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

If you have any questions about this Notice, please contact Ms. Audrey Valenzuela at:

The Center for the Partially Sighted Attention: Medical Records Director 6101 W. Centinela Ave., Suite 150 Culver City, CA 90230 310-988-1970

Who will follow this notice

This Notice describes practices of The Center for the Partially Sighted (CPS) including that of:

Any health care professional authorized to enter information into your medical chart.
All employees, staff and other CPS personnel.
Any member of a volunteer group we allow to help you while you are at The Center for the Partially Sighted.

Our promise regarding medical information

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at The Center for the Partially Sighted in order to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by CPS.

This Notice will tell you about the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

make sure that medical information that identifies you is kept private;
make available to you this Notice of our legal duties and privacy practices with respect to medical information about you;
follow the terms of the Notice that is currently in effect. This Notice may change, in the manner described below under "CHANGES TO THIS NOTICE";
train our personnel concerning privacy and confidentiality;
implement a sanction policy to discipline those who breach stated privacy/confidentiality policies; and
mitigate (lessen the harm of) any breach of privacy / confidentiality.

How we may use and disclose medical information about you

We will use your health information in the following ways. (Examples are provided for each catagory, but not every use or disclosure is listed.)

If you give us your consent, we will use your health information for Treatment.

We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to state agencies such as the California Department of Rehabilitation, referring physicians, community health agencies, social services agencies, and personnel who are involved in taking care of you. Our different departments also may share medical information about you among themselves, in order to coordinate the different treatments you need, such as rehabilitation services, low vision aids training, emotional support, etc. We also may disclose medical information about you to people outside the medical group who may be involved in your medical care, such as family members or others who assist us with your care.

If you give us your consent, we will use your health information for Payment.

We may use and disclose medical information about you so that the treatment and services you receive here may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about your optometric diagnosis and the optometric low vision services you received so your health plan will pay us for the exams. We may also tell your health plan about a low vision device you are going to receive to obtain prior approval or to determine whether your plan will cover it.

If you give us your consent, we will use your health information for Health Care Operations.

As an example, we may provide some of you health information to our Clinical Services Director, Department Heads or members of the quality assurance team to assess the care and outcome in your case and the competence of the caregivers. We will use this information in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.

Other uses of your information include:

Business Associates: We provide some services through contracts with business associates. For example, most of our prescription low vision devices are developed in optical labs. When we use these services, we may disclose your health information to the business associate so that they can perform the function(s) we have contracted them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Continuity of Care / Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Communication with Family: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

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.

Fund-raising: We may contact you as part of a fund-raising effort. You have the right to request not to receive subsequent fund-raising materials.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse effects/events with respect to food, drugs, supplements, product or product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Correctional Institutions: If you are an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of others.

Law Enforcement: We may disclose health information as required by law or in response to a valid subpoena.

Health oversight: If a member of our work force or a business associate believes in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public, they may disclose your health information to health oversight agencies and/or public health authorities, such as the Department of Health.

The Federal Department of Health and Human Services (DHHS): Under the privacy standards, we must disclose your health information to DHHS as necessary for them to determine our compliance with those standards.

Your rights regarding medical information about you

You have the following rights regarding medical information we maintain about you:

Restrictions on disclosures: You have the right to request that we restrict the use and disclosure of your health information. In some cases, we are not required to agree to your requested restrictions. For example, we may disclose without your consent:
1. when disclosure is required by law
2. when disclosure is necessary for public health activities
3. when disclosure relates to victims of abuse, neglect or domestic violence
4. when disclosure is for health oversight activities
5. when disclosure is for law enforcement purposes
6. when disclosure relates to medical research
7. when disclosure relates to specialized government functions such as information related to veteran or military activities, national security and intelligence activities, protective service for the President, etc.
8. when disclosure relates to correctional institutions and in other law enforcement custodial situation.
If we agree to a restriction, we will adhere to it unless you request otherwise or we give you advance notice. You may request restrictions initially by noting them on the “Release of Information Form” that you will be asked to sign on your first visit to CPS. Release forms are valid for 2 years at which time a new release must be signed. If you choose to request a restriction at a later date, simply contact in writing Ms. Audrey Valenzuela, Medical Records Supervisor, at the address noted on page 1 of this document. Your written request 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, for example, disclosures to your spouse.
Different Ways to Communicate with You: You have the right to request how and where we contact you about your health information. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing. We must accommodate reasonable requests. We may place a condition on that accommodation asking you to provide us with information regarding how payment, if any, will be handled and your specification of an alternative address or other method of contact. You may request alternative communications by writing to Ms. Audrey Valenzuela, Medical Records Supervisor, at the address noted on page 1 of this document.
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. In some cases, we may provide a summary of the health information you requested if you agree in advance to the form and cost of the summary. We may deny your request in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by CPS will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of that review.

You must submit any request to inspect and copy your medical information to our Medical Records Supervisor in writing. If you request a copy of your information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. Your request must be in writing and must explain your reason(s) for the amendment. We may deny your request if: 1) the information was not created by us; 2) the information is not part of the records used to make decisions about you; 3) we believe the information is correct and complete or 4) the information is not part of the information you were allowed to review. We will tell you in writing the reasons for your denial and describe your rights to give us a written statement disagreeing with the denial. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including persons you name who have received information about you and who need the amendment.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we have made of medical information about you, with some exceptions. The exceptions are governed by federal health privacy law, and include (1) routine disclosures for treatment, payment and operations conducted pursuant to your signed consent form, and (2) disclosures to you.

You must submit any request for an accounting of disclosures to our Medical Records office at the location noted on the first page of this Notice, in writing. Your written request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003, when current federal health privacy laws became effective for CPS. Your request should indicate whether you want the report on paper or electronically. The first report you request within a 12-month period will be free. For additional reports, we may charge you for the costs of providing the report. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to a Paper Copy of This Notice. You may ask us to give you a paper copy of this Notice at any time by contacting our Medical Records office at the location noted on the first page of this Notice.

Changes to this notice

We reserve the right to change this Notice as well as our privacy policy and procedures. When we do, we may make the changed Notice effective for medical information we already have about you, as well as any information we receive in the future. We will post a copy of the current Notice in our reception area. Each Notice will contain on the first page, in the top left-hand corner, its effective date.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with CPS or with the Secretary of the Department of Health and Human Services. To file a complaint with CPS, contact our Clinical Services Director or Medical Records Supervisor at the location noted on the first page of this Notice. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Last Updated: Tuesday, January 5th, 2010 at 18:16:11 Back to top