Privacy Policy

The following information is the Eye Associates of Colorado Springs, P.C. privacy notice.

Eye Associates of Colorado Springs, P.C. Privacy Notice

This notice describes how your medical information may be used and disclosed and how you can get access to this information. Please read it carefully. We are required to abide by the terms of this Privacy Notice. We may change the terms of this notice at any time. The new notice will be effective for all protected health information (PHI) that we maintain at the time of any change. At your request, we will be happy to provide you with any revised Privacy Notice. You may pick one up at the time of your appointment, or you may call and request that a copy be mailed to you.

Uses and Disclosures of Protected Health Information Based Upon Your Written Consent

You will be asked to sign a consent form. Your physician may use or disclose your PHI information for treatment, payment and health care operations.

Treatment: We may use and disclose your health information to provide, coordinate or manage your health care and any related services. For example, your PHI may be given to another physician to whom you've been referred so that physician has the necessary information to diagnose and/or treat you.

Payment: Your information may be used to obtain payment for your health care services, determination of coverage for insurance benefits, review of services for determination of medical necessity, and utilization review. For example, approval for eye surgery may require that your PHI be given to your insurer.

Health care Operations: We may use your information to support the business activities of the practice. These include, but are not limited to, quality assessment, employee evaluation, licensing and conducting other business functions. We may call you by name in the waiting room when your doctor is ready to see you. We may contact you to remind you of your appointment or to provide you with information regarding treatment. We may share your information with associates who provide services to the practice (such as billing or medical transcription). We will have a written contract with those associates that will protect your PHI.

Uses and Disclosures of Protected Information Based Upon your Written Authorization

Other uses of your PHI will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization at any time, in writing, except to the extent that we have already taken actions relying on your authorization.

Your Rights

You have the right to see and copy your protected health information. Please give us your request(s) in writing.

You have the right to request a restriction of your protected health information. This means that you may ask us not to use or disclose any part of your PHI to family members or friends who may be involved in your care or for notification purposes as described in this Privacy Notice. Your doctor is not required to agree to a restriction that you may request. If your physician believes it is in your best interest to permit use/disclosure of your PHI, the information will not be restricted. If your doctor does agree to the requested restriction, we will not use or disclose your information unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction request with your doctor. You may request restriction(s) by giving us a signed statement listing restrictions and dates.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests.

You may have the right to have your physician amend your protected health information. You may request a change in your medical record for as long as we maintain this information. In certain cases, we may deny your request. If your request is denied, you have the right to file a statement of disagreement with us. We may prepare a rebuttal and will provide you with a copy.

You have the right to receive an accounting of disclosures we have made, if any, of your protected health information. This right applies to disclosures other than for treatment, payment or health care operations as described above. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after 4/14/03. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to receive a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.


You may complain to the Secretary of Health and Human services, if you believe we have violated your privacy rights. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint. Our Compliance Officer, Greg Tesitor, can be reached at our downtown office (719-471-2020) for further information.

This notice was published and becomes effective on 4/11/03.



Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the PHI, your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.

Others Involved in Your Health care: Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your PHI that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies: We may use or disclose your PHI in an emergency treatment situation. If this happens, your physician will try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your physician (or another physician in the practice) is required by law to treat you, and the physician has attempted to obtain your consent, but is unable to obtain your consent, he or she may still use or disclose your PHI to treat you.

Communication Barriers: We may use or disclose you PHI if your physician (or another physician in the practice) attempts to obtain consent from you but is unable to do so due to substantial communication barriers, and the physician determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.

Additional Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object We may use or disclose your PHI in the following situations without your consent or authorization. These situations include:

Required by Law: We may use or disclose your PHI to the extent that law requires the use or disclosure. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health: We may use or disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect and receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases: We may disclose you PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law--such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child or elder abuse and neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental agency or entity authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your PHI to a person or company required by the FDA to report adverse events, product defects or problems, biological product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the practice's premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors, and Organ Donation: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out his/her duties. We may disclose such information in reasonable anticipation of death. PHI may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Research: We may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

Criminal Activity: Consistent with applicable federal and state laws, we may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans' Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized. Workers' Compensation: Your PHI may be disclosed by us as authorized to comply with workers' compensation laws and other similar legally established programs.

Inmates: We may use or disclose your PHI if you are an inmate in a correctional facility and your physician created or received your PHI in the course of providing care to you.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et.seq.

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