The following information is the Eye Associates of Colorado Springs, P.C.
privacy notice. You may also view the
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Eye Associates of Colorado Springs, P.C. Privacy Notice
This notice describes how your medical information may be used
and disclosed and how you can get access to this information. Please read
We are required to abide by the terms of this Privacy Notice. We may
change the terms of this notice at any time. The new notice will be effective
for all protected health information (PHI) that we maintain at the time
of any change. At your request, we will be happy to provide you with any
revised Privacy Notice. You may pick one up at the time of your
appointment, or you may call and request that a copy be mailed to you.
Uses and Disclosures of Protected Health Information Based Upon
Your Written Consent
You will be asked to sign a consent form. Your physician may use or
disclose your PHI information for treatment, payment and health care
Treatment: We may use and disclose your health
information to provide, coordinate or manage your health care and any
related services. For example, your PHI may be given to another physician
to whom you've been referred so that physician has the necessary
information to diagnose and/or treat you.
Payment: Your information may be used to obtain payment
for your health care services, determination of coverage for insurance
benefits, review of services for determination of medical necessity, and
utilization review. For example, approval for eye surgery may require
that your PHI be given to your insurer.
Health care Operations: We may use your information to
support the business activities of the practice. These include, but are
not limited to, quality assessment, employee evaluation, licensing and
conducting other business functions. We may call you by name in the
waiting room when your doctor is ready to see you. We may contact you
to remind you of your appointment or to provide you with information
regarding treatment. We may share your information with associates who
provide services to the practice (such as billing or medical transcription).
We will have a written contract with those associates that will protect
Uses and Disclosures of Protected Information Based Upon your
Other uses of your PHI will be made only with your written authorization,
unless otherwise permitted or required by law. You may revoke this
authorization at any time, in writing, except to the extent that we have
already taken actions relying on your authorization.
You have the right to see and copy your protected health
information. Please give us your request(s) in writing.
You have the right to request a restriction of your protected
health information. This means that you may ask us not to use
or disclose any part of your PHI to family members or friends who may be
involved in your care or for notification purposes as described in this
Privacy Notice. Your doctor is not required to agree to a restriction
that you may request. If your physician believes it is in your best
interest to permit use/disclosure of your PHI, the information will not
be restricted. If your doctor does agree to the requested restriction,
we will not use or disclose your information unless it is needed to
provide emergency treatment. With this in mind, please discuss any
restriction request with your doctor. You may request restriction(s)
by giving us a signed statement listing restrictions and dates.
You have the right to request to receive confidential
communications from us by alternative means or at an alternative
location. We will accommodate reasonable requests.
You may have the right to have your physician amend your protected
health information. You may request a change in your medical
record for as long as we maintain this information. In certain cases,
we may deny your request. If your request is denied, you have the right
to file a statement of disagreement with us. We may prepare a rebuttal
and will provide you with a copy.
You have the right to receive an accounting of disclosures
we have made, if any, of your protected health information.
This right applies to disclosures other than for treatment, payment or
health care operations as described above. It excludes disclosures we
may have made to you, to family members or friends involved in your care,
or for notification purposes. You have the right to receive specific
information regarding these disclosures that occurred after 4/14/03.
The right to receive this information is subject to certain exceptions,
restrictions and limitations.
You have the right to receive a paper copy of this notice
from us, upon request, even if you have agreed to accept this
You may complain to the Secretary of Health and Human services, if you
believe we have violated your privacy rights. You may file a complaint
with us by notifying our privacy contact of your complaint. We will not
retaliate against you for filing a complaint. Our Compliance Officer,
Greg Tesitor, can be reached at our downtown office (719-471-2020) for
This notice was published and becomes effective on 4/11/03.
DETAILED DESCRIPTION OF USES OF YOUR INFORMATION WITHOUT YOUR CONSENT
Other Permitted and Required Uses and Disclosures That May Be
Made Without Your Consent, Authorization or Opportunity to Object
We may use and disclose your PHI in the following instances. You have
the opportunity to agree or object to the use or disclosure of all or part
of your protected health information. If you are not present or able to
agree or object to the use or disclosure of the PHI, your physician may,
using professional judgment, determine whether the disclosure is in your
best interest. In this case, only the PHI that is relevant to your
health care will be disclosed.
Others Involved in Your Health care: Unless you object,
we may disclose to a member of your family, a relative, a close friend,
or any other person you identify, your PHI that directly relates to that
person's involvement in your health care. If you are unable to agree or
object to such a disclosure, we may disclose such information as necessary
if we determine that it is in your best interest based on our professional
judgment. We may use or disclose PHI to notify or assist in notifying a
family member, personal representative or any other person that is
responsible for your care, general condition or death. Finally, we may
use or disclose your PHI to an authorized public or private entity to assist
in disaster relief efforts and to coordinate uses and disclosures to family
or other individuals involved in your health care.
