Dr. Angela Milam & Associates, PLLC
Doing Business As Angel Eyes Vision
Notice Of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY AND WILL BE USED AND DISCLOSED AND YOUR INDIVIDUAL RIGHTS TO PROTECT AND OBTAIN THIS INFORMATION.
PLEASE REVIEW THIS DOCUMENT CAREFULLY.
THE INTEGRITY OF YOUR INFORMATION IS IMPORTANT TO US. IF YOU HAVE ANY
QUESTIONS, PLEASE DO NOT HESITATE TO ASK A MANAGER OF THIS PRACTICE LOCATION.
OUR LEGAL RESPONSIBILITIES
We are required by applicable federal and state law to maintain the privacy and security 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 upon your request. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect on January 1, 2021. It will remain in effect until otherwise amended or replaced.
We reserve the right to change our privacy practices and the terms of this notice at any time, without specific notice to you, provided such changes are permitted by applicable law. We reserve the right to make such changes in our privacy practices and the new terms of our notice effective for all health information that we maintain at that time, including health information we created, maintained, or recieved before the changes become effective.
You may request a copy of our active and prevailing Notice of Privacy Practices and other related policies at any time. For information about our privacy practices or for additional information, please contact us by the methods and at the addresses detailed at the end of this notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and healthcare operations specific to your individual case.
Examples of these appropriate uses and disclosures included, but are not limited to:
TREATMENT: We may use or disclose your health information to an optician, ophthalmologist, or other healthcare provider providing treatment to you for (a) the provision, coordination, or management of healthcare and related services by your healthcare providers; (b) consultation between healthcare providers related to the patient; (c) the referral of the patient for healthcare from one healthcare provider to another; or (d) recall information to maintain consistency of care and healthcare regime across multiple patient visits.
PAYMENT: We may use and disclose your health information to obtain payment for services we provide to you. This may include (a) billing and collection activities and related data processing; (b) actions by a health plan or insurer to obtain premiums or to determine or fulfill its responsbilities for coverage and provision of benefits under its health plan or insurance agreement, determiniations of eligibility or coverage, or adjudications or subrogations of health benefit claims; (c) medical necessity and appropriateness of care reviews, utilization review activities; and (d) disclosure to consumer reporting agencies of information relating to collection of premiums, fees, or reimbursements.
HEALTHCARE OPERATIONS: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
YOUR AUTHORIZATION: In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us such authorization, you may revoke it in writing at any time, such that such revokation comes with such time as to make subsequent disclosures administratively impermissible. Your revocation may not effect any use or disclosures previously permitted by your authorization while it was in effect, or uses or disclosures which occured during a reasonable administrative period during which your authorization revocation was placed into effect. Unless you give us a written authorization, we cannot — and will not — use or disclose your health information for any reason, except where provided for in this notice or where required by law.
MARKETING HEALTH PRODUCTS OR SERVICES: We will not use your health information for marketing communications performed by us, nor shall we provide your information to third parties for such marketing, without your prior written consent. We may provide you with information regarding products or services that we offer related to your healthcare needs. We may also provide you with generally applicable healthcare information and education delivered across several media platforms, including but not limited to social media, email, and text messaging; but such information and education will be of broadly relevant nature and not tied to your or any specific patient’s case. We will never sell your health information without your prior authorization.
TO YOU, YOUR FAMILY, AND FRIENDS: We will always disclose your health information to you, as described in the Patient Rights section of this notice. We may disclose your health information to your family member, friend, or any other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree — either verbally if you are present, or in written if in your absence — that we may do so; or if you are not able to agree, if it is necessary in the professional judgment of a healtchare provider familiar with your specific case.
PERSONS INVOLVED IN YOUR CARE: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to the use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a reasonable determination using our professional judgment, and disclosing only the health information that is directly relevant to the person’s involvement in your healthcare, or directly relevant to the needs of the situation in our professional judgment. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interests in allowing a person to pick up filled perscriptions, medical supplies, x-rays, or other similar forms of health information.
REQUIRED BY LAW: We will use or disclose your health information when we are required to do so by law, including all proper judicial and administrative proceedings.
ABUSE OR NEGLECT: We will disclose your health information to the appropriate legal authorities if we reasonably believe, in our professional experience and judgment, that you are a possible victim of abuse, neglect, or domestic violence, or the possible victim of other crimes. We will also disclose your health information to the extent necessary in our professional experience and judgment to avert a possibly serious threat to your health or safety — or the health or safety of others.
NATIONAL SECURITY: We will disclose to military or other appropriate authorities the health information of Armed Forces personnel under certain reasonable circumstances. We will disclose to authorized local, state, or federal officials any health information required for the lawful collection of intelligence, counterintelligence, or other national security or public health activities. We may also disclose to correctional instition or law enforcement officials having lawful custody of protected health information of inmate or patients under certain circumstances.
APPOINTMENT REMINDERS AND TREATMENT ALTERNATIVES: We may use or disclose your health information to provide you with appointment reminders (such as phone calls, voicemail messages, postcards, text messages, letters, or other means) or information about treatment alternatives or other health-related benefits, services, or information which we believe in our professional experience may be of interest to you.
ACCESS: You have the right to review or obtain copies of your health information, with limited exceptions. You may request that we provide copies of your information in a format other than photocopies. We will use the format you request unless we cannot practically do so. We will be free to charge you a reasonable cost-based fee for the expense of providing you with a copy of your health records, such as copies and staff time. You may request such copies in person at the locations specified at the end of this notice or in writing to the address at the end of this notice. If you choose, we can also prepare a summary or explanation of your health information for a fee.
DISCLOSURE ACCOUNTING: You have the right to receive a list of instances in which we or our business disclosed your health information for purposes other than treatment, payment, healthcare operations, or where you have provided an authorization, and certain other activites detailed in this notice, for the preceeding six years. If you request this accounting more than once in a twelve-month period, we may charge you a reasonable cost-based fee.
RESTRICTIONS: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do we will abide by such agreement, except in accordance with such emergency situations related to your health and safety, the health and safety of others, or police or national security or public health.
ALTERNATIVE COMMUNICATION: You have the right to request in writing that we communicate with you about your health information by alternative means or to alternative locations. Your request must specify the alternative means or locations, and provide satisfactory explanation of how service and product fees will be satisfied. Your request must also come within a period in which it is administratively reasonable to comply.
AMENDMENT: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the informaiton should be amended. We may deny your request under certain reasonable circumstances.
ELECTRONIC NOTICE: If you recieve this notice on our website, by email, or other electronic or digital means, you may also elect to receive this notice in writting.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy policies and practices, or you have additional questions or concerns, please contact us or visit our physical locations.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we have made about access to your health information to either you or a third party, or about an amendment or restriction you have requested to your information, or a request to have us communicate with you by alternative means or locations, you may file a complaint using the contact information listed at the end of this notice. You may also submit a written complaint to the U.S. Department of Health and Human Services or other appropriate local, state, or federal authorities.
Any communication under this notice may be delivered in person, physical mail, or written electronic communication (except where otherwise noted) to us at:
Angel Eyes Vision
2760 N Germantown Pkwy, Ste 109
Memphis, TN 28133
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