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Privacy Policy

Keats Family Vision, P.A.
DBA Northwood Vision
2518-C McMullen Booth Rd, Clearwater, FL 33761

 

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 of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health care services.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Your protected health information may be used and disclosed by your physician, our office staff and to others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, or support the operation of the physician’s practice, and any other use required by law.

TREATMENT: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  This includes the coordination or management of your health care with a third party.  For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

PAYMENT:  Your protected health information will be used, as needed to obtain payment for your health care services.  For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

HEALTHCARE OPERATIONS: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician’s practice.  These activities include, but are not limited to, quality assessment, employee review, training of medical students, licensing, fundraising, and conducting or arranging for other business activities.  For example, we may disclose your protected health information to medical school students that see patients at our office.  In addition, we may use a sign-in-sheet at the registration desk where you will be asked to sign your name and indicate your physician.  We amy also call you by name in the waiting room when your physician is ready to see you.  We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment, and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you.

We may use or disclose your protected health information in the following situations without your authorization.  These situations include: as required by law, public health issues as required by law, communicable diseases, health oversight, abuse or neglect, food and drug administration requirements, legal proceedings, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military activity and national security, workers’ compensation, inmates, and other required uses and disclosures.  Under the law, we must also disclose your protected health information when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements under Sections 164.500.

Other permitted and required uses and disclosures will be made only with your consent, authorization, or opportunity to object unless required by law.  You may revoke the authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS

The following are statements of your rights with respect to your protected health information.

YOU HAVE THE RIGHT TO INSPECT AND COPY YOUR PROTECTED HEALTH INFORMATION (FEES MAY APPLY) – Under federal law, however, you may not inspect or copy the following records: Psychotherapy notes, information compiled in reasonable anticipation of, or used in, a civil, criminal, or administrative action or proceeding, protected health information restricted by law, information that is related to medical research in which you have agreed to participate, information whose disclosure may result in harm or injury to you or to another person, or information that was obtained under a promise of confidentiality.

YOU HAVE THE RIGHT TO REQUEST A RESTRICTION OF YOUR PROTECTED HEALTH INFORMATION – This means you may ask us not to use or disclosed any part of your protected health information and by law we must comply.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.   Your request must state the specific restriction requested and to whom you want the restriction to apply.  By law, you may not request that we restrict the disclosure of your PHI for treatment purposes.

YOU HAVE THE RIGHT TO REQUEST TO RECEIVE CONFIDENTIAL COMMUNICATIONS –  You have the right to request confidential communication from us by alternative means or at an alternative location.  You have the right to obtain a pater copy of this notice from us, upon request, even if you have agreed to accept this nitice alternatively i.e. electronically.

YOU HAVE THE RIGHT TO REQUEST AN AMENDMENT TO YOUR PROTECTED HEALTH INFORMATION – If we deny your request for amendment, you have the right to file a statement of disagreement with us and me may prepare a rebuttal you your statement and will provide you with a copy of any such rebuttal.

YOU HAVE THE RIGHT TO RECEIVE AN ACCOUNTING OF CERTAIN DISCLOSURES – You have the right to receive an accounting of all disclosures except for disclosures: pursuant to an authorization, for purposes of treatment , payment, healthcare operations; required by law, that occurred prior to April 14, 2003, or six years prior to the date of this request.

You have the right to obtain a paper copy of this notice even if you have agreed to receive the notice electronically.  We reserve the right to change the terms of this notice and we will notify you of such changes on the following appointment.  We will also make available copies of our new notice if you wish to obtain one.

COMPLAINTS

You may complain to us or to the Secretary of Health and Human Service if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying our Compliance Officer (Coleen E., 727-725-5558) of your complaint.  We will not retaliate against you for filing a complaint.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information.  We are also required to abide by the terms of the notice currently in effect.  If you have any questions in reference to this form, pelase ask to speak with our HIPAA COMPLIANCE OFFICER in person or by phone at our main phone number. 

Please sign the accompanying “Acknowledgment” form.  Please note that by signing the Acknowledgment form you are only acknowledging that you have received or been given the opportunity to receive a copy of our Notice of Privacy Practices.

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Dear Northwood Vision patient,

COVID-19 has the potential to cause grave harm to many of the citizens in our population. According to Harvard epidemiologist Dr. Mark Lipsitch it is likely that at least between 40-70 % of the population will become infected with COVID-19. This virus is twice as contagious as the flu. About 80 percent will not have severe concerns, but based on the current data, 20% of the infected will become severe or critical, needing some form of hospital care to do well. Currently, about 30 % of those who become classified as severe based on WHO classification, will not survive. These are the unfortunate realities at the moment.

Meanwhile, at Northwood Vision, we want to do as much as possible to minimize this risk, to prevent mortality and long term side effects, while doing our best to provide the services our patients need. We are convinced you care about these same things. (Read more)

Here is what we are asking you to do to make a smaller exposure footprint:

  1. If you have any symptoms of a cold or flu (coughing, fever, difficulty breathing, running nose, etc), please reschedule your appointment for at least one month from now.
  2. Try not to touch any surfaces in the office you do not have to touch.
  3. If you are trying on glasses, DO NOT put the frames back on the shelf. Rather, we will collect them from you for proper cleaning before they are returned to the shelves.
  4. If you are ordering contact lenses, a year supply (and some 6 month supplies) order can be direct shipped to your home at no cost. Please take advantage of this so you don’t have to come into the office more than necessary.
  5. If you do need to come into the office for an adjustment, please call the office at 727-725-5558 when you arrive in your vehicle. We will let you know if there is a wait and will put you on a list so we can call or text you to come therefore minimizing the time you are in the enclosed space of our office.
  6. Please come to your appointment with the least number of people possible to reduce exposure to them and to others at the office.
  7. If you have any loved ones that have been exposed to the virus or certainly if they have symptoms of a respiratory illness, please wear a mask in case you are an asymptomatic carrier, or if possible, wait at least 4 weeks before coming in for non-essential care.

In an effort to protect you, here is what we are doing to help lower your risk:

  1. All surfaces in the office will be cleaned several times per day with antiviral/antibacterial cleaner. Surfaces in the exam room will be cleaned thoroughly in between each patient.
  2. No sick or symptomatic staff will be permitted to work while sick with a known viral respiratory infection or symptoms, or while directly caring for a sick relative/friend.
  3. For your safety, payments can be done ahead of time over the phone if you call ahead. This will decrease the amount of time you are in the store and your exposure risk in our enclosed space.
  4. No glasses frames other patients try on will be put back on display until the frames are cleaned with an antiviral cleanser.
  5. We are actively asking patients to reschedule for 4 weeks later if they have any symptoms themselves or in their family/ social network.
  6. We are giving options for patients to acquire goods by mail rather than coming into the store.
  7. We altering our schedule to decrease the number of patients that might be in the office at the same time to maximize social distancing.
  8. We are practicing frequent hand washing at our office to protect you and each other.
  9. We will ask patients to reschedule if they present to our clinic with a cough or other COVID-19 symptoms.

Thank you for your patience and understanding during this stressful and trying time. Let us all work together to lower risk of the spread so that less people die and less people have permanent side effects from COVID-19. Each of us can do our part. May God bless each of you and keep you well. Thank you for your understanding and care for your fellow humans.

Dr. Christopher K. Keats, OD