HIPAA privacy practices.

Effective Date: April 14, 2003.

THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US. If you have any questions about this notice, please contact our Privacy Officer, Sebastian Filutowski, at (407) 333-5111.

Our Legal Duty

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make the changes effective for all health information that we maintain. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. This Notice applies to Filutowski Eye Institute and its associated surgical centers.

Uses and Disclosures of Health Information

We use and disclose health information about you for treatment, payment, and health care operations. For example, we may use or disclose your health information to a physician or other provider giving you treatment; to obtain payment for services we provide to you; and in connection with our health care operations such as quality assessment, training, accreditation, licensing, and credentialing.

Your Authorization: Apart from treatment, payment, or health care operations, you may give us written authorization to use or disclose your health information for any purpose. You may revoke that authorization in writing at any time; the revocation will not affect uses or disclosures permitted while it was in effect.

To Your Family and Friends: We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your care or payment for your care, but only if you agree.

Other permitted uses include: appointment reminders; required-by-law disclosures; reporting abuse or neglect; national security and law-enforcement custody situations; military and veterans matters; workers’ compensation; public health activities; and disaster-relief coordination. We will not use your health information for marketing communications without your written authorization.

Your Rights

• Access: You have the right to look at or get copies of your health information, with limited exceptions. Requests must be made in writing. Florida law allows a reasonable copying fee of $1.00 per page for the first 25 pages and $0.25 for each page thereafter (Florida Administrative Code rule 64B8-10.003).
• Disclosure Accounting: You have the right to receive a list of certain disclosures of your health information for the last six years, but not before April 14, 2003.
• Restriction: You have the right to request additional restrictions on our use or disclosure of your health information. We are not required to agree, but if we do, we will abide by our agreement except in an emergency.
• Alternative Communication: You have the right to request that we communicate with you by alternative means or at alternative locations. Requests must be made in writing.
• Amendment: You have the right to request that we amend your health information. Requests must be in writing and explain why the information should be amended. We may deny the request under certain circumstances.
• Electronic Notice: If you receive this Notice electronically, you are entitled to receive a paper copy on request.
• Notification of a Breach: You have the right to be notified if a breach involving your protected health information occurs.
• Self-Pay: You have the right to request that your medical information not be shared with your insurance carrier if you pay out of pocket for the services rendered.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with Filutowski Eye Institute or with the Secretary of the U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street SW, Atlanta, GA 30303-8909. To file a complaint with Filutowski Eye Institute, contact our Compliance Officer at (407) 333-5111. We will not retaliate against you for filing a complaint.