Barnett Opticians Notice of Privacy Practices April 14, 2003
We respect our legal obligation to keep health information that identifies you private. This Notice describes how we protect your health information and what rights you have regarding it. We are obligated by law to give you notice of our privacy practices.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your health information is for normal treatment, payment or health care operations. Disclosures for these reasons are done without your written permission.
We use your health information for treatment within our office when: inquiring about your insurance or health plans, determining your need and preferences for eyeglasses, contact lenses, or other remedies. We routinely disclose selected health information outside our office for treatment when, for example: When communicating with manufacturers and distributors of eye care products such as contact lenses, eyeglass lenses, or other remedies; When consulting with another eye care professional’s office if they are, were, or may be involved in your care; Or when discussing your information with specialist providers as deemed necessary. There may be other circumstances of this type.
We use your health information for payment purposes preparing and sending bills or claims to you, your health or vision care plan, or other sources of payment. We may call, write, or fax your insurance company or health plan to clarify benefits available or to aid in processing claims. Your insurance claims may be sent electronically through a billing clearinghouse that has agreed to keep your information private. We may also use your information in collecting unpaid amounts (either ourselves or through a collection agency or attorney).
Health care operations mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing reports or audits; personnel decisions; participation in managed care plans; defense of legal matters; and business planning.
Our office works with the office of Dr. Kristi Schied OD, PC very closely, with some employees performing functions for both businesses. Your health information will be shared freely with the Dr. Kristi Schied OD, PC as necessary for normal treatment, payment, and operations of both businesses. We have a business associates agreement with them that requires them to respect your privacy per this notice.
Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your eye care.
We will call you when your eyeglasses, contact lenses, or other eye care products are ready for pickup. It is our policy to leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home, unless you tell us otherwise. If you cannot be contacted by phone, we will mail a postcard. You may request that the notice be sent in a sealed envelope. We may also call or write to notify you of other treatments or services available at our office that might help you.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up at our office at all. Such uses or disclosures are:
· When a state or federal law mandates that certain health information be reported for a specific purpose;
· For public health purposes, such as contagious disease reporting or investigation; and notices to the federal Food and Drug Administration regarding drugs or medical devices;
· Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
· Uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
· Disclosures for judicial and administrative proceedings;
· Disclosures for law enforcement purposes, such as to provide information about someone who is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;
· Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to organizations that handle organ or tissue donations;
· Uses or disclosures for health related research;
· Uses and disclosures to prevent a serious threat to health or safety;
· Disclosures of de-identified information;
· Disclosures relating to worker’s compensation programs;
· Disclosures of a “limited data set” for research, public health, or health care operations;
· Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
· Disclosures to “business associates” who perform health care operations for us and who commit to respect the privacy of your health information.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your health information unless you sign a written “authorization form.” Federal law determines the content of the “authorization form”. Sometimes, you may initiate the process if you would like us to send your information to someone else. In this situation you must give us a properly completed authorization form, or you can use one of ours. Sometimes, we may initiate the authorization process. If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of this Notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding your health information. You can:
· ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want.
· ask us to communicate with you in a confidential way, such as by phoning you at an alternate number rather than at home, or by mailing health information to a different address. We will accommodate these requests if they are reasonable.
OUR NOTICE OF PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site if applicable.
COMPLAINTS
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact at the address or fax shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.
FOR MORE INFORMATION
If you want more information about our privacy practices, call, write, or visit the contact person at the address or phone number shown in the contact information.
We respect our legal obligation to keep health information that identifies you private. This Notice describes how we protect your health information and what rights you have regarding it. We are obligated by law to give you notice of our privacy practices.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your health information is for normal treatment, payment or health care operations. Disclosures for these reasons are done without your written permission.
We use your health information for treatment within our office when: inquiring about your insurance or health plans, determining your need and preferences for eyeglasses, contact lenses, or other remedies. We routinely disclose selected health information outside our office for treatment when, for example: When communicating with manufacturers and distributors of eye care products such as contact lenses, eyeglass lenses, or other remedies; When consulting with another eye care professional’s office if they are, were, or may be involved in your care; Or when discussing your information with specialist providers as deemed necessary. There may be other circumstances of this type.
We use your health information for payment purposes preparing and sending bills or claims to you, your health or vision care plan, or other sources of payment. We may call, write, or fax your insurance company or health plan to clarify benefits available or to aid in processing claims. Your insurance claims may be sent electronically through a billing clearinghouse that has agreed to keep your information private. We may also use your information in collecting unpaid amounts (either ourselves or through a collection agency or attorney).
Health care operations mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing reports or audits; personnel decisions; participation in managed care plans; defense of legal matters; and business planning.
Our office works with the office of Dr. Kristi Schied OD, PC very closely, with some employees performing functions for both businesses. Your health information will be shared freely with the Dr. Kristi Schied OD, PC as necessary for normal treatment, payment, and operations of both businesses. We have a business associates agreement with them that requires them to respect your privacy per this notice.
Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your eye care.
We will call you when your eyeglasses, contact lenses, or other eye care products are ready for pickup. It is our policy to leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home, unless you tell us otherwise. If you cannot be contacted by phone, we will mail a postcard. You may request that the notice be sent in a sealed envelope. We may also call or write to notify you of other treatments or services available at our office that might help you.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up at our office at all. Such uses or disclosures are:
· When a state or federal law mandates that certain health information be reported for a specific purpose;
· For public health purposes, such as contagious disease reporting or investigation; and notices to the federal Food and Drug Administration regarding drugs or medical devices;
· Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
· Uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
· Disclosures for judicial and administrative proceedings;
· Disclosures for law enforcement purposes, such as to provide information about someone who is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;
· Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to organizations that handle organ or tissue donations;
· Uses or disclosures for health related research;
· Uses and disclosures to prevent a serious threat to health or safety;
· Disclosures of de-identified information;
· Disclosures relating to worker’s compensation programs;
· Disclosures of a “limited data set” for research, public health, or health care operations;
· Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
· Disclosures to “business associates” who perform health care operations for us and who commit to respect the privacy of your health information.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your health information unless you sign a written “authorization form.” Federal law determines the content of the “authorization form”. Sometimes, you may initiate the process if you would like us to send your information to someone else. In this situation you must give us a properly completed authorization form, or you can use one of ours. Sometimes, we may initiate the authorization process. If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of this Notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding your health information. You can:
· ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want.
· ask us to communicate with you in a confidential way, such as by phoning you at an alternate number rather than at home, or by mailing health information to a different address. We will accommodate these requests if they are reasonable.
- ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. You will be able to review or have a copy of your health information within 30 days of asking us (or sixty days if the information is stored off-site). You may have to pay for photocopies in advance. If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30 day extension of the time for us to give you access or photocopies if we send you a written notice of the extension.
- ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to persons who we know got the wrong information, and others that you specify. If we do not agree, you can write a statement of your position, and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law, we can have one 30 day extension of time to consider a request for amendment if we notify you in writing of the extension.
- get a list of the disclosures that we have made of your health information within the past six years. By law, the list will not include: disclosures for normal treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30 day extension of time if we notify you of the extension in writing
- get additional paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already.
OUR NOTICE OF PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site if applicable.
COMPLAINTS
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact at the address or fax shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.
FOR MORE INFORMATION
If you want more information about our privacy practices, call, write, or visit the contact person at the address or phone number shown in the contact information.
