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Glaucoma Associates of Texas
Notice of Protected Health Information 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 Health Record/
Information
This notice describes the
practices of Glaucoma Associates of Texas (hereinafter “Glaucoma
Associates”) and that of its physicians with respect to your
protected health information created while you are a patient at
Glaucoma Associates. Physicians and personnel of Glaucoma Associates
authorized to have access to your medical chart are subject to this
notice. In addition, physicians of Glaucoma Associates may share
medical information with each other for treatment, payment or health
care operations described in this notice.
We create a record of the care
and services you receive at Glaucoma Associates. We understand that
medical information about you and your health is personal. We are
committed to protecting medical information about you. This notice
applies to all of the records of your care at Glaucoma Associates.
This notice will tell you about
the ways in which we may use and disclose medical information about
you. We also describe your rights and certain obligations we have
regarding the use and disclosure of medical information.
Your Health Information Rights
Although your health record is
the physical property of Glaucoma Associates, the information
belongs to you. You have the right to:
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Request a restriction on
certain uses and disclosures of your information for treatment,
payment, health care operations and as to disclosures permitted
to persons, including family members involved with your care and
as provided by law. However, we are not required by law to agree
to a requested restriction;
-
Obtain a paper copy of this
notice of protected health information practices;
-
Inspect and request a copy of
your health record as provided by law;
-
Request that we amend your
health record as provided by law. We will notify you if we are
unable to grant your request to amend your health record;
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Obtain an accounting of
disclosures of your health information as provided by law;
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Request communication of your
health information by alternative means or at alternative
locations. We will accommodate reasonable requests; and
-
Revoke your authorization to
use or disclose health information except to the extent that
action has already been taken in reliance on your authorization.
You may exercise your rights set
forth in this notice by providing a written request, except for
requests to obtain a paper copy of the notice, to the Glaucoma
Associates’ Privacy Officer at 7150 Greenville Avenue, Suite 300,
Dallas, Texas 75231.
Our Responsibilities
In addition to the
responsibilities set forth above, we are also required to:
-
Maintain the privacy of your
health information;
-
Provide you with a notice as
to our legal duties and privacy practices with respect to
information we maintain about you;
-
Abide by the terms of this
notice;
-
Notify you if we are unable
to agree to a requested restriction on certain uses and
disclosures;
-
We reserve the right to
change our practices and to make the new provisions effective
for all protected health information we maintain, including
information created or received before the change. Should our
information practices change we are not required to notify you,
but we will have the revised notice available for you to request
at any Glaucoma Associates’ location. The revised notice will
also be posted at our offices and on the Glaucoma Associates’
web page at www.GlaucomaAssociates.com;
and
-
We will not use or disclose
your health information without your written authorization,
except as described in this notice.
Examples of Disclosures for
Treatment, Payment, Health Care Operations and As Otherwise Allowed
By Law.
The following categories describe
different ways that we use and disclose medical information. For
each category of uses or disclosures we will explain what we mean
and try to give some examples. Not every use or disclosure in a
category will be listed. However, all of the ways we are permitted
to use and disclose information should fall within one of the
categories.
We will use your health
information for treatment.
For example: We may disclose
medical information about you to doctors, nurses, technicians,
medical students, or other personnel who are involved in taking care
of you at Glaucoma Associates. We may share medical information
about you in order to coordinate different treatments, such as
prescriptions, lab work and x-rays. We may also provide your
physician or a subsequent health-care provider with copies of
various reports to assist in treating you once you are discharged
from care at Glaucoma Associates.
We will use your health
information for payment.
For example: A bill may be
sent to you or a third-party payer. The information on or
accompanying the bill may include information that identifies you,
as well as your diagnosis, procedures, and supplies used.
We will use your health
information for regular health care operations.
For example: We may use the
information in your health record to assess the care and outcome in
your case and others like it. This information will then be used in
an effort to continually improve the quality and effectiveness of
the health care and services we provide.
We will use your health
information as otherwise allowed by law. The following are
some examples of how we may use or disclose medical information
about you.
Business associates: There
are some services provided in our organization through agreements
with business associates. Examples include answering services and
copy services. To protect your health information, however, we
require business associates to appropriately safeguard your
information.
Notification: We may use or
disclose information to notify or assist in notifying a family
member, personal representative, or another person responsible for
your care, your location, and general condition.
Research: 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 protect the privacy of your
health information.
Funeral directors: We may
disclose health information to funeral directors consistent with
applicable law to carry out their duties.
Organ procurement organizations:
Consistent with applicable law, we may disclose health information to organ
procurement organizations or other entities engaged in the
procurement, banking, or transplantation of organs for the purpose
of tissue donation and transplant.
Communications for treatment and
health care operations: 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.
Food and Drug Administration
(FDA): We may disclose to the FDA health information relative to
adverse events with respect to food, medications, devices,
supplements, product and product defects, or post marketing
surveillance information to enable product recalls, repairs, or
replacement.
Worker’s compensation: We
may disclose health information to the extent authorized by and to
the extent necessary to comply with laws relating to worker’s
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.
Abuse, neglect or domestic
violence: As required by law, we may disclose health information
to a governmental authority authorized by law to receive reports of
abuse, neglect, or domestic violence.
Judicial, administrative and law
enforcement purposes: Consistent with applicable law, we may
disclose health information about you for judicial, administrative
and law enforcement purposes.
Required or allowed by law: We
will disclose medical information about you when required or allowed
to do so by federal, state or local law.
For More Information or to
Report a Problem
If you have questions and would
like additional information, you may contact Glaucoma Associates’
Privacy Officer at (214) 360-0000.
If you believe your privacy
rights have been violated, you can file a complaint with Glaucoma
Associates’ Privacy Officer or with the Secretary of Health and
Human Services. There will be no retaliation for filing a complaint.
Effective Date: 04/01/03
Version: 1
Copyright © 2003
Burford & Ryburn, L.L.P.
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Glaucoma Associates of Texas
7150 Greenville Avenue, Suite 300
Dallas, TX 75231
Office: 214-360-0000
Fax: 214-360-0083
Copyright
© Glaucoma Associates of Texas 2000-2003
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