Scott Seo, M.D., Ph.D.

Eye Surgeon & Physician

Comprehensive Ophthalmology

and Cataract Surgery



Fairfield Ophthalmology

Old location:
1300 Post Road
Fairfield, CT  

203.254.8050

F 203.254.8051

We moved
to our Bridgeport
office

 

Our location:

Merritt Medical Center
3715 Main Street #309
Bridgeport, CT 06606
Ph 203.372.4211
Fax 203.372.4142

 

 

NOTICE OF PRIVACY PRACTICES    

 

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FAIRFIELD OPHTHALMOLOGY, LLC

1300 Post Rd, Suite 209, Fairfield, CT 06824

(203) 254-8050

 

Effective Date of this Notice:  May 3, 2010

Privacy Officer/Contact Person:  Scott Seo, M.D., Ph.D.

Phone number:  (203) 254-8050

I  NTRODUCTION   

Fairfield Ophthalmology, LLC, is required by law to protect the privacy of your health information, called “protected health information” (PHI). This Notice of Privacy Practices (hereafter, “Notice”) describes the ways in which we may use and disclose your medical/protected health information and how you can get access to this information. Your health information is contained in your medical and billing records maintained by Fairfield Ophthalmology. It includes demographic information and information that relates to your present, past or future physical or mental health and related healthcare services. This Notice applies to uses and disclosures we may make of all your protected health information whether created by us in our practice or received by us from another healthcare provider. 

 

A.     OUR LEGAL DUTY TO PROTECT YOUR HEALTH INFORMATION 

Federal and State Laws require us to: 

·            Maintain the privacy of your protected health information that we have created in our practice or received from another health care provider whether it is about your past, present, or future health care condition; 

·            Maintain the privacy of your protected health information regarding payment for your healthcare; 

·            Notify you about how we protect your protected health information; 

·            Explain how, when and why we use and disclose protected health information about you; 

·            Abide by the terms of this Notice, as currently in effect; 

·            Notify you if we are unable to agree to a requested restriction on how your protected health information is used or disclosed; 

·            Accommodate reasonable requests that you make to communicate health information by alternative means or at alternative locations; and 

·            Obtain your written authorization to use or disclose your protected health information for reasons other than those listed below and permitted by law. We know that your protected health information is personal. We are committed to protecting your information. So as to provide you with good care and to insure that we follow all legal requirements, we document (in a medical record) the care and services that we provide to you. This Notice applies to those records. 

 

We reserve the right to change the terms of this Notice of Privacy Practices and to make the new provisions effective for all protected health information we already have about you as well as any protected health information we create or receive in the future. If we make any changes, we will: post the revised Notice in our office(s), which will contain the new effective date; post the Notice on our website (www.ScottSeoMD.com) and make copies of the revised Notice available to you upon request either at our offices or through the contact person listed in this Notice. 

 

B.     WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU TO PROVIDE TREATMENT TO YOU, TO OBTAIN PAYMENT FOR SERVICES RENDERED TO YOU, AND FOR HEALTHCARE OPERATIONS. 

For Treatment  :  We may use and disclose your protected health information to provide you with medical treatment and services and to coordinate or manage your healthcare and related services. Examples of how we will disclose information for treatment may include sharing information about you with: referring physicians, primary care physicians, family physicians, specialists, ambulatory care centers, pharmacies, visiting nurses, nursing homes, opticians, or other eye care facilities. A practice-specific example would be: A person or persons who accompany a patient (or a minor) into the exam room would be included in the treatment and discussion with our eye care professionals unless otherwise specified by the patient.  

For Payment  : We may use and disclose your protected health information so that we can bill and receive payment for the treatment and services you receive from us. For billing and payment purposes, we may disclose your protected health information to an insurance company or managed care company, Medicare, Medicaid, or any other third party payer. Our practice may discuss family accounts with spouses, parents or children of patients unless otherwise objected to.  

For Healthcare Operations  : We may use and disclose your protected health information in performing business activities that we call “healthcare operations.” This includes internal operations, such as for general administrative activities and to monitor the quality of care you receive at our facility. This type of use is necessary for us to run our practice and to be sure that our patients are receiving quality care.  

We may use or disclose your protected health information: to review and improve the quality of care you receive; to doctors, nurses, residents, students, volunteers or non-healthcare providers for education and training purposes;  to our lawyers, consultants, accountants; to organizations that assess the quality of care we provide to our patients (such as government agencies or accrediting bodies); to organizations that evaluate, certify or license healthcare providers, staff or facilities in a particular specialty; 

We may disclose information as it relates to healthcare operations when we: Leave messages on your answering machine by a physician or staff member; leave messages at your place of employment; send postcard reminders for appointments; call you by name when you are in our practice; use sign-in sheets in our reception areas. 

