THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

THIS NOTICE IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.

Right to Notice As a patient, you have the right to ade­quate notice of the uses and dis­clo­sures of your pro­tect­ed health infor­ma­tion. Under the Health Insur­ance Porta­bil­i­ty and Acces­si­bil­i­ty Act (HIPAA), Dr. Casel­la can use your pro­tect­ed health infor­ma­tion for treat­ment, pay­ment and health care oper­a­tions. a) Treat­ment — We may use or dis­close your health infor­ma­tion to a physi­cian or oth­er health­care provider pro­vid­ing treat­ment to you. b) Pay­ment — We may use and dis­close your health infor­ma­tion to obtain pay­ment for ser­vices we pro­vide you. c) Health care 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 com­pe­ten­cy or qual­i­fi­ca­tions of health­care pro­fes­sion­als, eval­u­at­ing provider per­for­mance, con­duct­ing train­ing pro­grams, accred­i­ta­tion, cer­ti­fi­ca­tion, licens­ing or cre­den­tial­ing activities.

Your Autho­riza­tion Most uses and dis­clo­sures that do not fall under treat­ment, pay­ment, health care oper­a­tions will require your writ­ten autho­riza­tion. Upon sign­ing, you may revoke your autho­riza­tion (in writ­ing) through our prac­tice at any time.

Emer­gency Sit­u­a­tions In the event of your inca­pac­i­ty or an emer­gency sit­u­a­tion, we will dis­close health infor­ma­tion to a fam­i­ly mem­ber, or anoth­er per­son respon­si­ble for your care, using our pro­fes­sion­al judg­ment. We will only dis­close health infor­ma­tion that is direct­ly rel­e­vant to the per­son­’s involve­ment in your healthcare.
Mar­ket­ing We will not use your health infor­ma­tion for mar­ket­ing com­mu­ni­ca­tions with­out your writ­ten authorization.

Required by Law We may also use or dis­close your health infor­ma­tion when we are required to do so by law.

Abuse or Neglect We may dis­close your health infor­ma­tion to appro­pri­ate author­i­ties if we rea­son­ably believe that you are a pos­si­ble vic­tim of abuse, neglect, or domes­tic vio­lence or the vic­tim of oth­er crimes. We may dis­close your health infor­ma­tion to the extent nec­es­sary to avert a seri­ous threat to your or oth­er peo­ple’s health or safety.

Nation­al Secu­ri­ty We may dis­close the health infor­ma­tion of Armed Forces per­son­nel to mil­i­tary author­i­ties under cer­tain cir­cum­stances. We may dis­close health infor­ma­tion to autho­rized fed­er­al offi­cials required for law­ful intel­li­gence, coun­ter­in­tel­li­gence and oth­er nation­al secu­ri­ty activ­i­ties. We may dis­close health infor­ma­tion of inmates or patients to the appro­pri­ate author­i­ties under cer­tain circumstances.

Appoint­ment Reminders We may use or dis­close your health infor­ma­tion to pro­vide you with appoint­ment reminders via phone, e‑mail or letter.

Your Rights as a Patient You have the right to restrict the dis­clo­sure of your pro­tect­ed health infor­ma­tion (in writ­ing). The request for restric­tion may be denied if the infor­ma­tion is required for treat­ment, pay­ment or health care oper­a­tions. ‑You have the right to receive con­fi­den­tial com­mu­ni­ca­tions regard­ing your pro­tect­ed health infor­ma­tion. ‑You have the right to inspect and copy your pro­tect­ed health infor­ma­tion. ‑You have the right to amend your pro­tect­ed health infor­ma­tion. ‑You have the right to receive an account of dis­clo­sures of your pro­tect­ed health infor­ma­tion. ‑You have the right to a paper copy of this notice of pri­va­cy practices.

Legal Require­ments CASELLA EYE CENTER PC is required by law to main­tain the pri­va­cy of your pro­tect­ed health infor­ma­tion. We are required to abide by the terms of this notice as it is cur­rent­ly stat­ed, and reserve the right to change this notice. The poli­cies in any new notice will not be in effect until they are post­ed to this site, or are avail­able with­in our office.

Com­plaints If you have com­plaints regard­ing the way your pro­tect­ed health infor­ma­tion was han­dled, you may sub­mit a com­plaint in writ­ing to our office. You will not be retal­i­at­ed against in any man­ner for a complaint.

Con­tact Infor­ma­tion For fur­ther infor­ma­tion about CASELLA EYE CENTER PC’s pri­va­cy poli­cies, please con­tact Dr. Casel­la at the fol­low­ing address or phone num­ber: CASELLA EYE CENTER PC 767 Broad Street Augus­ta, GA. 30901 (706) 722‑0817