privacy Officer at 501-450-9191.
WHO WILL FOLLOW THIS NOTICE
This notice describes our office's practices and that of all healthcare
professionals, employees and staff.
OUR PLEDGE REGARDING
MEDICAL INFORMATION
We understand that medical information about you and your health is
personal. We are committed to protecting medical information about you. We
create a record of the care and services you receive in our office. We need
this record to provide you with quality care and to comply with certain
legal requirements. This notice applies to all of the records of your care
generated by our office.
This notice will tell you about the ways in which we may use and disclose
medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical information.
We are required by law to:
make sure that medical information that identifies you is kept private;
give you this notice of our legal duties and privacy practices with respect
to medical information about you; and
follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE
MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose
medical information. For each category of uses or disclosures we will
explain what we mean and try to give some examples. Not every use or
disclosure in a category will be listed. However, all of the ways we are
permitted to use and disclose information will fall within one of the
categories.
For Treatment. We may use medical information about you to provide you with
medical treatment or services. We may disclose medical information about you
to doctors, nurses, technicians, or other medical personnel who are involved
in taking care of you at the hospital. For example, a doctor treating you
for a broken leg may need to know if you have diabetes because diabetes may
slow the healing process. We also may share medical information about you
with other healthcare providers who are treating your medical conditions in
order to coordinate the different things you need, such as prescriptions,
lab work and x-rays.
For Payment. We may use and disclose medical information about you so that
the treatment and services you receive at our office may be billed to and
payment may be collected from you, an insurance company or a third party.
For example, we may need to give your health plan information about
treatment you received at our office so your health plan will pay us or
reimburse you for the services. We may also tell your health plan about a
treatment you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
For Healthcare Operations. We may use and disclose medical information about
you for healthcare operations. These uses and disclosures are necessary to
run our office and make sure that all of our patients receive quality care.
For example, we may use medical information to review our treatment and
services and to evaluate the performance of our staff in caring for you. We
may also combine medical information about many of our patients to decide
what additional services we should offer, what services are not needed, and
whether certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, medical students, and other
personnel for review and learning purposes. We may also combine the medical
information we have with medical information from other physician offices to
compare how we are doing and see where we can make improvements in the care
and services we offer. We may remove information that identifies you from
this set of medical information so others may use it to study healthcare and
healthcare delivery without learning who the specific patients are.
Appointment Reminders. We may use and disclose medical information to
contact you as a reminder that you have an appointment for treatment or
medical care at our office. We may leave messages on your answering machine
about appointments unless you tell us not to do so.
Treatment Alternatives. We may use and disclose medical information to tell
you about or recommend possible treatment options or alternatives that may
be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical
information to tell you about health-related benefits or services that may
be of interest to you.
Communication with Family. Healthcare professionals, using their best
judgment, may disclose to a family member, a close personal friend or any
other person you identify, health information needed for that person to be
involved in your care or payment related to your care.
As Required By Law. We will disclose medical information about you when
required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose
medical information about you when necessary to prevent a serious threat to
your health and safety or the health and safety of the public or another
person. Any disclosure, however, would only be to someone able to help
prevent the threat.
SPECIAL SITUATIONS
Military and Veterans. If you are a member of the armed forces, we may
release medical information about you as required by military command
authorities. We may also release medical information about foreign military
personnel to the appropriate foreign military authority.
Workers' Compensation. We may release medical information about you for
workers' compensation or similar programs. These programs provide benefits
for work-related injuries or illness.
Public Health Risks. As required by law, we may disclose medical information
about you to authorities charged with preventing or controlling disease or
disability.
Health Oversight Activities. We may disclose medical information to a health
oversight agency for activities authorized by law. These oversight
activities include, for example, audits, investigations, inspections, and
licensure. These activities are necessary for the government to monitor the
healthcare system, government programs, and compliance with civil rights
laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may
disclose medical information about you in response to a court or
administrative order. We may also disclose medical information about you in
response to a subpoena, discovery request, or other lawful process by
someone else involved in the dispute, but only if efforts have been made to
tell you about the request or to obtain an order protecting the information
requested.
