NOTICE OF PRIVACY PRACTICE
USES AND DISCLOSURES WITHOUT YOUR AUTHORIZATION
1. TREATMENT - We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
THIS NOTICE DESCRIBES HOW OCULAR PROSTHETIC INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THAT INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Right to Notice: As a patient, you have the right to adequate notice of the uses and disclosures of your Protected Health Information ("PHI"). Under the Health Insurance Portability and Accessibility Act (HIPPA), Wm. Randall Trawnik, B.C.O., doing business as Dallas Eye Prosthetics/Fort Worth Eye Prosthetics is committed to maintaining the privacy of your PHI. Your PHI includes information about your ocular prosthetic condition and the care and treatment you receive.
2. PAYMENT - We may use and disclose your health information to obtain payment for services we provide you.
3. HEALTH CARE OPERATIONS - To operate in accordance with applicable law and insurance requirements, and to provide quality and efficient care, we may need to compile, use and disclose your PHI.
Most uses and disclosures that do not fall under treatment, payment, healthcare operations will require your written authorization. Upon signing, you may revoke your authorization (in writing) through our practice at any time.
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.
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 you or other people's health or safety.
We may disclose 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.
We may use or disclose your health information to provide you with appointment reminders via, phone, e-mail, letter, or postcard.
We maintain a sign-in log at the reception desk for individuals seeking care and treatment in the office. The sign-in log is located in a position where staff can readily see who is seeking care in the office. The information may be seen by, and is accessible to, others who are seeking care or services in our office.
YOUR RIGHTS AS A PATIENT
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.
Wm. Randall Trawnik 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 available within our office.
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.
For further information about Wm. Randall Trawnik, B.C.O. privacy policies, please contact Linda Pacheco at the following address and phone number.
Dallas Eye Prosthetics
8226 Douglas Avenue, #415
Dallas, TX 75225