Effective date of notice: April 14, 2003
NOTICE OF PRIVACY PRACTICES
Dr Barry P Siegel, Optometrist, P.C.
1926 W Irving Park Rd.
NOTICE OF PRIVACY PRACTICES
Note: This Notice of Privacy Practices is provided for educational and informational purposes only. This Notice is not intended as legal advice, and is not provided for adoption or publication by any party. The publication of any such notice may create legal obligations or liabilities which may vary depending upon the legal status and business operations of different organizations. The form and content of any Notice of Privacy Practices should be determined only upon informed consultation with qualified legal counsel, including consideration of any state laws that are more stringent than the rights outlined in this Notice.
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.
THIS NOTICE IS EFFECTIVE April 14th, 2003 UNTIL FURTHER NOTICE.
DR. BARRY P. SIEGEL is required by law to maintain the privacy of your protected health information. We are required to abide by the terms of this notice as it is currently stated, and reserve the right to change this notice and make the new policies effective for all protected health information that we maintain. The policies in any new notice will not be in effect until they are posted to this site and are available in our office. We will make any new notice available to you upon request.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Routine Uses and Disclosures of Protected Health Information for Treatment, Payment or Health Care Operations
As a patient, you have certain rights relating to the uses and disclosures of your protected health information. Under the Health Insurance Portability and Accountability Act (HIPAA), DR. BARRY P. SIEGEL can use and disclose your protected health information without your specific permission for treatment, payment and health care operations.
Set out below are examples of the uses and disclosures of your protected health information DR. BARRY P. SIEGEL is permitted to make for these routine purposes. While this list is not exhaustive, it should give you an idea of the everyday uses and disclosures “behind” the scenes that are essential to the care you receive.
a) Treatment – We may use or disclose your health information for purposes of providing treatment to you. For example, your protected health information will be used to diagnose and counsel you regarding your health condition and appropriate treatment options.
We may also use and disclose your protected health information to provide you with information regarding possible alternative treatment options and other health-related benefits and services that we believe might interest you. For example, we may use or disclose your health information to provide you with appointment reminders via phone, e-mail or letter.
b) Payment – We may use and disclose your health information to obtain payment for services we provide you. For example, we may communicate your protected health information to your insurance company so that it can process payment for your office visit.
c) Health care operations – We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competency or qualifications of healthcare professionals, evaluating provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
Other Uses and Disclosures of Protected Health Information DR. BARRY P. SIEGEL is Permitted or Required to Make Without Your Authorization
Most uses and disclosures that do not fall under treatment, payment, or health care operations will require your written authorization. However, there are exceptions to this general rule pursuant to which we are permitted or required to make certain uses and disclosures or your protected health information. These situations include:
Required by the Secretary of Health and Human Services
We may be required to disclose your protected health information to the Secretary of Health and Human Services to investigate or determine our compliance with the federal privacy law.
Required by Law
We may also use or disclose your health information when we are required to do so by state or federal law.
Public Health: We may disclose your protected health information for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the victim of other crimes.
We may disclose protected health information to a health oversight agency for activities authorized by law, such as: civil or criminal investigations; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight, governmental health benefit programs, or compliance with laws.
Judicial and Administrative Proceedings
We may disclose protected health information in response to a court or agency order, and, in some cases, in response to a subpoena or other lawful process not accompanied by a court order.
We may disclose protected health information for law enforcement purposes, such as providing information to the police about the victim of a crime.
Coroners, Medical Examiners, and Funeral Directors
We may disclose protected health information to a coroner, medical examiner, or funeral director if it is needed to carry out their duties. We also may disclose protected health information to facilitate organ donation or transplantation.
We may disclose your protected health information to researchers when the research is being conducted under established protocols to ensure the privacy of your information.
Serious Threat to Health or Safety
Your protected health information may be disclosed if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and it is to someone we reasonably believe is able to prevent or lessen the threat.
In the event of your incapacity or an emergency situation, we will disclose health information to a family member, or another person responsible for your care, using our professional judgment. We will only disclose health information that is directly relevant to the person’s involvement in your healthcare.
We may disclose the health information of Armed Forces personnel to military authorities under certain circumstances. We may disclose health information to authorized federal officials required for lawful intelligence, counterintelligence and other national security activities.
We may disclose health information of inmates to the appropriate authorities under certain circumstances.
Your protected health information may be disclosed to comply with workers’ compensation laws and other similar programs.
Disclosures to Other Parties for Conducting Permitted Activities
DR. BARRY P. SIEGEL may conduct the above-described activities ourselves, or we may use other entities to perform those operations. In those instances where we disclose your protected health information to a third party acting on our behalf, we will protect your protected health information through an appropriate privacy agreement.
Other Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
We will not use your health information for marketing communications without your written authorization.
Other uses and disclosures of your protected health information not described above will be made only with your written authorization. You may revoke your authorization (in writing) through our practice at any time, except to the extent that we have taken action in reliance on the authorization.
You have the right to request a restriction on certain uses and disclosures of your protected health information. This means that you may ask us not to use or disclose any part of your protected health information for purposes of treatment, payment, or health care operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care. Your request must be in writing and must state the specific restriction requested and to whom you want the restriction to apply.
DR. BARRY P. SIEGEL is not required to agree to such a restriction. If we do agree, we will abide by your restriction unless we need to use your protected health information to provide emergency treatment. In addition, we may elect to terminate the restriction at any time.
You have the right to request to receive information from us by an alternative means or at an alternative location if you believe it would enhance your privacy. For example, you may request that we send written communications to an alternative address. We will attempt to accommodate all reasonable requests, and will not request an explanation from you as to the basis for your request.
You have the right to inspect and copy your protected health information. If you would like to see or copy your protected health information, we are required to provide you access to your protected health information for inspection and copying within 30 days after receipt of your request (60 days if the information is stored off-site). We may charge you a reasonable fee to cover duplicating costs. In addition, there may be situations where we may decide to deny your request for access. For example, we may deny your request if we believe the disclosure will endanger your life or health, or that of another person. Depending on the circumstances of the denial, you may have a right to have this decision reviewed.
You have the right to amend your protected health information. This means you may request an amendment of your protected health information in our records for as long as we maintain this information. We will respond to your request within 60 days (with up to a 30-day extension, if needed). We may deny your request if, for example, we determine that your protected health information is accurate and complete. If we deny your request, we will send you a written explanation and allow you to submit a written statement of disagreement.
You have the right to receive an accounting of certain disclosures we have made of your protected health information. An accounting is a record of the disclosures that have been made of protected health information. This right generally applies to non-routine disclosures, i.e., for purposes other than treatment, payment, or health care operations as described in this Notice, made in the six-year period prior to your request (although you are free to request an accounting for a shorter period). We are required to provide the accounting within 60 days (with one 30-day extension, if needed) and to provide one accounting free of charge in any 12-month period (for more frequent requests, a reasonable fee may be charged).
You have the right to obtain a paper copy of this notice from DR. BARRY P. SIEGEL .
If you believe your privacy rights have been violated, you have the right to report such alleged violations to DR. BARRY P. SIEGEL , and we will promptly investigate the matter. You may file a complaint with DR. BARRY P. SIEGEL by contacting our office. Rest assured we will not retaliate against you in any way for filing a complaint about our privacy practices. You may also contact the Secretary of Health and Human Services.
For further information about DR. BARRY P. SIEGEL ‘s privacy policies, please contact our Privacy Officer at the following address or phone number:
DR. BARRY P. SIEGEL
1926 W Irving Park Rd
Chicago , IL, 60613