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 of Privacy Practices (“Notice”) applies to all protected health information (“PHI”) about you that is held or transmitted by a United States-based LASIK MD location, each of which is listed at the bottom of this Notice.

OUR COMMITMENT TO PRIVACY

LASIK MD is committed to maintaining the privacy of your medical information. This notice tells you about the ways in which we may use and disclose PHI about you. It also describes your privacy rights and some of the obligations we have regarding the use and disclosure of health information.

All people who work at LASIK MD are required to follow this notice, including employees and contractors who are authorized to enter information in your clinical record or who need to review your record in order to provide services to you, and health care professional trainees who participate in your care here.

This notice applies to records that LASIK MD creates or keeps relating to your health care and treatment, such as medical records and billing records, whether on paper or in a computer system. If you are identifiable in those records, then it is considered “protected health information” or “PHI”. PHI may also include photographs, video, digital images, or other images that record or document your medical care.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION (PHI)

Although your health record belongs to LASIK MD, and we are legally required to maintain it, you have certain rights concerning the information it contains.

RIGHT TO INSPECT AND COPY: You have the right to inspect and receive a copy of your PHI, including information maintained in our medical and billing records. If you request a copy of your PHI, we may charge a reasonable fee for the cost of copying.
Under certain circumstances, we may deny your request to inspect or obtain a copy of your PHI. If your request for inspection is denied, we will provide you a written notice explaining our reasons for such denial, and will include a description of your rights to have the decision reviewed and how you can exercise those rights.
RIGHT TO AMEND: If you feel that medical information we have about you is incorrect or incomplete, you may ask LASIK MD to amend the information by submitting your request in writing to us via the contact information at the bottom of this notice. Your request should include the reason(s) why you believe we should amend your information. We will respond to your request for amendments no later than 60 days after the receipt of your request.
If we deny your request for an amendment we will provide you with a written notice that explains our reasons. You will have the right to submit a written statement disagreeing with our denial. You will also be informed of how to file a complaint with the Secretary of the Department of Health and Human Services.
RIGHT TO AN ACCOUNTING OF DISCLOSURES: You have the right to request an “accounting of disclosures.” An accounting of disclosures is a list of disclosures LASIK MD has made of your PHI except for the following:

Disclosures to carry out treatment, payment, and health care operations.
Disclosures made to you.
Disclosures in accordance with an authorization you signed.
Disclosures made in a facility directory or to persons involved in your care.
Disclosures for national security or intelligence purposes.
Disclosures to correctional institutions or law enforcement officials.
Disclosures made before April 14, 2003.

To request an accounting of disclosures, your must submit your request in writing to us via the contact information at the bottom of this notice. Your request must state the time period for which you are requesting an accounting of disclosures, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request will be free. If you request additional lists within 12 months, we will charge you for the costs of providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before costs are incurred. We will respond to your request for an accounting of disclosures within 60 days.
RIGHT TO REQUEST RESTRICTIONS: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. We are not required to agree with your request. If we do agree, we will limit the disclosure of your PHI unless the information is needed to provide you with emergency treatment or to comply with the law. You also have the right to request a limit in the medical information we disclose about you to someone who is involved in your care, like a family member or friend. To request restriction on disclosures, you must submit your request in writing to us via the contact information at the bottom of this notice. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You have the right to request that we communicate with you about medical matters in a certain way, or at a certain location. To request confidential communications, you must submit your request in writing to us via the contact information at the bottom of this notice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted, and how payment for your health care will be handled if we communicate with you through this alternative method or location.
RIGHT TO RECEIVE A PAPER COPY OF THIS NOTICE: You have the right to request a paper copy of this notice at any time. To obtain a paper copy of this notice, please ask any staff member or submit your request in writing to us via the contact information at the bottom of this notice.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI)

In general, your PHI will be used and disclosed only with your written authorization. You may revoke an authorization for the use or disclosure of PHI at any time, except to the extent that we have already relied upon the authorization.

The categories listed below describe some of the ways in which we may use and disclose PHI without your written authorization. We will make reasonable efforts to limit the use and disclosure of your PHI to the necessary minimum to accomplish the intended purpose; however, the necessary minimum limitation does not apply to disclosures that we make to other health care providers for purposes of your treatment, disclosures required by law, and disclosures that we make to you or pursuant to your authorization.

