SUMMARY OF NOTICE OF PRIVACY PRACTICES
THIS NOTICE SUMMARIZES HOW MEDICAL INFORMATION ABOUT YOU AT EMG MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
This notice applies to all of the records of your care held by EMG, whether generated by EMG or an associated facility. EMG is providing you with this Notice to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
EMG MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
For Medical Treatment Purposes:
To other health care professionals involved in your care both inside the practice as well as with outside optometrists, physicians, and labs, among others;
To friends or family involved in your medical care;
For informing you of new treatment options that may be available;
To other health care facilities or organizations providing you medical care such as hospitals, home health agencies or nursing homes; and
To staff, including but not limited to, clinical staff, transcriptionists or receptionists who need your information to do their jobs.
For Payment Purposes:
When asking about your health care plans or other sources of payment;
When we prepare bills to send, or get prior approval from, your health care plan;
When we process payment by credit card;
To friends or family assisting you in making payment or checking balances; and
When we try to collect unpaid amounts due through collection agencies.
For Health Care Operations:
For financial or billing audits;
For internal quality assurance and benchmarking;
For our providers to participate in managed care plans;
For defense of legal matters; and
For the development of business plans.
We may fax your information to pharmacies, optometrists, optical labs, optical shops, or other health care providers or health care facilities.
We may call, e-mail or send a reminder card to you to remind you of your appointment (this might involve leaving a message).
We will disclose medical information about you when required to do so by federal or state law. For example:
To government authorities about suspected abuse, neglect or domestic abuse;
For health oversight activities such as infectious diseases;
In response to subpoenas, court orders or administrative agencies;
For law enforcement purposes or specialized government functions;
For health related research;
To prevent a serious threat to health or safety;
To workers compensation programs;
About inmates, to the correctional institution or to a law enforcement official; and
To business associates who perform health care operations for us.
Other uses and disclosures of medical information not covered by this notice will be made only with your written permission, unless those uses can be reasonably inferred from the intended uses above. We will not make any other disclosures without your written authorization. We can not take back any disclosures we have already made with your permission.
THIS SECTION DESCRIBES YOUR RIGHTS AND THE OBLIGATIONS OF EMG REGARDING THE USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION.
You have the following rights regarding medical information we maintain about you: You may request that we restrict how we disclose your health information for treatment, payment or organizational operations. We do not have to agree to this request. If we do agree with this request we will comply, except in case of emergency; You may request that we communicate your health information in a certain way; You may request to review or get photocopies of your health information. This request must be in writing and there may be a fee for the cost of copying; You may request that we amend your health information, but at no time will information be edited, deleted or removed. This request must be in writing and must include the reason you want to amend your health information; You may request a list of how we have disclosed your health information regarding any authorizations you have signed. Your request must be in writing; and You may request a paper copy of this notice at any time. You may request a copy of our complete Notice of Privacy Practices.
If you feel that the privacy of your health information has not been handled properly, please contact the Eyecare Medical Group Compliance Officer at 828-2020 or in writing at 53 Sewall Street, Portland, Maine 04102. You can file a complaint with the Secretary of the U. S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.