NOTICE OF PRIVACY PRACTICES FOR BELLPORT PERSPECTIVE EYE CARE.
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.
Bellport Perspective Eye Care/B. Cho Optometry PLLC may use and disclose your medical information for different purposes, all of which are described below. The examples are provided to illustrate the types of disclosure.
Treatment. We will use your medical information to provide treatment to you. For example, we may use it for coordinating care between optometrists, optometric assistants and opticians and office staff. In addition, we may share your health information with optical and contact lens laboratories, pharmacies or other health care personnel providing you treatment.
Payment. We may use and disclose your medical information to collect payment for treatment you receive in our office. For example, we may file insurance forms on your behalf by mail or electronically. We may also disclose the information to third party collection agencies in an effort to obtain payment.
Health Care Operations. We may use and disclose your medical information to run our office. For example, your information may be used for internal quality improvement, financial audits and defense of legal matters. It is also possible that health information will be disclosed during audits by insurance companies or government agencies as part of their compliance reviews.
Patient Reminders. We may remind you of a scheduled appointment or that it is time for you to contact us and make an appointment. In addition, we may contact you to follow up on your care or inform you of treatment options or products and services that may be of interest to you. Communications may include postcards, letters, telephone reminders or electronic reminders, such as email.
OTHER REQUIRED OR PERMITTED DISCLOSURES
As Required by Law.
We must disclose medical information about you when required to do so by federal or state law.
For Public Health Activities.
We may disclose medical information to public health agencies for reasons such as preventing or controlling disease.
Victims of Abuse, Neglect or Domestic Violence.
We may disclose in certain circumstances medical information to government agencies about abuse, neglect or domestic violence.
Health Oversight Activities.
We may disclose your medical information to a health oversight agency, such as the Board of Optometry, Medicare, for activities authorized by law.
Judicial and Administrative Proceedings.
We may disclose your medical information in response to a court or administrative order. We may also disclose medical information in certain cases about you in response to a subpoena, discovery request, or other lawful process.
We may release medical information under limited circumstances if required to do so by a law enforcement official in response to a warrant or similar process.
Family, Friends and Caregivers.
We may share your medical information with those you tell us will be helping you with your treatment or payment. We will ask your permission first. In case of an emergency, we will use our best judgment when sharing your medical information to those assisting in your care.
We may disclose medical information about you for research purposes, provided certain measures have been taken to protect your privacy.
To Avert a Serious Threat to Health or Safety.
We may use and disclose medical information about you, with some limitations, when necessary to prevent a serious threat to the health and safety of the public, you or another person.
Special Government Functions.
We may disclose information as required by military authorities or to authorized federal officials for national security and other governmental activities.
We may disclose medical information about you for workers’ compensation to allow these programs to provide benefits for work-related injuries or illness as required by state law.
OTHER USES OR DISCLOSURES WITH AN AUTHORIZATION
Other uses or disclosures of your medical information will be made only with your written authorization. Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing, and disclosures that would be a sale of medical information require your authorization. If you provide Bellport Perspective Eye Care with authorization to use or disclose medical information about you for purposes other than those listed above, you may revoke that authorization at any time by providing a written request to do so. If you revoke your authorization, 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 made already with your permission.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have certain rights regarding medical information that Bellport Perspective Eye Care obtains about you.
Right to Inspect and Copy Your Medical Information.
You have the right to inspect and request in writing a copy of your records that may be used to make decisions about you. Usually, this includes medical and billing records.
Right to Amend Your Medical Information.
If you feel that medical information maintained by Bellport Perspective Eye Care is incorrect or incomplete, you may request in writing that we amend the information.
Right to an Accounting of Disclosures by Bellport Perspective Eye Care.
You have the right to request in writing a list of the disclosures we have made of your medical information. The list will not include our disclosures related to your treatment, payment or our health care operations, disclosures made to you or with your authorization, and certain other disclosures.
Right to Request Restrictions on the Use and Disclosure of Your Medical Information.
You have the right to request in writing that we restrict or limit how we use or disclose your medical information for treatment, payment or health care operations. We are not required to agree to your request unless the disclosure is to a health plan for a payment or health care operation purpose and the medical information relates solely to a health care item or service for which we have been paid out out-of-pocket in full.
Right to Receive Confidential Communications.
You have the right to request in writing that we use a certain method to communicate with you or that we send information to a certain location if the communication could endanger you.
Right to a Paper Copy of This Notice.
You have a right at any time to obtain a paper copy of this Notice, even if you had previously agreed to receive an electronic copy.
Right to Notification of Breach of Medical Information.
You have the right to be notified following any breach of unsecured medical information that compromises the privacy of the information.
You have a right to express a complaint to Bellport Perspective Eye Care and/or to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been compromised. All complaints to Bellport Perspective Eye Care must be made in writing and sent to the contact listed at the end of this Notice. You will not be penalized for filing a complaint.
Bellport Perspective Eye Care/B.Cho Optometry PLLC’S LEGAL OBLIGATIONS
The federal privacy regulations require us to keep medical information about you private, to give you notice of our legal duties and privacy practices and to follow the terms of the notice currently in effect. We may change the terms of this notice and our privacy policies at any time. If we do, the new terms and policies will then apply to the medical information we maintain. If we make any material changes, we will distribute a new notice to our patients. We also post a copy of our current notice on our website at www.bellporteyecenter.com.
CONTACT Bellport Perspective Eye Care/B. Cho Optometry PLLC.
If you have any complaints or questions about this Notice or you want to submit a written request to Bellport Perspective Eye Care regarding your medical information, please contact:
B.Cho Optometry PLLC
5 Bellport Lane
Bellport, NY 11713
Telephone: (631) 286-4014