McCannel Eye Clinic Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. McCannel Eye Clinic is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples:

a. Treatment, which means providing, coordinating or managing health care and related services. An example would be referral management.
b. Payment, which are activities such as obtaining reimbursement for services, confirming coverage, billing or collection activities and utilization review. An example for this would be helping a physician office obtain reimbursement for services.
c. Health care operations includes the business aspects of health care such as conducting quality assessment and improvement activities, auditing functions, cost management analysis and customer service. An example of this would be preparing your medical chart for an upcoming office visit. 2. McCannel Eye Clinic is permitted or required, under specific circumstances, to use or disclose protected health information without the individual's written authorization.

3. Other uses and disclosures will be made only with the Individual's written authorization, and the individual may revoke such authorization.

4. McCannel Eye Clinic intends to engage in one or more of the following activities:
a. McCannel Eye Clinic may create and share with its doctors aggregate health information by removing all references to individually identifiable health information.
b. McCannel Eye Clinic may contact the individual to provide case management services upon the request of a physician.
c. McCannel Eye Clinic may disclose protected health information to the sponsor of a plan, such as a group health plan, a health insurance company or HMO. 5. The individual has the following rights regarding protected health information:

a. The right to request restrictions on certain uses and disclosures of protected health information. McCannel Eye Clinic is not required to agree to a requested restriction, however.
b. The right to receive confidential communications of protected health information, as applicable.
c. The right to inspect and copy protected health information, as provided in the Privacy Regulation.
d. The right to amend protected health information, as provided in the Privacy Regulation.
e. The right to receive an accounting of disclosures of protected health information.
f. The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically. 6. McCannel Eye Clinic is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy practices with respect to protected health information.

7. McCannel Eye Clinic is required to abide by the terms of the Notice currently in effect.

8. McCannel Eye Clinic reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.

9. McCannel Eye Clinic will provide individuals or patients with a revised Notice by posting it on the McCannel Eye Clinic web site.

10. Individuals may complain to McCannel Eye Clinic and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows: Submit a typewritten, signed complaint addressed to the Privacy Officer at McCannel Eye Clinic (contact information below) and/or to the US Department of Health & Human Services; Office of Civil Rights; 200 Independence Ave SW; Washington, DC 20201; Toll Free 1-877-696-6775.