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PATIENT PRIVACY
& PRIVACY PRACTICES
of
the
FLORIDA OPTOMETRIC
PHYSICIANS NETWORK
The
Information Provided Here Will Describe How Medical Information
about Patients Served Through a FLORIDA OPTOMETRIC PHYSICIANS NETWORK
Managed-Care Program May Be Used and Disclosed, and How an FOPN
Patient Can Get Access to That Information. Please Review
This Information Carefully.
AN
OBLIGATION TO OUR PATIENTS
The
FLORIDA OPTOMETRIC PHYSICIANS NETWORK is sincerely committed to
protecting the privacy of our patients and their medical information.
We are required by law to maintain the confidentiality of all information
which may identify a patient and any health-care services he or
she has received in the past or is now receiving, as well as all
information regarding payments for those services and other financial
information. We are also required to give patients notice
of our privacy practices and our legal responsibilities regarding
their rights. We disclose information only when absolutely
necessary — and then, only to appropriate persons or companies
involved in the delivery or administration of those services and
related matters — and those other persons or companies are bound
by the same patient-privacy rules as we are. We require those other
persons and companies to protect our patients privacy, too.
HOW
WE USE & DISCLOSE INFORMATION
FOR
TREATMENT:
We may receive information, for example, about a patient from Medicaid
or Medicare, the patient’s primary-care physician or the patient
him- or herself. In order to provide the services called for,
we may share this information among our various departments to conduct
the “business of our business” — that is, to schedule and perform
comprehensive eye examinations, to evaluate the findings of those
exams and recommend appropriate care and treatment, to produce and/or
dispense corrective lenses called for (eyeglasses and/or contact
lenses) and, when appropriate, to refer patients to another practice
for follow-up care and treatment.
FOR
PAYMENT:
We provide appropriate coverage information to our Network physicians
when Health Plan members or another party representing them calls
to schedule an exam. We may contact the Department of Health
or the Health Plan itself to confirm member eligibility for services.
FOPN will share information among its departments for the purpose
of determining eligibility, pre-authorization, payment or enrollment
data, and we may also use or disclose information to obtain payment
from third parties who may be responsible for payment, such as Health
Plans or other insurance companies.
FOR
HEALTH-CARE OPERATIONS:
We conduct quality assessment and improvement activities, for example,
in order to improve the performance of FOPN overall and our individual
Network Providers. We also use information for facility management
and strategic planning.
TO
OTHER PROVIDERS:
For example, for their treatment, payment and/or operations support
as those activities relate to a patient’s evaluation, care and treatment.
TO
INDIVIDUALS: To
individuals involved in a patient’s care if the patient or
legal guardian has given us the name of such person in writing at
some point since enrolling in a Health Plan we support. We
will also give information about a child to the child’s parent or
legal guardian, and we may disclose information to Disaster Relief
Organizations such as the Red Cross, when appropriate, so that they
can contact the patient’s family if that is necessary.
FOR
APPOINTMENTS AND SERVICES:
To remind a patient of an appointment, for example, or tell a patient
about treatment alternatives or health-related benefits available
through FOPN or the Health Plan we are supporting.
WITH
A PATIENT’S WRITTEN AUTHORIZATION:
We may use or disclose medical information for purposes not described
in this notice only with a patient’s written authorization.
The patient may revoke any authorization at any time, in writing,
but only as to future disclosures or uses — not disclosures we have
already made which relied on an authorization previously given to
us.
USES
& DISCLOSURES WE MAY MAKE
WITHOUT
YOUR AUTHORIZATION
AS
REQUIRED BY LAW:
However, we will only do that to the extent and under the
specific circumstances provided for by such law.
TO
PUBLIC HEALTH AUTHORITIES:
For activities such as tracking communicable disease, reporting
child abuse or for public-health investigations.
TO
REPORT ABUSE, DOMESTIC VIOLENCE OR NEGLECT:
If, for example, we believe a patient is a victim, we may disclose
that patient’s information as permitted by law unless we think that
would place the patient at risk of serious harm. We will not
inform the patient’s personal representative if we believe that
would put the patient at risk of serious harm.
FOR
HEALTH OVERSIGHT ACTIVITIES: We
may disclose to health oversight agencies, such as a state Department
of Health or Department of Health & Human Services, for activities
authorized by law, including audits, civil, administrative or criminal
investigations, licensure or disciplinary actions, and monitoring
of compliance with law.
