THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. When signing the “Authorization for Examination and Treatment” form you are authorizing the following:
Center For Sight and any physician examining and/or treating you to release to any subsequent treating physician any medical information and/or records concerning diagnosis and treatment.
Medical records and/or information will be shared with third party payers, such as insurance companies or the Social Security Administration or its intermediaries or carriers when requested for use in connection with determining a claim for payment.
We may use or disclose your health information to provide you with appointment reminders, including but not limited to voicemail messages, postcards or letters.
Medical record information may be used in performing the following activities:
- Quality Improvement
- Underwriting, premium rating and other insurance activities
- Business planning and development
- Compliance management
- Resolution of internal grievances
- Reviewing competence or qualifications of healthcare professionals
- Conducting or arranging for medical review, legal services and auditing functions, including fraud and abuse detection and compliance programs
- General administrative duties including, but not limited to:
- Customer service
- You have the right to request restrictions regarding usage / disclosure of information
- You have the right to inspect and copy protected health information
- You have the right to receive an accounting of disclosures
- You have the right to receive confidential communications
- You have the right to amend incorrect or incomplete protected health information
- You have the right to receive a paper copy of this Notice
Additional HIPAA compliance notification information is available. Please ask to speak to the Privacy Officer if you have any questions.