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. We are required by law to maintain the privacy of your protected health information (PHI). This notice applies to all records of the health care and services you received at the Santamaria Eye Center. This notice will tell you about the ways in which we may use and disclose your PHI. This notice also describes your rights and certain obligations we have regarding the use and disclosure of your PHI.

This notice describes the Santamaria Eye Center’s privacy practices, as well as the privacy practices of:

any health care professional authorized to enter information into your Santamaria Eye Center medical record;
all departments, sections and units of the Santamaria Eye Center; and
all employees, staff, students and other Santamaria Eye Center personnel.

Santamaria Eye Center’s Commitment

We are required by law to:

make sure that your PHI is kept private;
give you this notice of our legal duties and privacy practices with respect to your PHI;
follow the terms of this notice as long as it is currently in effect. If we revise this notice, we will follow the terms of the revised notice as long as it is currently in effect;
train our personnel concerning privacy and confidentiality; and mitigate (lessen the harm of) any breach of privacy/confidentiality.

Understanding Your Health Record

Each time you visit the Santamaria Eye Center, a record of your visit is made. Typically, this record contains your diagnoses, examination and test results, treatment, and a plan for care or treatment. This information, often referred to as your health or medical record, serves as a:

basis for planning your care, treatment and any follow up care you may need;
means of communication among the health professionals who contribute to your care;
legal document describing the care you received;
means by which you or a third-party payer can verify that services billed were actually provided;
tool in educating heath professionals;
source of information for medical research;
source of information for public health officials charged with improving the health of the nation;
source of information for facility planning and marketing; and
tool which can be used to assess and improve the care rendered and the results achieved.

Understanding what is in your record and how your health information is used helps you to:

ensure its accuracy;
better understand who, what, when, where and why others may access your health information; and
make more informed decisions when authorizing disclosure to others.

How We May Use and Disclose Information about You

The following categories (listed in bold-face print, below) describe different ways that we use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and give you 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 fall within the categories below.

For Treatment. We are permitted to use and disclose your PHI to doctors, nurses, technicians, medical students or other personnel who are involved in taking care of you at the Santamaria Eye Center or provide you with medical treatment or services. For example, a doctor treating you may need to know if you have diabetes because diabetes may slow the healing process. Different departments of the Santamaria Eye Center also may share your PHI in order to coordinate the different services that you need. We also may disclose your PHI to health care providers outside the Santamaria Eye Center who may be involved in your medical care such as physicians who will provide follow-up care.

For Payment. We are permitted to use and disclose your PHI so that the treatment and services you receive at the Santamaria Eye Center may be billed to (and payment may be collected from) a third party. For example, we may need to give your health plan information about the surgery you received at the Santamaria Eye Center so your health plan will pay us or reimburse you for the surgery. We also may 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.

To Business Associates for Treatment, Payment and Health Care Operations. We are permitted to disclose your PHI to our business associates in order to carry out treatment, payment or health care operations. For example, we may disclose your PHI to a company we hire to help us obtain payment for the health care services we provide.

Individuals Involved in Your Care or Payment for Your Care. We may release your PHI to a family member other relative or close personal friend who is involved in your medical care if the PHI released is directly relevant to the person’s involvement with your care. We also may release information to someone who helps pay for your care.

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 the Santamaria Eye Center.

Treatment Alternatives. We may use and disclose medical information to give you information about 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.

Special Situations

As Required By Law. We will disclose your PHI when required to do so by federal, state, or local law.

Public Health Activities. We may disclose your PHI for public health activities. For example, public health activities generally include:

reporting reactions to medications or problems with products; or
notifying patients of recalls of products they may be using.

Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law such as audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care 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 your PHI in response to a court or administrative order. We may also disclose your PHI 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 PHI if asked to do so by a law enforcement official:

in response to a court order, subpoena, warrant, summons or similar process; or
about criminal conduct we believed occurred on the Santamaria Eye Center’s premises.

Research. Under certain circumstances, we may use and disclose your PHI for research purposes. For example, a research project may involve comparing the outcomes of surgeries of all patients who received treatment from a particular laser to those who received treatment from another laser. Most research projects, however, are subject to a special approval process. This process requires an evaluation of the proposed research project and its use of PHI, and balances these research needs with our patients’ need for privacy. Before we use or disclose PHI for research, the project will have been approved through this special approval process. However, this special approval process is not required when we allow researchers who are preparing a research project to look at information about patients with specific medical needs, so long as the PHI they review does not leave the Santamaria Eye Center.

Armed Forces and Foreign Military Personnel. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.

National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

When Your Authorization is Required

Uses or disclosures of your PHI for other purposes or activities not listed above will be made only with your written authorization (permission). If you provide us authorization to use or disclose your PHI, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written permission. However, we are unable to take back any disclosures we have already made with your permission.

You may obtain a paper authorization form by contacting:

Santamaria Eye Center

104 Market Street
Perth Amboy, NJ 08861