Patient Privacy Statement & Printable Forms
Jefferson Eye Surgeons, LLP
Notice of Privacy Practices
Effective Jan. 1, 2010
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.
Our Promise To you,
Our Patients
Your information is important and confidential. Our ethics and policies require that your information be held in strict confidence.
We will use your health information for regular health operations.
We may disclose your health information for our routine operations. These uses are necessary for certain administrative, financial, legal and quality improvement activities that are necessary to run our practice and support the core functions.
For example:
Members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide and reduce health care costs.
- Appointment Reminders
We may disclose medical information to provide appointment reminders (e.g., contacting you at the phone number you have provided to us and leaving a message as an appointment reminder).
- Decedents
Consistent with applicable law, we may disclose health information to a coroner, medical examiner, or funeral director.
- Workers Compensation
We may disclose health information to the extent authorized by and necessary to comply with laws relating to workers compensation or other similar programs established by law.
- Public Health
As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
- Research
We may disclose information to researchers when
their research has been approved and the researcher has obtained a required waiver from the Institutional Review Board/Privacy Board who has reviewed the research proposal.
- Organ Procurement Organizations
Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of donation and transplant.
- As required By Law
We may disclose health information as required by law. This may include reporting a crime, responding to a court order, grandjury subpoena, warrant, discovery request, or other legal process, or complying with health over site activities, such as audits, investigations, and inspections, necessary to ensure compliance with government regulations and civil rights laws.
- Specialized Government functions
We may disclose health information for military and veteran’s affairs or national security and intelligence activities.
- Business Associates
There are some services provided in our organization through contacts with business associates. Some examples are laboratory transcription services may use. Due to the nature of business associates’ services, they must receive your health information in order to perform the jobs we’ve asked them to do. To protect your health information, however, when these services are contracted we require the business associate to appropriately safeguard your information.
- Practice Marketing
We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you (for example, to notify you of any new tests or services we may be offering).
- Food And Drug Administration (FDA)
We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement
- Personal Representatives
We may use or disclose information to your personal representative (person legally responsible for your care and authorized to act on your behalf in making decisions related to your health care).
- To Avert A Serious Threat To Health/Safety
We may disclose your information when we believe in good faith that this is necessary to prevent a serious threat to your safety or that of another person. This may include cases of abuse, neglect, or domestic violence.
- Communication With Family
Unless you object. Health professionals, using their best judgment, may disclose to a family member or close personal friend health information relevant to that person’s involvement in your care or payment related to your care. We may notify these individuals of your location and general condition.
- Disaster Relief
Unless you object, we may disclose health information about you to an organization assisting a disaster relief effort.
For all non-routine operations, we will obtain your written authorization before disclosing your personal information. In addition, we take great care to safeguard your information in every way that we can to minimize any incidental disclosures.