C.    OTHER USES AND DISCLOSURES WE MAY MAKE WITHOUT YOUR WRITTEN AUTHORIZATION 

Under the Health Insurance Portability and Accountability Act Privacy Regulations, we may use and disclose your protected health information in which you do not have to give authorization or otherwise have an opportunity to agree or object. “Use” refers to our internal utilization of your protected health information. Disclosure refers to the provision of information by us to parties outside of our organization.  We may make the following uses and disclosures of your protected health information  without obtaining a written Authorization from you in situations such as: 

·           Public Health Risk   

·           Our Facility Directory   

·           Individuals Involved in Your Care or Payment for Your Care 

·           Disaster Relief 

·           Reporting Victims of Abuse, Neglect or Domestic Violence 

·           Health Oversight Activities   

·           Judicial and Administrative Proceedings 

·           Law Enforcement 

·           Coroners, Medical Examiners, Funeral Directors, Organ/Tissue Donation Organizations 

·           Research 

·           To Avert a Serious Threat to Health or Safety 

·           Military and Veterans 

·           National Security and Intelligence Activities Protective Services for the President and Others: 

·           Inmates / Law Enforcement Custody 

·           Workers’ Compensation 

·           Appointment Reminders 

·           Treatment Alternatives and Health-Related Benefits and Services   

·           Business Associates (e.g. optical labs, computer vendors, accounting services) 

D.    ANY OTHER USE OR DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION REQUIRES YOUR WRITTEN AUTHORIZATION 

Under any circumstances other than those listed above, we will request that you provide us with a written authorization before we use and disclose your protected health information to anyone, which you can later revoke in writing. 

E.     YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION 

The Right to Access Your Personal Protected Health Information :  Upon written request, you have the right to inspect and obtain a copy of your medical/protected health information except under certain limited circumstances. Under state law, if we make a copy of your medical record, we will not charge you more than is permitted by the current rate allowed by state law for copies. We may also charge you a reasonable fee for goods and services related to this request. We may deny your request to inspect or receive copies in certain limited circumstances.  

The Right to Request Restrictions  : You have the right to request that a restriction on the way we use or disclose your protected health information for treatment, payment or healthcare operations. Additionally, you can request that we limit the information we disclose about you to those individuals involved in your care or the payment of your services, such as a relative or friend. You must tell us what information you want restricted, to whom you want the information restricted, and whether you want to limit our use, disclosure, or both.  However, we are not required to agree to such a restriction. If we do agree to the restriction, we will honor that restriction except in the event of an emergency and will only disclose the restricted information to the extent necessary for your emergency treatment.   

The Right to Request Confidential Communications : You have the right to request that we communicate with you concerning your health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number or a specific address. We may deny the request if you are unable to provide us with appropriate methods of contacting you. 

The Right to Request an Amendment  : You have the right to request that we make amendments or modify your clinical, billing and other protected health information for as long as the information is kept by us. We may deny your request for amendment if the information was not created by us (unless you prove the creator of the information is no longer available to amend the record); is not part of the records maintained by us; in our opinion, is accurate and complete; is information to which you do not have a right of access If we deny your request for amendment, we will give you a written denial notice, including the reasons for the denial and explain to you that you have the right to submit a written statement disagreeing with the denial. Your letter of disagreement will be attached to your medical record. 

The Right to An Accounting of Disclosures  : You have the right to request an accounting (a report) of certain disclosures of your protected health information. You may ask for disclosures made up to six years before your request. We are not required to include disclosures: made for treatment; made for billing or collection of payment for your treatment; made directly to you, that you authorized, or those which are made to individuals involved in your care; allowed by law when the use or disclosure relates to certain government functions or in other law enforcement custodial situations; and/or made in the process of our healthcare operations. We reserve the right to charge you a reasonable fee to fulfill requests for reports of disclosures. 

The Right to a Paper Copy of This Notice  : You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. In addition, you may obtain a copy of this Notice at our website, www.ScottSeoMD.com.   

F.     DISCLOSURE OF PSYCHIATRIC, SUBSTANCE ABUSE AND HIV-RELATED INFORMATION. 

Psychiatric Information : We will not disclose records relating to a diagnosis or treatment of your mental condition between you and the psychiatrist without specific written authorization or as required or permitted by law.   

HIV-related Information  : HIV-related information will not be disclosed, except under limited circumstances set forth under state or federal law, without your specific written authorization.   

Substance Abuse Treatment  : If you are treated in a substance abuse program, information which could identify you as alcohol or drug-dependant will not be disclosed without your specific authorization except for purposes of treatment or payment or when specifically required or allowed under state or federal law.   

 

G.    COMPLAINTS 

If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the government. 

 

To file a complaint with the government, you may contact: 

 

Office of Civil Rights 

U.S. Department of Health and Human Services 

200 Independence Avenue, S.W., Room 509F 

HHH Building 

Washington, D.C. 20201 

 

To file a complaint with us, you should contact the privacy officer mentioned on page one. You will not be retaliated against for filing a complaint.