Mark W. Preslan, M.D., F.A.C.S.
Pediatric Ophthalmology and Adult Strabismus – (410) 356-9876
Notice of Privacy Practices-Effective 4/14/03
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 respect the need to maintain confidentiality of "Protected Health Information" (PHI) about you and are obligated by law to provide you with this notice of privacy practices, which describes how we will protect your health information (PHI).
TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS-this is the most common reason we use your PHI. Healthcare information will be recorded in your medical record and may be shared with other providers in the course of your treatment. Examples include consultation with other specialists or pharmacy prescriptions.
Your PHI will be used in order to receive payment for services rendered by this office. A bill or claim may be sent to either you or a third party payer with information that identifies you, your diagnosis and/or procedure performed.
Staff in this office may use your PHI to assess care you received with the purpose of improving the quality and effectiveness of the care and services we provide.
In certain ADDITIONAL CIRCUMSTANCES, as listed below, we may need, or be required, to disclose all or part of your PHI without your permission:
1. Business Associates that assist this office in providing healthcare may need to view PHI and are required to follow the same standards for protecting your information. 2. Family members: We may share relevant PHI with family members in the course of providing your healthcare, unless you have instructed us otherwise. 3. Government Agencies: we may be required, by law, to disclose your PHI to:
Public health agencies (as in contagious diseases, disease surveillance)
Food and Drug Administration - (adverse drug effects or product defects)
Law enforcement agencies in the event of abuse, neglect or domestic violence
Healthcare oversight agencies at the state and/or federal level
Judicial proceedings – such as court orders and subpoenas
Correctional facilities – PHI relating to incarcerated individuals 4. Funeral directors, consistent with the law, organ procurement organizations 5. Worker’s Compensation: information released to the extent authorized by law 6. Special Government Needs – as required by law, for the military, national security 7. Notification: we may contact you to remind you about appointments, to discuss treatment options or other health-related benefits
OTHER USES AND DISCLOSURES
We may not make any other use or disclosure of your PHI without your written authorization. Once given, you may revoke an authorization in writing to our privacy officer. Any disclosure previously made with your permission cannot be rescinded.
YOUR RIGHTS REGARDING HEALTH INFORMATION- you have many rights concerning the confidentiality of your PHI:
Your health record is the physical property of our practice, but the content is about you, and therefore belongs to you. You have the right to request, in writing, restrictions on certain uses and disclosures of your information. We do not have to agree to a restriction and must notify you in writing if we are unable to grant your restriction.
You have the right to receive confidential communication regarding PHI by alternative means or at alternative locations, if the request is reasonable and you are willing to bear any additional cost associated with this alternative request.
Your rights include being able to review or obtain a paper copy of your PHI. This request must be in writing and may involve a fee for copying and forwarding this information. In certain limited circumstances, by law, we may deny your request to review/copy PHI and will provide a written explanation and method of review.
You have the right to amend your PHI. By law, information cannot be deleted from the medical record. Requests to amend PHI should be in writing to this office, and include a detailed explanation of your reasons for amending the medical record.
You have the right to receive an accounting of all disclosures of your PHI after 4/14/2003, for a period of 6 years prior. This account will not contain disclosures for treatment, payment, healthcare operations, special circumstances listed above and those authorized by you. You have the right to receive a paper copy of this privacy notice.
Complaints: If you believe we have violated your privacy rights, a complaint can be made verbally or in writing to our privacy officer (410-356-9876) or to the U.S. Department of Health and Human Services, without fear of retaliation by this office.
Contact Person: All questions, comments or requests should be directed to:
Mark W. Preslan, M.D., F.A.C.S.
Changes to this Notice: We reserve the right to change our privacy practices and effect new provisions that enhance the privacy standards of your PHI. Any revision to our privacy practices will be described in a revised notice posted prominently in our office.
Notice Effective Date: April 14, 2003