TREATMENT: We may use PHI to provide you with medical treatment and services. We may disclose PHI about you to physicians, nurses, technicians, or other personnel who are involved in your care and treatment at LASIK MD. We may also disclose PHI about you to health care providers outside of LASIK MD who are involved in your care or treatment. For example, we may disclose your PHI to your referring physician for purposes of treating or coordinating your care. We may also share your PHI in order to coordinate services such as lab tests.
PAYMENT: We may use and disclose PHI in order to bill and collect payment for the services and items you receive from us. For example, we may contact your health insurer to certify you are eligible for benefits, and we may need to disclose PHI to your health insurer in order to obtain payment for services, to obtain prior approval, or to determine whether your plan will cover the treatment or service.
HEALTH CARE OPERATIONS: We may use and disclose PHI in order to conduct our normal business operations. For example, we may use your PHI to review the treatment and services provided, to evaluate the performance of your staff in caring for you, or to educate our staff on how to improve the care they provided for you. We may also disclose PHI to other companies that perform business services for us, such as billing companies, technology and software vendors, attorneys, or external auditors. In those situations, we will have a written agreement with those other companies to ensure that they will protect the privacy of your PHI.
APPOINTMENT REMINDERS AND FOLLOW-UP PHONE CALLS: We may use and disclose PHI to contact you with a reminder that you have an appointment with us. We may also call to follow-up on care you received with us, to tell you of test results, or to confirm an appointment with us or another health care provider.

TREATMENT ALTERNATIVES OR OTHER HEALTH RELATED BENEFITS

We may use and disclose PHI to tell you about possible treatment alternatives or health-related benefits or services that may be of interest to you.

INDIVIDUALS INVOLVED IN PAYMENT OF YOUR CARE: Health professionals at LASIK MD using their professional judgment may disclose PHI to a family member, other relative, a close personal friend, or any other individual who is involved in your care or in payment for your care.
EMERGENCIES: We may use or disclose PHI in emergency situations if there is no opportunity to object to such uses and disclosures because of your incapacity or an emergency treatment circumstance.
AS REQUIRED BY LAW: We will use or disclose PHI to the extent that such use or disclosure is required by federal, state, or local laws.
PUBLIC HEALTH RISKS: We may use or disclose PHI to authorized public health officials so they may carry out public health activities. For example:

To prevent or control disease, injury or disability
To report vital events such as births or deaths
In relation to quality, safety, or effectiveness of FDA-regulated products or activities.

TO AVERT SERIOUS THREAT TO HEALTH OR SAFETY: We may use or disclose PHI if, in good faith, we believe that it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, and the disclosure is to a person or persons reasonably able to prevent or lessen the threat, including the target of a threat; or it is necessary for law enforcement authorities to identify or apprehend an individual.
VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE: We may disclose PHI to government authorities including a social service or protective services agency authorized by law to receive reports of abuse, neglect, or domestic violence. For example: we may report your PHI to government officials if we reasonably believe that you have been a victim of abuse, neglect, or domestic violence. We will make every effort to obtain your permission before releasing this information; however, in some cases we may be required or authorized to act without your permission.
HEALTH OVERSIGHT ACTIVITIES: We may disclose your PHI to a health oversight agency for activities authorized by law. These agencies typically monitor the operation of the health care system government benefits programs, and compliance with government regulatory program. The oversight activities may include audits; civil criminal, or administrative investigations or actions; inspections; and licensure or disciplinary actions.
WORKERS’ COMPENSATION: We may, in accordance with the law, disclose PHI for workers’ compensation or other similar programs that provide benefits for work-related injuries or illnesses.
LAWSUITS AND LEGAL PROCEEDINGS: We may use or disclose your PHI in response to a court of administrative agency order, if you are involved in a lawsuit of similar proceedings. We also may disclose your PHI in response to a subpoena or other lawful process by another party involved in the dispute, but only if we have received satisfactory assurances from the party requesting the information that reasonable efforts have been made to inform you of the request, or a qualified protective order has been obtained.
LAW ENFORCEMENT PURPOSES: LASIK MD may disclose your PHI to law enforcement officials for reasons such to the following:

In response to court orders, warrants, subpoenas, or similar legal process.
To assist law enforcement officials with identifying or locating a suspect, fugitive, material witness, or missing person.
If you have been or are suspected of being a victim of a crime and you agree to the disclosure, or if we are unable to obtain your agreement because of incapacity or other emergency.
If we suspect that a death resulted from criminal conduct.
To report evidence of criminal conduct that occurred on our premises.
To report a crime, including the location or victims of the crime, or the identity, description or location of the person who committed the crime.

