Corneal Consultants of Indiana, P.C., d/b/a Price Vision Group
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.
Understanding Your Medical Health Record Information
Each time that you visit a hospital, a physician, or another health care provider, the provider makes a record of your visit. Typically, this record contains your health history, current symptoms, examination and test results, diagnoses, treatment, and plan for future care or treatment. This information, often referred to as your medical record, serves as the following:
Understanding what is in your health record and how your health information is used helps you to—
Your Rights under the Federal Privacy Standard
Although your health records are the physical property of the health care provider who completed the records, you have the following rights with regard to the information contained therein:
In other situations, we may deny you access, but if we do, we must provide you a review of our decision denying access. These “reviewable” grounds for denial include the following:
For these reviewable grounds, another licensed professional must review the decision of the provider denying access within 60 days. If we deny you access, we will explain why and what your rights are, including how to seek review. If we grant access, we will tell you what, if anything, you have to do to get access. We reserve the right to charge a reasonable, cost-based fee for making copies.
If we deny your request for amendment/correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), and how you can complain. If we grant the request, we will make the correction and distribute the correction to those who need it and those whom you identify to us that you want to receive the corrected information.
We must provide the accounting within 60 days. The accounting must include the following
Date of each disclosure.
o Name and address of the organization or person who received the protected health information.
o Brief description of the information disclosed.
o Brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure or, in lieu of such statement, a copy of your written authorization or a copy of the written request for disclosure. The first accounting in any 12-month period is free. Thereafter, we reserve the right to charge a reasonable, cost-based fee.
• Revoke your consent or authorization to use or disclose health information except to the extent that we have taken action in reliance on the consent or authorization.
Our Responsibilities under the Federal Privacy Standard
In addition to providing you your rights, as detailed above, the federal privacy standard requires us to take the following measures:
• Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information.
• Provide you this notice as to our legal duties and privacy practices with respect to individually identifiable health information that we collect and maintain about you.
• Abide by the terms of this notice.
• Train our personnel concerning privacy and confidentiality.
• Implement a sanction policy to discipline those who breach privacy/confidentiality or our policies with regard thereto.
• Mitigate (lessen the harm of) any breach of privacy/confidentiality.
We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law. These include most uses or disclosures of psychotherapy notes, marketing communications, and sales of PHI. Other uses and disclosures not described in this notice will be made only with your written authorization.
Examples of Disclosures for Treatment, Payment, and Health Care Operations
• We may use your health information for treatment.
Example: A physician, a physician’s assistant, a therapist or a counselor, a nurse, or another member of your health care team will record information in your record to diagnose your condition and determine the best course of treatment for you. The primary caregiver will give treatment orders and document what he or she expects other members of the health care team to do to treat you. Those other members will then document the actions that they took and their observations. In that way, the primary caregiver will know how you are responding to treatment. We will also provide your physician, other health care professionals, or a subsequent health care provider copies of your records to assist them in treating you once we are no longer treating you. Note that some health information, such as substance abuse treatment information, may not be used or disclosed without your consent.
• We may use your health information for payment.
Example: We may send a bill to you or to a third-party payer, such as a health insurer. The information on or accompanying the bill may include information that identifies you, your diagnosis, treatment received, and supplies used. Note that some health information, such as substance abuse treatment information, may not be used or disclosed without your consent.
• We may use your health information for health care operations.
Example: Members of the medical staff, the risk or quality improvement manager, or members of the quality assurance team may use information in your health record to assess the care and outcomes in
your cases and the competence of the caregivers. We will use this information in an effort to continually improve the quality and effectiveness of the health care and services that we provide. Note that some health information, such as substance abuse treatment information, may not be used or disclosed without your consent.
• Business associates.
We provide some services through contracts with business associates. Examples include certain diagnostic tests, a copy service to make copies of medical records, and the like. When we use these
services, we may disclose your health information to the business associates so that they can perform the function(s) that we have contracted with them to do and bill you or your third-party payer for
services provided. To protect your health information, however, we require the business associates to appropriately safeguard your information. After February 17, 2010, business associates must comply with the same federal security and privacy rules as we do.
Unless you notify us that you object, we may use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.
We may use or disclose information to notify or assist in notifying a family member, a personal representative, or another person responsible for your care, location, and general condition.
• Communication with family.
Unless you object, we, as health professionals, using our best judgment, may disclose to a family member, another relative, a close personal friend, or any other person that you identify health information relevant to that person’s involvement in your care or payment related to your care.
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.
We may disclose health information to funeral directors consistent with applicable law to enable them to carry out their duties.
• Marketing/continuity of care.
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. If we contact you to provide marketing information for other products or services, you have the right to opt out of receiving such communications. At Price Vision Group, we leverage cookie-based technology to group users into
re-marketing audiences who have expressed an interest in our procedures by accessing key pages throughout our website. We do not collect any personally identifying information with this cookie. Audience members may be shown Price Vision Group text and/or image ads on 3rd party Internet sites for a limited period of time. Visitors may opt out of re-marketing by changing their Internet Ad
We may contact you as a part of a fundraising effort. You have the right to request not to receive subsequent fundraising materials.
• Food and Drug Administration (FDA).
We may disclose to the FDA health information relative to adverse effects/events with respect to food, drugs, supplements, product or product defects, or postmarketing surveillance information to enable product recalls, repairs, or replacement.
• Workers compensation.
We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
• Public health.
As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
• Correctional institution.
If you are an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
• Law enforcement.
We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
• Health oversight agencies and public health authorities.
If members of our work force or business associates believe in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially
endangering one or more patients, workers, or the public, they may disclose your health information to health oversight agencies and/or public health authorities, such as the Department of health.
• The federal Department of Health and Human Services (DHHS).
Under the privacy standards, we must disclose your health information to DHHS as necessary to determine our compliance with those standards.
Price Vision Group
9002 N. Meridian St, Ste 100
Indianapolis, IN 46260
Effective date: April 1, 2016
Name of covered entity: Corneal Consultants of Indiana, Inc., d/b/a Price Vision Group
April 1, 2016 Corneal Consultants of Indiana d/b/a Price Vision Group
HIPAA Documents Resource Center CD, 6th ed.
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