IN
JUDICIAL PROCEEDINGS:
In response to court or administrative orders; with subpoenas, discovery
requests or other process, after reasonable efforts to notify you
or obtain a protective order.
TO
LAW ENFORCEMENT:
To identify or locate suspects, fugitives or witnesses, or victims
of crime (with your consent in some circumstances), to report crimes
on our premises or in emergencies, or the commission of a crime.
TO
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS:
If required by the appropriate authorities, we may disclose information
to coroners, medical examiners and funeral directors to help them
(1) identify a deceased person, (2) determine cause of death, or
(3) as reasonably necessary to permit them to carry out their duties.
MILITARY
AND VETERANS:
If a patient is a member of the armed forces, as required by command
authorities.
FOR
NATIONAL SECURITY, INTELLIGENCE ACTIVITIES, PROTECTIVE SERVICES
FOR THE PRESIDENT AND OTHERS, AND STATE DEPARTMENT PURPOSES:
To officials as authorized by law to perform their duties and conduct
investigations or make medical suitability determinations for foreign
service.
TO
CORRECTIONAL INSTITUTIONS:
We may disclose information for the health and safety of inmates
and others.
FOR
WORKERS COMPENSATION: We
may disclose to Workers Compensation or similar programs, as required
by the federal and state applicable laws.
PATIENTS
HAVE THE FOLLOWING RIGHTS
To
exercise these rights, see the contact information below.
To
Obtain a Copy of This Notice, On Request:
To request a copy of this Patient Privacy & Privacy Practices
notice, a patient must send a formal request in writing. That
request may be either typed or, if the patient’s handwriting is
legible, hand-written.
To
Inspect and Request a Copy of Your Health Record:
A patient may inspect and request a copy of his or her health record
except in limited circumstances defined by federal and state regulations.
The copy may be requested by the patient or his or her legal guardian.
The request must be made in writing, and it may be either typed
or hand-written if the handwriting is legible. If the request
is being made by the patient, a copy of the patient’s photo-identification
confirming his/her identity and signature must accompany the written
request. If the request is being made by the patient’s legal
guardian, then a copy of the document giving the guardian legal
authority for the patient must also accompany the request as well
as the guardian’s photo-identification confirming his/her identity
and signature. A nominal fee will be charged to copy your
record. The actual cost will depend on how many years back
the file goes and the number of pages being copied. If a patient
is denied access to his/her record for certain reasons, we will
tell the patient why and what his/her rights are to challenge that
denial.
To
Request An Amendment To a Patient’s Record:
The request must be in writing and give a reason. We may deny
that request if the information was not created by us, not a part
of the information that the patient would be permitted to inspect
and copy, or if the information is accurate and complete.
If we agree with the patient’s request, we will not delete any information
already in the patient’s record. We will add the patient’s
correction to the record.
To
an Accounting of Disclosures of a Patient’s Health Information:
For purposes other than treatment, payment for health operations;
disclosures to you or authorized by you; disclosures incidental
to permitted disclosure and certain other disclosures excluded by
regulation.
To
Request a Restriction on Certain Uses and Disclosures:
We are not required to agree with your request. If we do agree
with the request, we will comply with your request except to the
extent that the disclosure has already occurred or if you are in
need of emergency treatment and the information is needed to provide
the emergency treatment.
To
Request That We Contact You by Alternate Means:
You may request that we contact you by alternate means, (e.g., fax
versus mail) or at alternate locations (alternate address or phone
number). Your request must be in writing. We must honor
your request if it is reasonable.
CONTACT
INFORMATION:
To
exercise any of the above rights, or if you have any questions,
contact the FLORIDA OPTOMETRIC PHYSICIANS NETWORK at 7352
N.W. 34th Street; Miami, FL 33122; (305) 418-2025; FAX
(305) 418-7627.
If you believe your privacy rights have been violated, you may file
a complaint in writing addressed to PRIVACY OFFICER, FLORIDA OPTOMETRIC
PHYSICIANS NETWORK at 7352
N.W. 34th Street; Miami, FL 33122.
There will be no retaliation for filing a complaint. You also
have a right to complain to the appropriate federal and state Department.
CHANGES
TO THIS NOTICE: We reserve the right to change this notice.
We reserve the right to make the revised or changed notice effective
for information we already have about a patient as well as information
we may receive in the future. We post a copy of the current
notice in our offices and on our website. A copy of the current
notice in effect will be available at our offices upon request.
EFFECTIVE DATE September 1, 2004.
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