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Notice of Privacy Practices
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.
We respect our legal obligation to keep your health information private. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your health information and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your health information is for treatment, payment or health care operations.
The doctors and staff at Optometric Associates may use or disclose your health information for treatment purposes such as: scheduling an appointment, pre-testing and examining your eyes, prescribing glasses, contact lenses, and medications, faxing the prescription to be filled, demonstrating low vision devices, referring you to another doctor, or obtaining copies of your health information from another doctor.
The doctors and staff at Optometric Associates may use or disclose your health information for payment purposes such as: asking whether you have health or vision care insurance or another source of payment, preparing and sending bills or insurance claims, and collecting outstanding amounts through a collection agency.
The doctors and staff at Optometric Associates may use or disclose your health information for “Health Care Operations” (those administrative and managerial functions that we do on a day-to-day basis to run our office). Examples of Health Care Operations would be: financial or billing audits, internal quality assurance, participation in managed care plans, and outside storage of our records.
USES AND DISCLOSURES WITHOUT CONSENT OR AUTHORIZATION
In some situations the law requires us to use or disclose your health information without your permission. Examples of such uses or disclosures are: when the state or federal law mandates that certain health information be reported for a specific purpose such as communicable disease outbreaks, notices from the Food and Drug Administration regarding drugs, medical devices, and health related research, disclosures relating to worker’s compensation programs, and disclosures to business associates who perform health care operations for us.
APPOINTMENT REMINDERS
The staff at Optometric Associates may use your health information to call or write to remind you of scheduled appointments, that it’s time for your routine eye appointment, or that your glasses or contact lenses are ready. This may be done by postcard or leaving a message on an answering machine.
OTHER USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION
Disclosure of your health information or its use for any purpose other than those listed above requires written authorization signed by you except in the case of an emergency. You have the right to revoke the authorization at anytime by submitting a written revocation. Send the written revocation to the contact person named at the top of the first page of this notice.
However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have certain rights in regards to your personal health information they are as follows:
- The right to request restrictions on the use and disclosure of your protected health information.
- The right to request we communicate with you in a confidential way, such as by calling you on your cell phone rather than at work or by mailing health information to a different address.
- The right to inspect or obtain photocopies of your health information. You will be able to review or have a photocopy 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 the photocopies in advance.
- The right 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. 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.
- The right to receive an accounting of how and to whom your protected health information has been disclosed.
- The right to receive additional paper copies of the Notice of Privacy Practices upon request.
For assistance with any of the statements above, please send a written request to the contact person at the address or fax at the beginning of this Notice.
OUR RIGHT TO REVISE PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Privacy Practices. We reserve the right to amend or modify our Notice of Privacy Practices 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.
COMPLAINTS
If you feel that we have not properly respected the privacy of your health information, you are free to submit your comments or complaints to our office to the contact person at the top of this Notice or the U.S. Department of health and Human Services, Office for Civil Rights. If you prefer, you can discuss your complaint in person or by phone. You will not be penalized or otherwise retaliated against for filing a complaint.
EFFECTIVE DATE
This notice is effective on or after April 1, 2003