HIPAA 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.
OUR ORGANIZATION’S PLEDGE TO YOU
This notice is intended to inform you of the privacy practices followed by Jean A. Astorino O.D. P.C. An explanation of the federal privacy rights afforded to you will also be included.
Jean A. Astorino O.D. P.C. often needs access to health information in order to provide services. We want to assure individuals receiving services through Jean A. Astorino O.D. P.C. that we comply with federal privacy laws and respect your right to privacy. We require all members of our workforce and third parties that are provided access to health information to comply with the privacy practices below.
USES AND DISCLOSURES OF HEALTH INFORMATION
Health Care Operations Jean A. Astorino O.D. P.C. may use and disclose health information in order to perform administrative functions such as quality assurance activities, resolution of internal grievances, and evaluation of services. We may use and disclose your health information to remind you of an appointment or to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Payment Jean A. Astorino O.D. P.C. may use and disclose health information without your written authorization in order to determine eligibility for benefits, seek reimbursement from a third party and to coordinate benefits with other third party providers.
Treatment Jean A. Astorino O.D. P.C. may use and disclose health information to give you medical treatment or services. We may share your health information with other health care personnel who are involved in providing your health care. We may share health information about you with people outside Jean A. Astorino O.D. P.C. who perform services related to your treatment, or to provide follow-up care to you.
As Permitted or Required by Law Jean A. Astorino O.D. P.C. may use and disclose health information without your written authorization in certain special situations where the law permits, and under some circumstances requires us to do so. Subject to Pennsylvania law, Jean A. Astorino O.D. P.C. may share your health information under circumstances, including, but not limited to, (i) when law requires that we report information about suspected abuse, neglect or domestic violence, or related to suspected criminal activity, or in response to a court order, (ii) when we are required to collect or report health information for public health activities or health oversight activities, or (iii) when we must do so in order to prevent serious harm to you or others, or (iiii) for fund raising activities, certain limited marketing activities and research activities.
Pursuant to your Authorization When required by law, Jean A. Astorino O.D. P.C. will ask for your written authorization before using or disclosing your health information. If you choose to sign the authorization, you can later revoke that authorization at any time to cease any further uses or disclosures. However, we are unable to take back any information that we have already shared with your permission.
Right to Inspect and Copy In most cases, you have the right to inspect and copy the health information Jean A. Astorino O.D. P.C. maintains about you. If we deny your request, we will provide you with written reasons for the denial and explain your right to have the denial reviewed. Your request to inspect or review your information must be submitted in writing to the address below.
Right to an Accounting of Disclosures You have the right to receive a list of instances where Jean A. Astorino O.D. P.C. has disclosed health information about you for reasons other than treatment, payment, or health care operations. Your request for an accounting must be submitted in writing to the address below.
Right to Amend If you believe that the information within your records is incorrect or if important information is missing, you have the right to request that Jean A. Astorino O.D. P.C. correct the existing information or add the missing information. If we did not create the health information that you believe is incorrect, or if we disagree with you and believe your health information is correct, we may deny your request. Your request for an amendment must be submitted in writing to the address below.
Right to Request Restrictions You may request that Jean A. Astorino O.D. P.C. limit the health information we use or disclose to others for treatment, payment, or health care operations. Jean A. Astorino O.D. P.C. will consider your requests, but is not legally obligated to agree to those restrictions. Your request for a restriction must be submitted in writing to the address below.
Right to Request Confidential Communications You have the right to request to receive confidential communications containing your health information. Jean A. Astorino O.D. P.C. is required to accommodate reasonable requests. For example, you may ask that Jean A. Astorino O.D. P.C. contact you at your place of employment or send communications regarding treatment to an alternate address or in a desired format. Your request for confidential communications must be submitted in writing to the address below.
OUR LEGAL DUTIES
Jean A. Astorino O.D. P.C. is required by law to protect the privacy of your health information, provide this notice about health information practices, and follow the health information practices that are described in this notice.
Jean A. Astorino O.D. P.C. reserves the right to change this notice and its policies at any time and make new provisions effective for health information we already maintain. In addition to providing you a copy of the current notice, we will post a copy of the current notice in the waiting areas of Jean A. Astorino O.D. P.C. You can also request a copy of our current notice at any time. For more information about our privacy practices, contact us at the address below.
If you have any questions or complaints, please contact us at:
Jean A. Astorino O.D. P.C.
200 East State Street, Suite 302
Media PA 19063
610 892 8767
If you are concerned that Jean A. Astorino O.D. P.C. has violated your privacy rights, or you disagree with a decision Jean A. Astorino O.D. P.C. has made about access to your records, you may contact us at the address above. You also may send a written complaint to the U.S. Department of Health and Human Services- Office of Civil Rights. Contact the address above for the appropriate address or you may visit www.hhs.gov/ocr for further information.
You will not be penalized for filing a complaint.