Law Enforcement. We may release medical information if asked to do so by a
law enforcement official in response to a court order, subpoena, warrant,
summons or similar process; to identify or locate a suspect, fugitive,
material witness, or missing person; about the victim of a crime if, under
certain limited circumstances, we are unable to obtain the person's
agreement; about a death we believe may be the result of criminal conduct;
and in emergency circumstances to report a crime; the location of the crime
or victims; or the identity, description or location of the person who
committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release medical
information to a coroner or medical examiner. This may be necessary, for
example, to identify a deceased person or determine the cause of death. We
may also release medical information about patients to funeral directors as
necessary to carry out their duties.
National Security and Intelligence Activities. We may release medical
information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by
law.
Protective Services for the President and Others. We may disclose medical
information about you to authorized federal officials so they may provide
protection to the President, other authorized persons or foreign heads of
state or conduct special investigations.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice
or the laws that apply to us will be made only with your written permission.
If you provide us permission to use or disclose medical information about
you, you may revoke that permission, in writing, at any time and we will no
longer use or disclose medical information about you for the reasons covered
by your written authorization. You understand that we are unable to take
back any disclosures we have already made with your permission, and that we
are required to retain our records of the care that we provided to you.
YOUR RIGHTS REGARDING
MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain
about you:
Right to Inspect and Obtain a Copy. You have the right to inspect and obtain
a copy of medical information that may be used to make decisions about your
care. Usually, this includes medical and billing records, but does not
include psychotherapy notes.
To inspect and obtain a copy of medical information that may be used to make
decisions about you, you must submit your request in writing to Visioncare
Arkansas 201 Skyline Dr. #33, Conway, AR 72032. If you request a copy of the
information, we may charge a fee for the costs of copying, mailing or other
supplies associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information, you may
request that the denial be reviewed. Another licensed healthcare
professional chosen by our office will review your request and the denial.
The person conducting the review will not be the person who denied your
request. We will comply with the outcome of the review.
Right to Amend. If you feel that medical information we have about you is
incorrect or incomplete, you may ask us to amend the information. You have
the right to request an amendment for as long as the information is kept by
or for the Clinic.
To request an amendment, your request must be made in writing and submitted
to the Visioncare Arkansas 201 Skyline Dr., Conway, AR 72032. In addition,
you must provide a reason that supports your request.
Was not created by us, unless the person or entity that created the
information is no longer available to make the amendment:
Is not part of the medical information kept by or for our office:
Is not part of the information which you would be permitted to inspect and
copy; or
Is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an
"accounting of disclosures." This is a list of some of the disclosures we
made of medical information about you. To request this list or accounting of
disclosures, you must submit your request in writing to Visioncare Arkansas
201 Skyline Dr. #33, Conway, AR 72032. Your request must state a time period
which may not be longer than six (6) years and may not include dates before
April 14, 2003. Your request should indicate in what form you want the list
(for example, on paper, electronically). The first list you request within a
twelve (12) month period will be free. For additional lists, we may charge
you for the costs of providing the list. We will notify you of the cost
involved and you may choose to withdraw or modify your request at that time
before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction
or limitation on the medical information we use or disclose about you for
treatment, payment or healthcare operations. You also have the right to
request a limit on the medical information we disclose about you to someone
who is involved in your care or the payment for your care, like a family
member or friend. For example, you could ask that we not use or disclose
information about a particular type of treatment you had.
We are not required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you emergency
treatment.
To request restrictions, you must make your request in writing to our
office's Privacy Officer. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our use,
disclosure or both; and (3) to whom you want the limits to apply, for
example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request
that we communicate with you about medical matters in a certain way or at a
certain location. For example, you can ask that we only contact you at work
or by mail.
To request confidential communications, you must make your request in
writing to the Privacy Officer. We will not ask you the reason for your
request. We will accommodate all reasonable requests. Your request must
specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of
this notice. You may ask us to give you a copy of this notice at any time.
Even if you have agreed to receive this notice electronically, you are still
entitled to a paper copy of this notice.
To obtain a paper copy of this notice, inquire at the reception desk.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. 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 receive in the future. We will post
a copy of the current notice in our office. The notice will contain the
effective date. In addition, each time you register for treatment or
healthcare services, we will offer you a copy of the current notice in
effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a
complaint with our office or with the Secretary of the Department of Health
and Human Services. To file a complaint with our office, contact the Privacy
Officer at Visioncare Arkansas 201 Skyline Dr. #33, Conway, AR 72032. All
complaints must be submitted in writing.
You will not be penalized for filing a complaint.
EFFECTIVE DATE: APRIL 14, 2003
