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GVS | HIPAA
Notice of Privacy Practices
Effective date of notice: April 1, 2003
General Vision Services
520 8th Avenue, 9th Floor
New York, New York 10018
Phone: 212-729-5300
Fax: 212-967-4781
E-Mail: privacyofficer@gvs.bz
This notice describes how medical
information about you may be used and disclosed and how you can obtain access to this information.
Please review it carefully.
General Rule
We respect our legal obligation to keep health information, that identifies you, private. The law obligates us to give you notice of our privacy practices.
Generally, we can only use your health information in our office or disclose it outside of our office, without your written permission, for purposes of treatment, payment or healthcare operations. In most other situations, we will not use or disclose your health information unless you sign a written authorization form. In some limited situations, the law allows or requires us to disclose your health information without written authorization.
Uses or Disclosures of
Health Information
Examples of how we use information for
treatment purposes:
- When we set up an appointment for you.
- When our technician or doctor tests your eyes.
- When the doctor prescribes glasses or contact
lenses.
- When the doctor prescribes medication.
- When our staff helps you select and order
glasses or contact lenses.
- When we show you low vision aids.
We may disclose your health information outside of our office for treatment purposes, for example:
- If we refer you to another doctor or clinic for eye
care or low vision aids or services.
- If we send a prescription for glasses or contacts
to another professional to be filled.
- When we provide a prescription for medication
to a pharmacist.
- When we phone to let you know that your
glasses or contact lenses are ready to be picked
up.
Sometimes we may ask for copies of your health information from another professional that you may have seen before.
We may use your health information within our office or disclose your health information outside of our office for payment purposes. Some examples are:
- When our staff asks you about health or vision
care plans that you may belong to, or about
other sources of payment for our services.
- When we prepare bills to send to you or your
health or vision care plan.
- When we process payment by credit card and
when we try to collect unpaid amounts due.
- When bills or claims for payment are mailed,
faxed, or sent by computer to you or your health
or vision plan.
- When we occasionally have to ask a collection
agency or attorney to help us with unpaid
amounts due.
We use and disclose your health information for healthcare operations in a number of ways. Health care operations means those administrative and managerial functions that we have to do in order to run our office. We may use or disclose your health information, for example, for financial or billing audits, for internal quality assurance, for personnel decisions, to enable our doctors to participate in managed care plans, for the defense of legal matters, to develop business plans, and for outside storage of our records.
Appointment Reminders
We may call to remind you of scheduled appointments. We may also call to notify you of other treatments or services available at our office that might help you.
Uses & Disclosures without an Authorization
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never happen at our office at all. Such uses or disclosures are:
- A state or federal law that mandates certain
health information be reported for a specific
purpose.
- Public health purposes, such as contagious
disease reporting, investigation or surveillance;
and notices to and from the Food and Drug
Administration regarding drugs or medical
devices.
- Disclosures to governmental authorities about
victims of suspected abuse, neglect or domestic
violence.
- Uses and disclosures for health oversight
activities, such as for the licensing of doctors,
audits by
Medicare or Medicaid, or investigation of
possible violations of healthcare laws.
- Disclosures for judicial and administrative
proceedings, such as in response to subpoenas
or orders of courts or administrative agencies.
- Disclosures for law enforcement purposes, such
as to provide information about someone who is
or is suspected to be a victim of a crime; to
provide information about a crime at our office;
or to report a crime that happened somewhere
else.
- Disclosure to a medical examiner to identify a
dead person or to determine the cause of death;
or to funeral directors to aid in burial; or to
organizations that handle organ or tissue
donations.
- Uses or disclosures for health related research.
- Uses and disclosures to prevent a serious threat
to health or safety.
- Uses or disclosures for specialized government
functions, such as for the protection of the
president or high ranking government officials;
for lawful national intelligence activities; for
military purposes; or for the evaluation and
health of members of the foreign service.
- Disclosures relating to workers' compensation
programs.
- Disclosures to business associates who perform
healthcare operations for us and who agree to
keep your health information private.
Other Disclosures
We will not make any other uses or disclosures of your health information unless you sign a written authorization form. You do not have to sign such a form. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it.
Your Rights Regarding Your Health Information
The law gives you many rights regarding your health information.
- You can ask us to restrict our uses and disclosures
for purposes of treatment (except emergency
treatment), payment or healthcare operations. We
do not have to agree to do this, but if we agree,
we must honor the restrictions that you want. To
ask for a restriction, send a written request to
General Vision Services, Privacy Officer at the
address, fax or e-mail shown at the beginning of
this notice.
- You can ask us to communicate with you in a
confidential way, such as by phoning you at work
rather than at home, by mailing health
information to a different address, or by using
e-mail to your personal email address. We will
accommodate these requests if they are
reasonable, and if you pay us for any extra cost.
If you want to ask for confidential
communications, send a written request to
General Vision Services, Privacy Officer at the
address, fax or e-mail shown at the beginning of
this notice.
- You can ask to see or to get photocopies of your
health information. By law, there are a few
limited situations in which we can refuse to permit
access or copying. Primarily, however, you will be
able to review or have a copy of your health
information within 30 days of asking us. You may
have to pay for photocopies in advance. If we
deny your request, we will send you a written
explanation, and instructions about how to get an
impartial review of our denial if one is legally
required. By law, we can have one 30-day
extension of the time for us to give you access or
photocopies if we sent you a written notice of the
extension. If you want to review or get
photocopies of your health information, send a
written request to General Vision Services,
Privacy Officer at the address, fax or e-mail
shown at the beginning of this notice.
- You can ask us to amend your health information
if you think that it is incorrect or incomplete. If we
agree, we will amend the information within 60
days from when you ask us. We will send the
corrected information to persons who we know
got the wrong information, and others that you
specify. If we do not agree, you can write a
statement of your position, and we will include it
with your health information along with any
rebuttal statement that we may write. Once your
statement of position and/or rebuttal is included
in your health information, we will send it along
whenever we make a permitted disclosure of your
health information. By law, we can have one
30-day extension of time to consider a request for
amendment if we notify you in writing of the
extension. If you want to ask us to amend your
health information, send a written request,
including your reasons for the amendment, to
General Vision Services, Privacy Officer at the
address, fax or e-mail shown at the beginning of
this notice.
- You can get a list of the disclosures that we have
made of your health information within the past
six years (or a shorter period if you want), except
disclosures for purposes of treatment, payment or
health care operations, disclosures made in
accordance with an authorization signed by you,
and some other limited disclosures. You are
entitled to one such list per year without charge. If
you want more frequent lists, you will have to pay
for them in advance. We will usually respond to
your request within 60 days of receiving it, but by
law we can have one 30-day extension of time if
we notify you of the extension in writing. If you
want a list, send a written request to General
Vision Services, Privacy Officer at the address,
fax or e-mail shown at the beginning of this
notice.
Our Notice of
Privacy Practices
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time in compliance with and as allowed by law. If we change this notice, the new privacy practices will apply to your health information that we already have, as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office and www.generalvision.com.
Complaints
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to General Vision Services, Privacy Officer at the address, fax or e-mail shown at the beginning of this notice. If you prefer, you can discuss your complaint in person or by phone.
For More Information
If you want more information about our privacy practices, call or visit General Vision Services, Privacy Officer at the address or phone number shown at the beginning of this notice.
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