NOTICE OF PRIVACY PRACTICES
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.
THIS NOTICE IS EFFECTIVE MAY 1, 2006 UNTIL FURTHER NOTICE.
Right to Notice: As a patient, you have the right to adequate notice
of the uses and disclosures of your protected health information. Under the
Health Insurance Portability and Accessibility Act (HIPAA), Mertins Family Eye
Care can use your protected health information for treatment, payment and
health care operations. a) Treatment - We may use or disclose your health
information to a physician or other healthcare provider providing treatment to
you. b) Payment - We may use and disclose your health information to obtain
payment for services we provide you. c) Health care operations - We may use and
disclose your health information in connection with our healthcare operations.
Healthcare operations include quality assessment and improvement activities,
reviewing the competency or qualifications of healthcare professionals,
evaluating provider performance, conducting training programs, accreditation,
certification, licensing or credentialing activities.
Your Authorization: Most uses and disclosures that do not fall under
treatment, payment, health care operations will require your written
authorization. Upon signing, you may revoke your authorization (in writing)
through our practice at any time.
Emergency Situations: In the event of your incapacity or an emergency
situation, we will disclose health information to a family member, or another
person responsible for your care, using our professional judgment. We will only
disclose health information that is directly relevant to the person's
involvement in your healthcare.
Marketing: We will not use your health information for marketing
communications without your written authorization.
Required by Law: We may also use or disclose your health information
when we are required to do so by law.
Abuse or Neglect: 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 victim of other crimes. We may
disclose your health information to the extent necessary to avert a serious
threat to your or other people's health or safety.
National Security: We may disclose the health information of Armed
Forces personnel to military authorities under certain circumstances. We may
disclose health information to authorized federal officials required for lawful
intelligence, counterintelligence and other national security activities. We
may disclose health information of inmates or patients to the appropriate
authorities under certain circumstances.
Appointment Reminders: We may use or disclose your health information
to provide you with appointment reminders via phone, e-mail or letter.
Your Rights as a Patient: You have the right to restrict the
disclosure of your protected health information (in writing). The request for
restriction may be denied if the information is required for treatment, payment
or health care operations.
-You have the right to receive confidential communications regarding
your protected health information.
-You have the right to inspect and copy your protected health
information.
-You have the right to amend your protected health information.
-You have the right to receive an account of disclosures of your
protected health information.
-You have the right to a paper copy of this notice of privacy practices.
Legal Requirements:
Mertins Family Eye Care, Inc. is required by law to maintain the privacy of
your protected health information. We are required to abide by the terms of
this notice as it is currently stated, and reserve the right to change this
notice. The policies in any new notice will not be in effect until they are
posted to this site, or are available within our office.
Complaints: If you have
complaints regarding the way your protected health information was handled, you
may submit a complaint in writing to our office. You will not be retaliated
against in any manner for a complaint.
Contact Information: For
further information about Mertins Family Eye Care's privacy policies, please
contact Dr. Allyson Mertins at the following address or phone number: Mertins
Family Eye Care, Inc. 1188 N. Salem Road, Suite 12 Fayetteville, AR 72704
479-442-8400
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