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. If you have any questions, please contact our Privacy Officer at 573-449-3846.

Who will follow this notice?

The information about privacy practices in this notice will be followed by:

• Any health care professional authorized to enter information into your chart
• All areas of the organization (front desk, administration, billing and collections, etc.)
• All employees, staff and other personnel that work for or with our medical practices
• Any business associate or partner of Columbia Eye Consultants with whom we share health information.

Our pledge to you.

We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain.

We are required by law to:

• keep medical information about you private.
• give you this notice of our legal duties and privacy practices with respect to medical information about you.
• follow the terms of the notice that is currently in effect.

How we may use and disclose medical information about you.

The following categories describe different ways that we use and disclose protected health information that we have and share with others.  Not every use or disclosure in a category is either listed or actually in place. We provide this explanation for your general information only.

We may use and disclose medical information about you for treatment (such as sending medical information about you to a specialist, your family doctor or other health care facility as part of a referral); to obtain payment for treatment (such as sending billing information to your insurance company or Medicare); and to support our health care operations (such as comparing patient data to improve treatment methods or to business associates for the purpose of helping us to comply with our legal requirements.)

We may use or disclose medical information about you for several other reasons.  Subject to certain requirements, we may give out medical information about you without prior authorization for

• public health risks such as disease control, child abuse or neglect, medication reactions or problems, product recalls.
• to avert a serious threat to health and safety
• government oversight audits or inspections
• research studies
• tissue and organ donation
• workers’ compensation purposes
• law enforcement requests in response to a request from law enforcement in regards to a criminal investigation or specific circumstances, or in response to valid judicial or administrative orders.
• lawsuits or disputes in response to a court or administrative order, subpoena, discovery request or other lawful process
• coroners or medical examiners
• correctional institution or law enforcement officials if you are an inmate
• when required by federal, state or local law

We may use and disclose medical information to contact you for appointment reminders, scheduling changes or notify you that you are due for periodic care. This contact may be by phone or in writing and may involve leaving a message on an answering machine that could (potentially) be received or intercepted by others.

We may use certain medical information in fundraising activities where we can contact you regarding specific products and/or services that may be of interest to you.  You may opt out of this type of communication by notifying us in writing.

We may disclose medical information about you to a family member who is involved in your medical care or other personal representatives authorized by you or by legal mandate (such as a guardian or other person who has been named to handle your medical decisions, should you become incompetent).

We may disclose medical information about you in an emergency situation or to disaster relief authorities so that your family can be notified of your location and condition.

The Health Information Technology for Economic and Clinical Health (HITECH) Act also requires us to notify you when the security or privacy of your health information is breached. Depending on the type of breach and how many individuals are affected, this may also involve notifying the media and/or government enforcement agencies, and keeping a log of all breach incidents.

Other uses of medical information.

The following uses and disclosures will be made only with additional written authorization from the individual:

• uses and disclosures for marketing purposes
• uses and disclosures that constitute the sale of PHI

In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. If you chose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.

Changes to this Notice.

We may change our policies at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. Before we make a significant change in our policies, we will change our notice and post the new notice in waiting areas and exam rooms. You can receive a copy of the current notice at any time. The effective date is listed at the top of the page. You will be offered a copy of the current notice when you check in to our office for the first time. You will also be asked to acknowledge in writing your receipt of this notice.

Complaints.

If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Officer at 573-449-3846.

Under no circumstance will you be penalized for filing a complaint.

YOUR RIGHTS REGARDING MEDICAL INFORMATION WE MAINTAIN ABOUT YOU.

In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care, when you submit a written request. If you request multiple copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.

If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the records. You must submit a request in writing that provides your reason for requesting the amendment. We could deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; or if we determine that record is accurate. You may appeal, in writing, a decision by us not to amend a record.

You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or where you specifically authorized a disclosure, when you submit a written request. The request must state the time period desired for the accounting, which must be less than a 6-year period and starting after April 14, 2003.  The first disclosure list request in a 12-month period is free; other requests will be charged according to our cost of producing the list. We will inform you before you incur any costs.

You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you.

You may request, in writing, that we not use or disclose medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. This includes your right to restrict disclosure of medical information to your health plan if the patient has paid for services out of pocket in full. We will consider your request but we are not legally required to accept it. We will inform you of our decision. All written requests or appeals should be submitted to our Privacy Officer.