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Notice of Privacy Practices


This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Please review it carefully.  The privacy of your health information is important to us.



We are required by applicable federal and state law to maintain the privacy of your health information.  We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.  We must follow the privacy practices that are described in this Notice while it is in effect.  This Notice takes effect April 14, 2003, and will remain in effect until we replace it.


We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law.  We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes.  In the event we make a material change in our privacy practices, we will change this Notice and provide it to you.


You may request a copy of our Notice at any time.  For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.



We use and disclose health information about you for treatment, payment and healthcare operations.  For example:

TREATMENT: We may use or disclose your health information to an optician, optometrist, ophthalmologist or other healthcare provider providing treatment to you for a} the provision, coordination, or management of health care and related services by health care providers; b} consultation between health care providers relating to a patient c} the referral of a patient for health care from one health care provider to another or d} recall information.


PAYMENT: We may use and disclose your health care information to obtain payment for services we provided to you.  This may include: a} billing and collection activities and related data processing; b} actions by a health plan or insurer to obtain premiums or to determine or fulfill its responsibilities for coverage and provision of benefits under its health plan or insurance agreement, determinations of eligibility or coverage, adjudication or subrogation of health benefit claims; c} medical necessity and appropriateness of care reviews, utilization review activities and; d} disclosure to consumer reporting agencies of information relating to collection of premiums or reimbursements.



We may use and disclose your health information in connection with our health care operations.  Health care operations could include quality assurance assessment and improvement activities, reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, conducting training programs, accreditations, certification, licensing or credentialing activities.



In addition to our health information for treatment, payment or health care operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose.  If you give us authorization, you may revoke it in writing at any time.  Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.  Unless you give us a written authorization, we can not disclose or use your health information for any reason except those described in this Notice.



We will not use your health information for marketing communications without your prior written consent or authorization.  We may provide you with information regarding products and services that we offer related to your health care needs.  We will never sell your health information without your prior authorization.



We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help you with your health care or payment for your health care, if you agree that we may do so or, if you are not able to agree, if it is necessary in our professional judgment.



We may use or disclose health information to notify, or assist in notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition or death.  If you are present, then prior to use or disclosure of your health information, we will provide you with any opportunity to object to such uses or disclosures.  In the event of your incapacity or emergency circumstances, we will disclose health information based on determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your health care.  We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.



We may use or disclose your health information when we are required to do so by law, including judicial and administrative proceedings.


We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.  We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or thehealth or safety of others.



We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.  We may disclose to authorized federal authorities/officials health information required for lawful intelligence, counterintelligence, and other national security activities.  We may disclose to correctional institutions or law enforcement officials having lawful custody of protected health information of inmate or a patient under certain circumstances.



We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards or letters) or information about treatment alternatives or other health-related benefits and services that may be of interest to you.



ACCESS: You have the right to review or get copies of your health information, with limited exceptions.  You may request that we provide copies in a format other than photocopies.  We will use the format you requested unless we can not practically do so.  You must make a request in writing to obtain access to your health information.  You may obtain a form to request access by using the contact information listed at the end of this Notice.  We will charge you a reasonable cost-based fee for expenses such as copies and staff time.  You may also request access by sending us a letter to the address at the end of this Notice.  If you request an alternate format, we will charge a cost-based fee for providing your health information in that format.  If you prefer, we will prepare a summary or an explanation of your health information for a fee.  Contact us using the information listed at the end of this Notice for a full explanation of our fee structure.



You have a right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, health care operations, where you have provided an authorization and certain other activities, for the last six years, but not for disclosure made prior to April 14, 2003.  If you request this accounting more than once in a twelve-month period, we may charge you a reasonable, cost-based fee for responding to this additional request.



You have the right to request that we place additional restrictions on our use and disclosure of your health information.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (Except in an emergency).



You have the right to request in writing that we communicate with you about your health information by alternate means or to alternate locations.  Your request must specify the alternate means or location, and provide satisfactory explanation how payments will be handled under the alternate means or location you request.



You have the right to request that we amend your health information.  Your request must be in writing, and it must explain why the information should be amended.  We may deny your request under certain circumstances.



If you receive this Notice on our Website or by email, you have the right to receive this Notice in written form.


If you want more information about our privacy practices, have questions or concerns, please contact us.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use of disclosure of your health information or to have us communicate with you by alternate means or alternate locations, you may complain to us using the contact information listed at the end of this Notice.  You may also submit a written complaint to the US Department of Health and Human Services.  We will provide you with the address to file your complaint with the UD Department of Health and Human Services upon request.

We support your right to the privacy of your health information.  We will not retaliate in any way if you choose to file a complaint with us or the US Department of Health and Human Services.



TELEPHONE: 410-224-8908   FAX: 410-224-0871



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