The Eye Center Surgeons and Associates provides the Notice of Privacy Practices to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Effective April 14, 2003

Understanding Your Health Record
Each time you visit The Eye Center Surgeons and Associates a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your medical record, serves as a:

• Basis for planning your care and treatment,
• Means of communication among the many 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,
• A tool in educating heath professionals,
• A source of data for medical research,
• A source of information for public health officials charged with improving the health of this state and the nation,
• A source of data for our planning and marketing,
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve,

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 disclosures to others.

Our Responsibilities
We understand that your protected health information is personal to you, and we are committed to protecting the information about you. We are required by law to:

• Maintain the privacy of your Protected Health Information;
• Provide you with this Notice of our Privacy Practices and your legal rights with respect to Protected Health Information about you;
• Follow the conditions of the Notice of Privacy Practices that is currently in effect;
• Notify you if we are unable to agree to a requested restriction, and;
• Accommodate, when possible, reasonable requests that you may have to communicate health information by alternative means or alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all Protected Health Information we maintain. We will not wittingly use or disclose your Protected Health Information without your authorization, except for treatment, payment and operations, and as described in this notice. We will also discontinue the use or disclosure of your Protected Health Information after we have received a written revocation of the authorization as provided by 45 CFR 164.508(b)(5). A written revocation of authorization to disclose Protected Health Information will be valid for disclosures from the date of receipt forward only, and is not retroactive.

Examples of Disclosures for Treatment,
Payment and Health Operations

How we may use and disclose Protected Health Information about you. The following categories describe different ways that we use and disclose Protected Health Information that we have and may share with others. Each category of uses or disclosures provides a general explanation and provides some examples of uses. Not every use or disclosure in a category is either listed or actually in place. The explanation is provided for your general information only.

• Medical Treatment. Information obtained by a technician, doctor or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. A doctor to whom we refer you for ongoing or further care may need a portion of your record. We may also disclose Protected Health Information about you to people outside the Practice who may be involved in your medical care, this may include your family members, or other personal representatives authorized by you or by a legal mandate (a guardian or other person who has been named to handle your medical decisions, should you become incompetent).
• Payment. We may use and disclose medical information about you for services and procedures so they may be billed and collected from you, an insurance company, or any other third party. For example, we may need to give your medical information, about treatment you received at The Eye Center, to obtain payment or reimbursement for care. We may also tell your health plan and/or referring physician about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment, to facilitate payment of a referring physician, or the like.
• Health Care Operations. We may use and disclose medical information about you so that we can run our Practice more efficiently and make sure that all of our patients receive quality care. These uses may include reviewing our treatment and services to evaluate the performance of our staff, deciding what additional services to offer and where and whether certain new treatments are effective. We may also use or disclose information about you for internal or external utilization review and/or quality assurance, to business associates for the purposes of helping us to comply with our legal requirements, to auditors to verify our records, to billing companies to aid us in this process and the like. We shall endeavor at all times when business associates are used, to advise them of their continued obligation to maintain the privacy of your medical records.
• Appointment and Patient Recall Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for medical care with or that you are due to receive periodic care from The Eye Center. This contact may be made by phone, in writing, by note card stating the type of exam you are due for, or otherwise and may involve the leaving of a message on an answering machine, with a contact person who answers the phone or reads the written reminder. This contact could potentially be received by or intercepted by others. The Eye Center may contact you at any phone number or address that you provide to us. If you do not wish for us to contact you at a specific number/address that you have provided, you must stipulate as to the nature of the restriction in writing. The Eye Center will make every effort to comply with your request but is not responsible for inadvertent contact made in the course of normal business operations.
• Emergency Situations. In addition, we may disclose Protected Health Information about you to an organization assisting in a disaster relief effort or in an emergency situation so that your family can be notified about your condition, status and location.
• Research. Under certain circumstances, we may use and disclose Protected Health Information for research purposes such as the Eye Injury Registry.
• Required by Law. We will disclose Protected Health Information about you when required to do so by federal, state or local law. If you are involved in a lawsuit or dispute, we may disclose medical information about in response to a court or administrative order. This is particularly true if you make your health an issue. We may disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. We may also use such information to defend ourselves or any member of our Practice in any actual or threatened action.
• Correctional Institution. Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof Protected Health Information necessary for your health and the safety of other individuals.
• Public Health Risks. As required by law, we may disclose your Protected Health Information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, to report child abuse or neglect, in reporting reactions to medications or problems with products, to notify people of recalls of products they are using, to notify a person who may have been exposed to a disease or may be at risk of spreading or contracting the condition, to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence (we will only make this disclosure if you agree or when required or authorized to do so).
• Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits from work-related injuries or illness.
• Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
• Investigation and Government Activities. We may disclose medical information to a local, state, or federal oversight activity authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
• Glasses/Contact Rx. We may and probably will fax/verbally give your glasses and/or contact lens prescriptions to any vendor requesting them on your behalf. It is unlikely that this vendor will be required to follow HIPAA guidelines. We will only give your name, date of birth and prescription in an effort to limit the amount of Protected Health Information Disclosed about you.

Your Health Information Rights
Although your health record is the physical property of The Eye Center Surgeons and Associates, the information belongs to you. You have the right to:

• Obtain a paper copy of this notice of information practices upon request,
• Inspect and copy your health record as provided for in 45 CFR 164.524,
• Amend your health record as provided in 45 CFR 164.526,
• Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528,
• Request communications of your health information by alternative means or at alternative locations,
• Receive confidential communications of Protected Health Information as provided by 45 CFR 164.522(b) as applicable
• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522(a), and

You may revoke your authorization to use or disclose health information in writing except to the extent that action has already been taken.

For More Information or to Report a Problem:
If have questions and would like additional information, you may contact the practice’s Privacy Officer, Ann Marie Giuliano, C.O.A. at 256-705-3937 ext 220, or in writing at:

The Eye Center Surgeons and Associates, LLC
Attn: Privacy Officer, Ann Marie Giuliano, C.O.A.

401 Meridian Street, Suite 200
Huntsville, AL 35801

If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201