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

INFORMATION COLLECTED ABOUT YOU

In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:

* Information relating to your medical history.
* Your insurance information and coverage.

 HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
We may use and disclose personal and identifiable health information about you for a variety of purposes. 

For Payment.  We may use and disclose health information about you to bill for our services to collect payment from you or your insurance company. 

For Health Care Operations.   We may use and disclose information about you for the general operation of our business.  For example, we may use and disclose your health information to review the quality of services provided to you, or to schedule a test or operation for you. 

Required Disclosures.  We are required to disclose health information about you to the Secretary of Health and Human Services, upon request, to determine our compliance with HIPAA and to you, in accordance with your right to access and right to receive an accounting of disclosures, as described below.

Public Policy Uses and Disclosures.  There are a number of public policy reasons why we may disclose information about you which are described below. 

We may disclose health information about you when we are required to do so by federal, state, or local law. 

We may disclose protected health information about you in connection with certain public health reporting activities.  Public health authorities include state health departments and the Center for Disease Control. 

We are also permitted to disclose protected health information to a public health authority or other government authority authorized by law to receive reports of abuse, neglect, domestic violence or to prevent or reduce a serious threat to anyones health or safety.

 We may disclose health information about you in connection with certain health oversight activities of licensing and other health oversight agencies which are authorized by law.

We may disclose your health information as required by law, including in response to a warrant, subpoena, or other order of a court or administrative hearing body. 

We may release your health information to workers’ compensation or similar programs, which provide benefits for work-related injuries or illnesses. 

We may share health information to help with product recalls or for health research. 

We may disclose your protected health information for legal or administrative proceedings that involve you.  We may release such information upon order of a court or administrative tribunal. 

Our Business Associates.  We sometimes work with outside individuals and businesses that help us operate our business successfully.  We may disclose your health information to these business associates so that they can perform the tasks that we hire them to do.  Our business associates must promise that they will respect the confidentiality of your personal and identifiable health information. 

Disclosures to Persons Assisting in Your Care or Payment for Your Care.  We may disclose information to individuals involved in your care or in the payment for your care.  This includes people and organizations that are part of your "circle of care" -- such as your spouse, your other doctors, or an aide who may be providing services to you.  

Appointment Reminders.  We may use and disclose medical information to contact you as a reminder that you have an appointment or that you should schedule an appointment.

OTHER USES AND DISCLOSURES OF PERSONAL INFORMATION 

We are required to obtain written authorization from you for any other uses and disclosures of medical information other than those described above.  If you provide us with such permission, you may revoke that permission, in writing, at any time. We will not sell your information, use it for marketing purposes or fundraising efforts. 

INDIVIDUAL RIGHTS

 You have the right to ask for restrictions on the ways we use and disclose your health information for treatment, payment and health care operation purposes.  You may also request that we limit our disclosures to persons assisting your care or payment for your care.  We will consider your request, but we are not required to accept it.

Except under certain circumstances, you have the right to inspect and copy medical, billing and other records used to make decisions about you.  If you ask for copies of this information, we may charge you a fee for copying and mailing. Copies will be provided within 30 days. 

If you believe that information in your records is incorrect or incomplete, you have the right to ask us to correct the existing information or add missing information.  Under certain circumstances, we may deny your request, such as when the information is accurate and complete. Corrections will be made within 60 days.

You have a right to receive a list of certain instances when we have used or disclosed your medical information.  We are not required to include in the list uses and disclosures for your treatment, payment for services furnished to you, our health care operations, disclosures to you, disclosures you give us authorization to make and uses and disclosures before April 14, 2003, among others.  If you ask for this information from us more than once every twelve months, we may charge you a fee. You have a right to a copy of this privacy notice.

If you pay for a health service or item out-of-pocket in full, you may request that we not share that information with your health insurance. You may allow another person through medical power of attorney or guardianship to exercise these rights.

You may complain to us if you feel your rights have been violated or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, 1-877-696-6755 or www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

OUR RESPONSIBILITIES
We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
To exercise any of your rights, please contact us in writing at 4707 Everhart, Suite 108, Corpus Christi, TX  78411.  When making a request for amendment, you must state a reason for making the request.

To obtain more information concerning this notice, you make contact our Privacy Officer, Angelica Gonzalez at 361-857-6600. 

Clear Vision Pediatric Ophthalmology, PLLC
Notice of Privacy Practices