OF PRIVACY PRACTICES
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.
as of April 14, 2003.
We are required
by law to maintain the privacy of your protected health information
and to provide you with notice of our legal duties and privacy practices
with respect to 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 care services.
We are required to abide by the terms of our Notice of Privacy Practices
("Notice") currently in effect. We reserve the right to make changes
to the terms of our Notice and to make such new Notice provisions
effective as to all your protected health information ("PHI"). We
will post each revised Notice in our office, make copies of the
revised Notice available upon request and post the revised Notice
on our web site.
AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITHOUT YOUR CONSENT.
may use or disclose your PHI to provide and coordinate your health
care and related services. This may include communications with
other health care professionals regarding your health care, including
your referral to another health care provider. For example, we may
share PHI with other health care providers involved in your treatment,
such with a pharmacy when calling in your prescription.
may use or disclose your PHI to obtain payment or be reimbursed
for the health care and related services we provide for you. Such
disclosures can be made to billing services, collection departments
or credit bureaus. For example, even before you receive services,
we may disclose your PHI with your health plan(s) to determine coverage
Care Operations. We
may use or disclose PHI in connection with certain administrative,
financial, legal and quality improvement activities that are necessary
for us to run our practice and to support our functions of treatment
and payment. For example, we may use or disclose your PHI for quality
assessments and improvement activities, employee training programs,
licensing requirements, or conducting a medical review or audit.
Use or Disclosure.
"incidental use or disclosure" is a use or disclosure that cannot
reasonably be prevented, is limited in nature and occurs as a result
of another permissible or required use or disclosure. We have set
up reasonable safeguards that protect against impermissible uses
and disclosures and limits incidental uses or disclosures. We also
have policies and procedures that set limits to ensure that, as
applicable, only the reasonable minimum necessary amount of your
PHI is used, disclosed and requested for certain purposes.
Can Object to Certain Uses or Disclosures.
each of the uses or disclosures of your PHI listed below, if you
are present and able, we will either (1) obtain your oral permission,
(2) give you the opportunity to object, or (3) reasonably infer
from the circumstances, based on our professional judgment, that
you do not object. If you are unable to object, we will use our
professional judgment to disclose only such PHI as is directly related
to such person's involvement in your health care. For uses or disclosures:
to a relative, friend or other person identified by you only your
PHI that is directly relevant to that person's involvement in
your health care or payment for health care;
to a family member, personal representative, or other person responsible
for your care only your PHI necessary to notify such individuals
of your location, general condition or death; or ·
a private or public agency for disaster relief purposes. (Even
if you object, we are still permitted to share your PHI as necessary
for emergency circumstances.)
Uses or Disclosures. We are required
by law to disclose your PHI to you pursuant to your patient right
of access and accounting as described below. We are also required
to disclose your PHI to the Secretary of the Department of Health
and Human Services when required for their investigation of our
compliance with privacy laws.
Contact with You. We may use or disclose
your PHI to provide you with appointment reminders (such as sending
postcards or leaving a voicemail message, etc.), to provide you
information regarding treatment alternatives or other health-related
benefits and services that may be of interest to you.
Associates. We may use and disclose
your PHI with our business associates.
A "business associate" is a person or entity that provides certain
functions, activities or services on our behalf pursuant to a written
agreement that contains terms regarding protection of your PHI.
Uses and Disclosures. We may use or disclose
your PHI when such use or disclosure is:
by law or used for law enforcement purposes; · necessary for public
to report abuse, neglect or domestic violence; · for health oversight
- for judicial
and administration proceedings; ·
- for medical
- to coroners,
medical examiners or funeral directors; · for cadaveric organ,
eye or tissue donation purposes;
- to avert
a serious threat to the health or safety of a person or the public;
- for specialized
governmental functions; or
- for workers
USES AND DISCLOSURES OF YOUR PHI REQUIRES YOUR WRITTEN AUTHORIZATION.
You may authorize us to use or disclose your PHI for other purposes.
You may revoke this authorization in writing at any time; however,
your revocation will not apply to any uses or disclosures that were
being processed before we received your revocation.
You have the right to ask us to restrict
our uses or disclosures of part or all of your PHI for treatment,
payment, health care operations or to individuals involved in your
care. However, we are not required to agree to your requested restriction.
If we do agree to your restriction, we will only use and disclose
your PHI in accordance with such restriction, unless otherwise permitted
or required by law.
Communications. You have the right
to request that communications about your PHI be delivered by an
alternative means or at alternative locations. For example, you
may request that we contact you at your workplace about appointments.
You must make such requests in writing. We will accommodate reasonable
requests, but may condition such accommodations upon our receipt
of a satisfactory explanation of how payments for your services
will be handled and an alternative address or other method of contact.
You have the right to inspect and obtain a copy
of your PHI contained in clinical, billing and certain other records
used to make decisions about you, except in certain limited situations.
Your request must be in writing, and we will charge you reasonable
cost-based fees for expenses (such as copying and employee time).
Instead of copies we may provide you with a summary of your PHI,
if you agree to the form and cost of such summary. We may, in some
cases, deny your request and will notify you in writing of the reasons
for our denial and provide you with information regarding your rights
to have our denial of your request reviewed.
You have the right to request an amendment
to your PHI contained in clinical, billing and certain other records
used to make decisions about you, except in certain limited situations.
Your request must be in writing and provide a reason to support
the requested amendment. We may, in some cases, deny your request
for amendment and will notify you in writing of the reasons for
our denial, provide you with information regarding your rights to
submit a written statement disagreeing with such denial and provide
information on how to file such statement.
You have the right to receive a listing of disclosures
of your PHI made for purposes other than treatment, payment, health
care operations, upon your request, your authorization, to individuals
involved in your care or as allowed by law. You may request all
such disclosures made during the last 6 years (but not any disclosures
made prior to April 14, 2003). If you request this list more than
once in a 12-month period, we may charge you reasonable cost-based
expenses to comply with your additional request.
Notice. If you received this notice by email
or off our web site, you have the right to receive this notice in
written form upon your request. You may request a written copy of
this Notice by contacting our business office.
you have any questions or feel that your privacy rights have been
violated by us or want to complain to us about our privacy practices,
you can contact our Privacy Officer at 1201 11th Avenue South, Suite
300, Birmingham, Alabama 35205 or by calling 205-933-2625.
also submit a written complaint to the U.S. Department of Health
and Human Services. We will not retaliate in any way against you
if you choose to file a complaint with us or the U.S. Department
of Health and Human Services.
us at 205-933-2625 or 800-292-8166.
or E-Mai lRetina
Specialists of Alabama