SPECIALIZED GOVERNMENT FUNCTIONS: We may use and disclose PHI to federal officials for intelligence and national security activities authorized by law, or for protective services for the President or foreign heads of the state. If you are a member or a veteran of the U.S. military forces, we may disclose your PHI if required by the appropriate authorities.
CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS: We may disclose PHI to a coroner, a medical examiner, or a funeral director as necessary to carry out their duties.
ORGAN, EYE, OR TISSUE DONATION PURPOSES: We may use or disclose PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissues for donation and transplantation.
RESEARCH: In most cases, we will ask for your written authorization before using or disclosing your PHI to conduct research. However, in limited circumstances we may use or disclose PHI without authorization if:

An Institutional Review Board or a Privacy Board approved the use or disclosure, and we obtain appropriate assurances from the researcher that the information is necessary for the research protocol. PHI will not be removed from the premises of LASIK MD, and the information will be used solely for research purposes.
The PHI sought by the researcher relates only to decedents and the researcher agrees that the use or disclosure is necessary for the research.

USES AND DISCLOSURES REQUIRING PERMISSION OR AUTHORIZATION

Except in very limited situations, any uses or disclosures of your PHI not listed above will be made only with your written authorization. Specifically:

Marketing - We must obtain your written authorization before using your PHI to send marketing materials to you. This does not include discussing possible treatment alternatives or health-related benefits or services that may be of interest to you.
Highly confidential and sensitive information - There are additional protections for certain types of health information. For example, psychotherapy notes; reproductive health information; diagnosis, prognosis, or treatment for alcohol or drug dependency; and HIV testing or results are all afforded special protection and additional authorizations.
Reproductive health – Without your written authorization, we will not use or disclose your PHI for purposes of conducting an investigation or imposing liability in the context of a person seeking, obtaining, providing, or facilitating reproductive health care.
Selling your information - We will not sell your PHI without your written authorization.

In addition, you have the right to give us permission to disclose information to your family, close friends, or others involved in your care, disclose information in a disaster relief situation, and include your information in a hospital directory, if applicable. If you are unable to tell us your preference, as noted above, our eye care professionals may share your information if we believe it is in your best interest. We may also share your information when needed to reduce a serious or imminent threat to health or safety.

ELECTRONIC COMMUNICATIONS:

We may disclose your PHI in electronic communications which are (a) in our text messages, emails or other electronic communications to you or in response to text messages, emails or electronic communications from you to us; and (b) statements or inquiries that you have posted on our web page, social media pages, or other public domains. Please note that the transmission and/or storage of text messages, emails, social media postings, and other electronic communications may not be encrypted or secure. If you have a specific question regarding your medical condition, we encourage you to contact us directly to discuss it.

CHANGES TO THIS NOTICE:

We reserve the right to revise the terms of this Notice of Privacy Practices. Any changes to this notice will be effective for all records that LASIK MD maintains. If we make any changes to our Notice of Privacy Practices the revised notice will be available to you on request and can be viewed on our website at www.lasikmd.com. If we make major changes to this notice that affect the use and disclosure of your PHI, your rights, our duties, or our privacy practices, you will be informed in accordance with the law. In addition, a copy of our current Notice of Privacy Practices is posted on our website and in a visible location at LASIK MD at all times. You may obtain a paper copy of our most current Notice of Privacy Practices at any time by submitting your request in writing to us via the contact information at the bottom of this notice.

COMPLAINTS:

If you believe your privacy rights have been violated, you may file a complaint with LASIK MD and/or with the Secretary of the Department of Health and Human Services at: U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue, S.W., Washington, DC 20201. To file a complaint with LASIK MD contact:

Privacy Officer at privacyus@lasikmd.com
Phone number: 1-855-341-2020
PO Box 803, Jupiter, FL 33468

Submitting a complaint to LASIK MD or the Secretary of the Department of Health and Human Resources will not affect your status as a patient of your practice. We will not penalize you for filing a complaint.

REQUESTS OF LASIK MD:

If you want to: request an amendment to your information, obtain an accounting of disclosure of your information, and/or request a restriction or other confidentiality protections on aspects of your information, your request must be made in writing, and submitted to:

Privacy Officer at: privacyus@lasikmd.com.