Emergencies: We may use or disclose your PHI in an
emergency treatment situation. If this happens, your physician will try to
obtain your consent as soon as reasonably practicable after the delivery of
treatment. If your physician (or another physician in the practice) is
required by law to treat you, and the physician has attempted to obtain your
consent, but is unable to obtain your consent, he or she may still use or
disclose your PHI to treat you.
Communication Barriers: We may use or disclose you PHI
if your physician (or another physician in the practice) attempts to obtain
consent from you but is unable to do so due to substantial communication
barriers, and the physician determines, using professional judgment, that
you intend to consent to use or disclosure under the circumstances.
Additional Permitted and Required Uses and Disclosures That May
Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your PHI in the following situations without your
consent or authorization. These situations include:
Required by Law: We may use or disclose your PHI to the
extent that law requires the use or disclosure. The use or disclosure will
be made in compliance with the law and will be limited to the relevant
requirements of the law. You will be notified, as required by law, of any
such uses or disclosures.
Public Health: We may use or disclose your PHI for
public health activities and purposes to a public health authority that
is permitted by law to collect and receive the information. The disclosure
will be made for the purpose of controlling disease, injury or disability.
We may also disclose your PHI, if directed by the public health authority,
to a foreign government agency that is collaborating with the public health
Communicable Diseases: We may disclose you PHI, if
authorized by law, to a person who may have been exposed to a communicable
disease or may otherwise be at risk of contracting or spreading the disease
Health Oversight: We may disclose PHI to a health
oversight agency for activities authorized by law--such as audits,
investigations and inspections. Oversight agencies seeking this
information include government agencies that oversee the health care
system, government benefit programs, other government regulatory programs
and civil rights laws.
Abuse or Neglect: We may disclose your PHI to a public
health authority that is authorized by law to receive reports of child or
elder abuse and neglect. In addition, we may disclose your PHI if we believe
that you have been a victim of abuse, neglect or domestic violence to the
governmental agency or entity authorized to receive such information. In
this case, the disclosure will be made consistent with the requirements of
applicable federal and state laws.
Food and Drug Administration: We may disclose your PHI
to a person or company required by the FDA to report adverse events, product
defects or problems, biological product deviations, track products; to
enable product recalls; to make repairs or replacements, or to conduct
post marketing surveillance, as required.
Legal Proceedings: We may disclose PHI in the course of
any judicial or administrative proceeding, in response to an order of a
court or administrative tribunal (to the extent such disclosure is expressly
authorized), in certain conditions in response to a subpoena, discovery
request or other lawful process.
Law Enforcement: We may also disclose PHI, so long as
applicable legal requirements are met, for law enforcement purposes.
These law enforcement purposes include (1) legal processes and otherwise
required by law, (2) limited information requests for identification and
location purposes, (3) pertaining to victims of a crime, (4) suspicion that
death has occurred as a result of criminal conduct, (5) in the event that
a crime occurs on the premises of the practice, and (6) medical emergency
(not on the practice's premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may
disclose PHI to a coroner or medical examiner for identification purposes,
determining cause of death, or for the coroner or medical examiner to perform
other duties authorized by law. We may also disclose PHI to a funeral director,
as authorized by law, in order to permit the funeral director to carry out
his/her duties. We may disclose such information in reasonable anticipation
of death. PHI may be used and disclosed for cadaveric organ, eye or tissue
Research: We may disclose your PHI to researchers when
their research has been approved by an institutional review board that
has reviewed the research proposal and established protocols to ensure
the privacy of your PHI.
Criminal Activity: Consistent with applicable federal
and state laws, we may disclose your PHI if we believe that the use or
disclosure is necessary to prevent or lessen a serious and imminent threat
to the health or safety of a person or the public. We may also disclose
PHI if it is necessary for law enforcement authorities to identify or
apprehend an individual.
Military Activity and National Security: When the
appropriate conditions apply, we may use or disclose PHI of individuals
who are Armed Forces personnel (1) for activities deemed necessary by
appropriate military command authorities; (2) for the purpose of a
determination by the Department of Veterans' Affairs of your eligibility
for benefits, or (3) to foreign military authority if you are a member of
that foreign military service. We may also disclose your PHI to authorized
federal officials for conducting national security and intelligence
activities, including for the provision of protective services to the
President or others legally authorized. Workers' Compensation: Your PHI
may be disclosed by us as authorized to comply with workers' compensation
laws and other similar legally established programs.
Inmates: We may use or disclose your PHI if you are an
inmate in a correctional facility and your physician created or received
your PHI in the course of providing care to you.
Required Uses and Disclosures: Under the law, we must
make disclosures to you and when required by the Secretary of the
Department of Health and Human Services to investigate or determine
our compliance with the requirements of Section 164.500 et.seq.