Southeast Connecticut Eye Care LLC

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to your medical records. Please review this notice carefully.

Your Rights

You have the right to:

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will try to follow your instructions. In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care.
• Share information in a disaster relief situation.

In general, we try to act in your best interest in sharing health information. This includes discussing your care with other clinicians, family members, and legal guardians.

If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information

Our Uses and Disclosures

We may use and share your information as we:

• Treat you
• Run our organization
• Bill for our services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

How to

To get an electronic or paper copy of your medical record:

• You can ask to see or get a copy of the medical and billing records we maintain about you, in either electronic or paper media. If you make the request in person or you call by telephone, we normally do not require the request in writing. We may require a written request if it comes from someone other than you. If it comes from a physician or other clinician we know to be involved in your care, we normally do not require a written request.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee for this.

To correct your medical record:

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request if we disagree about your correction, but we will put a notation about your request in the medical record if you want.

To request confidential communications:

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

To ask us to limit what we use or share:

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if we believe it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

To get a list of those with whom we’ve shared information:

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, with whom we shared it, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

To get a copy of this privacy notice:

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
• We will provide you with a paper copy promptly. You can also print this notice from our website.

To choose someone to act for you:

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

To file a complaint if you feel your rights are violated:

• You can complain if you feel we have violated your rights by contacting our privacy officer. Our privacy officer will discuss your complaint with you and investigate if needed. We will issue you a written report of the investigation if you request it.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways:

• To treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
• To run our organization We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and our services.
• To bill for our services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for services you receive from us.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
• Performing research, or helping with research by others
• Complying with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
• Responding to organ and tissue donation requests
• Working with a medical examiner or funeral director
• Addressing workers’ compensation, law enforcement, and other government requests
• Working with health oversight agencies for activities authorized by law
• Involvement with special government functions such as military, national security, and presidential protective services
• Responding to lawsuits and legal actions

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We do not pay for credit monitoring or provide services beyond notification of a breach.
• We must follow the duties and privacy practices described in this notice and provide you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Other information

• This notice is effective July 19, 2017, last update January 5, 2024.
• The privacy officer for our practice is the office manager. The office manager may be reached at 860-373-4148.
• This privacy notice applies to patient care at any site where we see patients, including our clinical locations, hospital emergency departments, and surgical sites, such as the Constitution Surgery Center East location in Waterford, Connecticut.