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.
Effective Date: September 2023
Our Commitment to Your Privacy
Your privacy is important to us. We are required by federal law to maintain the privacy of your protected health information (PHI), provide you with this Notice of Privacy Practices, and follow the terms of this notice.
How We May Use and Disclose Your Health Information
Treatment to provide medical care and coordinate treatment with physicians, nurses, pharmacies, laboratories, and other healthcare providers involved in your care.
Payment to bill and collect payment from Medicare, Medicaid, private insurance companies, workers’ compensations programs, or other responsible parties.
Healthcare Operations to improve the quality of care, conduct quality assessments, perform staff training, accreditation activities, risk management, and business planning.
Other Permitted Uses and Disclosures
We may disclose your information:
As required by law.
For public health activities.
To report abuse, neglect, or domestic violence.
For health oversight activities.
In response to court orders or legal proceedings.
To law enforcement officials when permitted by law.
To avert a serious threat to health or safety.
For workers’ compensation claims.
To coroners, medical examiners, or funeral directors.
For approved research, when permitted by law.
Uses Requiring you Authorization
We will obtain your written authorization before:
Using or disclosing psychotherapy notes (when applicable).
Using your information for most marketing purposes.
Selling your protected health information
You may revoke your authorization at any time in writing,
Your Rights
You have rights to:
Request access to your medical records.
Request a copy of your health information.
Request corrections to your records.
Request restrictions on certain uses or disclosures.
Request confidential communications by alternative means or locations.
Receive and accounting of certain disclosures.
Obtain a paper copy of the Notice upon request.
Our Responsibilities
We are required to:
Protect the privacy and security of your heart information.
Notify you if a breach occurs that may have comprised your information.
Follow the practices described in the Notice.
Provide you with an updated Notice whenever material changes occur.
Questions or Concerns
If you believe your privacy rights have been violated, you may contact:
Privacy Officer: Maria Ruttig
Ambulatory Surgery Center: Eye MD of Niceville Surgery LLC
Address: 1480 Hickory Street, Suite 106
Niceville, FL, 32578
Phone: 850-760-0520
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Upon request, the Privacy & Security Compliance Office will provide you with the correct address for the Director. You will not be retaliated against for filing a complaint.
Acknowledgment
Patients will be asked to acknowledge receipt of this Notice of Privacy Practices. Receiving treatment is not condition on signing the acknowledgment.