NOTICE OF PATIENT PRIVACY POLICY
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.
USES AND DISCLOSURES
Treatment. Your health information may be used by our
physicians and staff or disclosed to other health care professionals for
the purpose of evaluating your health, diagnosing medical conditions, and
providing treatment.
Payment. Your health information may be used to seek payment from your
health plan, other sources of coverage such as an automobile insurer, or
credit card companies that you may use to pay for services. For example,
your health plan may request and receive information on dates of service,
the services provided, and the medical condition being treated.
Health care operation. Your health information may be used as necessary
to support the day-to-day activities and management of South Jersey Eye
Associates, P.A. For example, information on the services you received
may be used to support budgeting and financial reporting and activities
to evaluate and promote quality to insure that our practice is meeting
state and federal guidelines and laws designated to protect your health
care information.
Law Enforcement. Your health information may be disclosed
to law enforcement agencies, without your permission, to support government
audits and inspections, to facilitate law enforcement investigations, and
to comply with government mandated reporting.
Appointment reminders. Your health information will be used by our staff
to call/send you appointment reminders.
Information about treatments. Your health information
may be used to send you information on the treatment and management of
your medical condition that you may find to be of interest. We may also
send you information describing other health-related goods and services
that we believe may interest you.
Other uses and disclosures require your authorization. Disclosure
of your health information or its use for any purpose other than those
listed above requires your specific written authorization. If you change
your mind after authorizing a use or disclosure of your information, you
may submit a written revocation of the authorization. However, your decision
to revoke the authorization will not affect or undo any use or disclosure
of information that occurred before you notified us of your decision.
Individual Rights
You have certain rights under the federal privacy standards. These include:
South Jersey Eye Associates, P.A. Duties
We are required by law, and reserve the right to amend or modify our privacy
policies and practices. These changes in our policies and practices
may be required by changes in federal and state laws and regulations. Whatever
the reason for these revisions, we will provide you with a revised notice
on your next office visit. The revised policies and practices will be applied
to all protected health information that we maintain.
Requests to inspect Protected Health Information
As permitted by federal regulation, we require that requests to inspect
and copy protected health information be submitted in writing. You
may obtain a form to request access to your records by contacting our Office
Manager or Practice Administrator.
Complaints and Contact Person
If you would like to submit a comment or complaint about our privacy
practices, or obtain additional information about our privacy practices,
you can do so by sending a letter outlining your concerns to the person
listed below. You will not be penalized or otherwise retaliated against
for filing the complaint.
Practice Privacy Officer
South Jersey Eye Associates, P.A.
205 Laurel Heights Drive
Bridgeton, NJ 08302
Effective date
This notice is effective on or after October 1, 2006.