NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW KORNMEHL LASER EYE ASSOCIATES MAY USE AND DISCLOSE YOUR HEALTHCARE INFORMATION AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Kornmehl Laser Eye Associates is required by law to maintain the privacy of your protected health information. This information consists of all records related to your health, including demographic information, either created by Kornmehl Laser Eye Associates or received by Kornmehl Laser Eye Associates from other healthcare providers.

We are required to provide you with notice of our legal duties and privacy practices with respect to your protected health information. These legal duties and privacy practices are described in this Notice, or the Notice currently in effect at the time of the use or disclosure of your protected health information.

Kornmehl Laser Eye Associates reserves the right to change the terms of this Notice and to make any new provisions effective for all protected health information that we maintain. Patients will be provided a copy of any revised Notices upon request. An individual may obtain a copy of the current Notice from our office at any time.

Uses and Disclosures of Your Protected Health Information not requiring Your Consent

Kornmehl Laser Eye Associates may use and disclose your protected health information, without your written consent or authorization, for certain treatment, payment and healthcare operations. There are certain restrictions on uses and disclosures of treatment records, which include registration and all other records concerning individuals who are receiving, or who at any time have received services for mental illness, development disabilities, alcoholism, or drug dependence. There are also restrictions on disclosing HIV test results.

Treatment may include:

· Providing, coordinating, or managing healthcare and related services by one or more healthcare providers;

· Consultations between healthcare providers concerning a patient;

· Referrals to other providers for treatment;

· Referrals to nursing homes, foster care homes, or home health agencies.

For example, Kornmehl Laser Eye Associates may determine that you require the services of a specialist. In referring you to another doctor, Kornmehl Laser Eye Associates may share or transfer your healthcare information to that doctor.

Payment activities may include:

· Activities undertaken by Kornmehl Laser Eye Associates to obtain reimbursement for services provided to you;

· Determining your eligibility for benefits or health insurance coverage;

· Managing claims and contacting your insurance company regarding payment;

· Collection activities to obtain payment for services provided to you;

· Reviewing healthcare services and discussing with your insurance company the medical necessity of certain services or procedures, coverage under your health plan, appropriateness of care, or justification of charges;

· Obtaining pre-certification and pre-authorization of services provided to you.

For example, Kornmehl Laser Eye Associates will submit claims to your insurance company on your behalf. This claim identifies you, your diagnosis, and the services provided to you.

Healthcare operations may include

· Contacting healthcare providers and patients with information about treatment alternatives;

· Conducting quality assessment and improvement activities;

· Conducting outcomes evaluation and development of clinical guidelines;

· Protocol development, case management, or care coordination;

· Conducting or arranging for medical review, legal services, and auditing functions.

For example, Kornmehl Laser Eye Associates may use your diagnosis, treatment, and outcome information to measure quality of the services we provide, or assess the effectiveness of your treatment when compared to patients in similar situations.

Kornmehl Laser Eye Associates may contact you, by telephone or mail, to provide appointment reminders. You must notify us if you do not wish to receive appointment reminders.

We may not disclose your protected health information to family members or friends who may be involved with your treatment or care without your written permission. Health information may be released without written permission to a parent, guardian, or legal custodian of a child; the guardian of an incompetent adult; the healthcare agent designated in an incapacitated patient’s healthcare power of attorney, or the personal representative or spouse of a deceased patient.

There are additional situations when Kornmehl Laser Eye Associates is permitted or required to use or disclose your protected health information without your consent or authorization. Examples include the following:

· As permitted or required by law.

In certain circumstances we may be required to report individual health information to legal authorities, such as law enforcement officials, court officials, or government agencies. For example, we may have to report abuse, neglect, domestic violence or certain physical injuries. We are required to report gunshot wounds or any other wound to law enforcement officials if there is reasonable cause to believe that the wound occurred as a result of a crime. Mental health records may be disclosed to law enforcement authorities for the purpose of reporting an apparent crime on our premises.

· For public health services.

We may release healthcare records, with the exception of treatment records, to certain government agencies or public health authority authorized by law, upon receipt of written request from that agency. We are required to report HIV test results to the state epidemiologist. We may also disclose HIV test results to other providers or persons when there has been or will be risk of exposure.

We may report to the state epidemiologist the name of any person known to have been significantly exposed to a patient who tests positive for HIV. We are required by law to report suspected child abuse and neglect and suspected abuse of an unborn child, but cannot disclose HIV test results in connection with the reporting or prosecution of alleged abuse or neglect. We may release healthcare records, including treatment records and HIV test results, to the Food and Drug Administration when required by federal law. We may disclose healthcare records, except for HIV test results, for the purpose of reporting elder abuse or neglect, provided the subject of the abuse or neglect agrees, or if necessary to prevent serious harm. Records may be released for the reporting of domestic violence if necessary to protect the patient or community from imminent and substantial danger.

· For health oversight activities.

We may disclose healthcare records, including treatment records, in response to a written request by any federal or state governmental agency to perform legally authorized functions, such as management audits, financial audits, program monitoring and evaluation, and facility or individual licensure or certification. HIV test results may not be released to federal or state governmental agencies, without written permission, except to the state epidemiologist for surveillance, investigation, or to control communicable diseases.

· Judicial and Administrative Proceedings.

Patient healthcare records, including treatment records and HIV test results, may be disclosed pursuant to a lawful court order. A subpoena signed by a judge is sufficient to permit disclosure of all healthcare records except for HIV test results.

· For activities related to death.

We may disclose patient healthcare records, except for treatment records, to a coroner or medical examiner for the purpose of completing a medical certificate or investigating a death. HIV test results may be disclosed under certain circumstances.

· For research.

Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research.

· To avoid a serious threat to health or safety.

We may report a patient’s name and other relevant data to the Department of Transportation if it is believed the patient’s vision or physical or mental condition affects the patient’s ability to exercise reasonable or ordinary control over a motor vehicle. Healthcare information, including treatment records and HIV test results, may be disclosed where disclosure is necessary to protect the patient or community from imminent and substantial danger.

· For worker’s compensation.

We may disclose your health information to the extent such records are reasonably related to any injury for which workers compensation is claimed.

Kornmehl Laser Eye Associates will not make any other use or disclosure of your protected health information without your written authorization. You may revoke such authorization at any time, except to the extent that Kornmehl Laser Eye Associates has taken action in reliance thereon. Any revocation must be in writing.