Health Insurance Portability and Accountability Act (HIPAA): Notice of Privacy Practices
The Contact Lens Institute of Colorado (CLIC) is required to follow the privacy practices described in this Notice. We reserve the right to change our privacy practices and the terms of this Notice at any time and apply any changes to our privacy practice to all medical information we have. If we do so, we will post a new Notice on this website (www.clicolorado.com). You may request a copy of the new notice from CLIC Privacy/Security Officer, 5236 Strauss Cabin Rd., Fort Collins, CO 80528
Your medical information will not be shared and/or disclosed without your permission except as described in this notice or required by law. You may authorize other disclosures by completing an authorization form. You may also retract (in writing) this authorization at any time. CLIC has procedures to assist you with your rights to your medical information. You may ask CLIC staff for a copy of this notice at any time. An electronic copy of this notice is also available on CLIC’s website at http://www.clicolorado.com under Patient Center and then HIPAA & Privacy Practices. Any requests you may have of CLIC must be submitted in writing. All required CLIC forms are available at CLIC office and website. You have the right to ask CLIC to:
Limit the use and/or disclosure of your medical information. CLIC will review all legal requests and provide a timely response.
Contact you by your preferred method including email, fax, a specific mailing address or phone number.
Look at or have a copy of any part of the designated record set maintained by CLIC.
You may be charged a processing and postage fee for this request.
Change or add information to your designated record set. However, CLIC may not change its original document but may add an amendment to your record.
Provide a list of disclosures of your medical information made after April 14, 2003. This will not include disclosures for purposes of treatment, payment, health care operations; or disclosures made to you or with your permission.
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 must follow the duties and privacy practices described in this notice and give you a copy of it, upon request.
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.
CLIC agrees to restrict disclosure to your health plan if you pay out of pocket in full for health care services.
If you need more information or believe that CLIC has violated your privacy rights, please contact: CLIC Privacy/Security Officer, 5236 Strauss Cabin Rd., Fort Collins, CO 80528
You may also file a complaint with: Office of Civil Rights, Department of Health and Human Services, 1961 Stout Street, Rm 1185 FOB, Denver, CO 80203, 303-844-2024
For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
CONFIDENTIALITY PRACTICES AND USES - CLIC, may access, use and or share medical information for:
Treatment - to appropriately determine approvals or denials of your medical treatment. For example, CLIC may share your health information with a doctor or hospital that is providing health care to you. Payment - to determine your eligibility benefits and payment. For example, CLIC may send medical claims for payment to your health insurance company.
Health Care Operations - to evaluate the performance of a health plan or a health care provider. For example, CLIC contracts with consultants who review the records of hospitals and other organizations to determine the quality of care you received.
Appointments - CLIC may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Fund Raising, Marketing, Sales - CLIC may contact you to raise funds for CLIC. Any other marketing or sales uses require your written permission. If you give your authorization to CLIC, you may revoke your authorization any time (opt out), unless we have already relied on your authorization to use or disclose information. If you would ever like to revoke your authorization, please notify the CLIC Medical Records Department in writing at: CLIC Medical Records Department, 5236 Strauss Cabin Rd., Fort Collins, CO 80528
SMS Terms of Service: By opting into SMS from a web form or other medium, you agree to receive SMS messages from Contact Lens Institute of Colorado. This includes SMS messages for external conversations. Message frequency varies. Message and data rates may apply. See privacy policy at www.clicolorado.com. Message HELP for help. Reply STOP to any message to opt out.
SMS consent is not shared with third parties.
DISCLOSURES NOT REQUIRING YOUR PERMISSION - CLIC can make the following disclosures as required by law or
Other Government Agencies and/or Organizations Providing Benefits, Services or Disaster Relief - to disclose information with other government agencies and/or organizations for you to receive those benefits and/or services offered.
Public Health - to disclose medical information to agencies for public health activities for disease control and prevention, problems with medical products or medications, and victims of abuse, neglect or domestic violence.
Health Oversight Activities - to disclose information to approved government agencies responsible for the Medicaid program, the U. S. Dept of Health and Human Services, and the Office of Civil Rights.
Judicial and Administrative Hearings - to disclose specific medical information in court and administrative proceedings.
Law Enforcement purposes - to disclose specific medical information for law enforcement purposes.
Coroners, Medical Examiners, and Funeral Directors - to disclose specific medical information to authorized persons who need it to administer their work.
Organ Donation and Disease Registries - to disclose specific medical information to authorized organizations involved with organ donation and transplantation, communicable disease registries, and cancer registries.
Research Purposes - in certain circumstances, and under supervision of a privacy board, we may disclose medical information to assist medical/psychiatric research.
To Avert Serious Threat to Health, Safety or Emergency Situation - to disclose specific medical information to prevent a serious threat to the health and safety of an individual or the public.
Specialized Government Functions - to disclose medical information for national security, intelligence and/or protective services for the President. CLIC may also disclose health information to the appropriate military authorities if you are or have been a member of the U. S. armed forces.
Correctional Institutions - to disclose medical information to correctional facilities or law enforcement officials to maintain the health, safety and security of the corrections system.
Workers’ Compensation - to disclose medical information to workers’ compensation programs that provide benefits for work-related injuries or illness without regard to fault.
Disclosures to Family, Friends, and Others - CLIC may disclose information to your family or other persons who are involved in your care. You have the right to object to the sharing of this information.
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