PILKINTON EYE CENTER
R. DALE PILKINTON, M.D.
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.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting the privacy of this information. We create a record of the care and services you receive at this facility and we need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Pilkinton Eye Center, whether made by personnel or your physician.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
You may exercise your rights set forth in this notice, by providing a written request to Pilkinton Eye Center, Privacy Officer, 300 20th Ave, N. Suite 504, Nashville, Tennessee 37203.
HOW WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Generally, we may not use or disclose your protected health information without your written authorization. However, in certain circumstances, we are permitted to use your protected health information with authorization. The following categories describe different ways that we may use and disclose your health information without your written authorization. For each category of uses or disclosures, we will explain what we mean and try to give 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 without your written authorization should fall within one of these categories.
We may use or disclose your health information for treatment.
For example: We may disclose your protected health information to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you within Pilkinton Eye Center. We may share medical information about you in order to coordinate different treatments, such as prescriptions, lab work and x-rays. We may also provide your physician or a subsequent health-care provider with copies of various reports to assist in treating you once you are discharged from care at Pilkinton Eye Center.
We may use or disclose your health information for payment.
For example: We may send a bill to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
We may use or disclose your health information for health care operations.
For example: We may use the information in your health record to assess the care and outcome in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide. We may otherwise use the information about you, as needed, to facilitate the operation of our facility.
We may use or disclose your health information as otherwise allowed by law.
The following categories describe different ways that we may use and disclose your protected health information for other than treatment, payment or health care operations without your written authorizations. Some of the examples listed in these categories may require your permission, though your permission need not be given in writing. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information for other than treatment, payment or health care operations without your written authorization should fall within one of these categories.
Business associates: We provide some services through business associates. Examples include certain laboratory tests, and copy services. To protect your information, however, we require business associates to take appropriate measures to safeguard your information.
Involvement in Care or Notification: We may use or disclose information to family members or others whom you have involved in your care or to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location, general condition or death.
Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Funeral directors coroners and medical examiners: We may disclose information to funeral directors, coroners and medical examiners consistent with applicable law to carry out their duties.
Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Communications for treatment and health care operations: We may contact you to provide appointment reminders (by phone or postcard) or information about treatment alternatives or other health related benefits and services that may be of interest to you.
Marketing: We may communicate with you face-to-face regarding goods and services that may be of interest to you and may provide you with promotional gifts of nominal value.
Fund raising: We may contact you as part of a fund-raising effort.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, medications, devices, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities might include audits, investigations, inspections, and licensure. The activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.
Worker’s compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Public health: Consistent with applicable law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Abuse, neglect or domestic violence: Consistent with applicable law, we may disclose health information to a governmental authority authorized by law to receive reports of abuse, neglect, or domestic violence.
Judicial, administrative and law enforcement purposes: Consistent with applicable law, we may disclose health information about you for judicial, administrative and law enforcement purposes. This may include, for example, disclosures to avert a serious threat to your or a third party’s health or safety as well as victims of crime or criminal conduct at Pilkinton Eye Center.
To avert a serious threat to health or safety: Consistent with applicable law, we may use and disclose your health information when we believe it is necessary to prevent a serious threat to your health and safety or the health and safety or the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat or to law enforcement authorities in particular circumstances.
National security and intelligence activities: We may release your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations to the extent permitted by law.
Custodial situations: If you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain representations to us, we may disclose your health information to a correctional institution or law enforcement official in certain circumstances.
Required or allowed by law: We may use and disclose your protected health information required to do so by federal, state or local law.
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of Pilkinton Eye Center, the information belongs to you. You have the right to:
Request a restriction on certain uses and disclosures of your protected health information for treatment, payment, or health care operations. You also have the right to request restrictions on certain disclosures to persons, such as family members involved with your care or the payment for your care. However, we are not required to agree to these requests. We will attempt to notify you if we are unable to grant your request;
Obtain a copy of this notice of privacy practices upon request. You may request a paper copy of this notice, in person at Pilkinton Eye Center.
Inspect and request a copy of your health record as provided by law;
Request that we amend your health record as provided by law. We will attempt to notify you if we are unable to grant your request;
Obtain an accounting of certain disclosures of your protected health information as provided by law;
Request communications of your protected health information by alternative means or at alternative locations. We will accommodate reasonable requests; and
Revoke your authorization to use or disclose your protected health information except to the extent that action has already been taken in reliance on your authorization.
OUR RESPONSIBILITIES
In addition to the responsibilities set forth above, we are also required to:
Maintain the privacy of your health information;
Provide you with a notice as to our legal duties and privacy practices with respect to protected health information we maintain about you;
Abide by the terms of Pilkinton Eye Center’s Notice of Privacy Practices currently in effect;
We reserve the right to change our practices and to make changes effective for all protected health information we maintain, including information created or received before the change. Should our privacy practices change, we are not required to notify you, but we may post the revised notice at Pilkinton Eye Center and you may request copies of the revised notice in person at Pilkinton Eye Center.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information, you may contact Pilkinton Eye Center’s Privacy/Security officer at 615/329-7890.
If you believe your privacy rights have been violated, you can file a written complaint with Pilkinton Eye Center’s Privacy/Security officer and mail to Pilkinton Eye Center, 300 20th Ave. N., Suite 408, Nashville, Tennessee 37203, or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
Effective 4-14-03