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Privacy Notice
NOTICE OF PRIVACY PRACTICES
EFFECTIVE: JUNE 2010
Primary Eye Care, Ltd.
75 S. Sutton Road (Rt. 59)
Streamwood, IL 60107-3367
630-837-8300
Fax: 630-837-9146
Contact: Diane Wojcik, Marisa Combs
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 health information that identifies you 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 HEALTHCARE OPERATIONS
The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose informa- tion for treatment purposes are making an appointment for you, testing or examining your eyes, prescribing glasses, contact lenses or eye medications, faxing prescriptions to be filled, reviewing low vision aids with you, referring you to another doctor or doctor’s office for eye care or low vision aids or services, or getting copies of your health information from another healthcare professional that you may have seen prior to visiting Primary Eye Care, Ltd. Examples of how we use or disclose your health informa- tion for payment purposes are asking you about your health or vision care insurance plans, other sources of payment, preparing and sending invoices or claims and collecting unpaid fees either by Primary Eye Care, Ltd., a collection agency or an attorney). “Healthcare operations” indicate any administrative and managerial function that we have to complete in order to maintain our office. Examples of you we use or disclose your health information for healthcare operations are financial or billing audits, internal quality assurance, personnel decisions, participation in managed care plans, defense of legal matter, business planning, and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we will not usually ask you for special written permission.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In 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 and some may never arise 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, investigation or surveillance, and notice to or from 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 the investigation of possible healthcare law violations
· disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies
· disclosures for law enforcement purposes, such as to provide information about someone who is or 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, to funeral directors to aid in burial or to organizations that handle organ or tissue donations
· uses or disclosures for health related research
· uses or disclosures to prevent a serious threat to health or safety
· uses or disclosures for specialized government functions, such as for the protection of the presi- dent or high ranking government officials, for lawful national intelligence activities, for mili- tary purposes, or for the evaluation and health of members of the foreign service
· disclosures of de-identified information
· disclosures relating to worker’s compensation programs
· disclosures of a “limited data set” for research, public health or healthcare operations
· incidental disclosures that are an unavoidable by-product of permitted uses of disclosures
· disclosures to “business associates” who perform healthcare operations in conjunction with our office and who commit to respect the privacy of your health information
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.
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled appointments or that it is time to make a routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you inform us otherwise, we will mail you an appointment reminder on a postcard and/or leave a you a reminder message on answering machine or voice mail. We may also leave a message with the person who may answer your phone. We may also send an email to the email address listed in your health record.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your health information unless you sign a written authorization form allowing us to release your information. The content of an authorization form is determined by federal law. Sometimes we may initiate the authorization process if the use or disclosure is our idea and best for you. Sometimes you may initiate the process if it is your idea for us to send your information to someone else or you would like a copy of your record. Typically, in this situation you will give us a properly completed authorization form provided by our office.
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 and will not make the use or disclosure. If you do sign the authorization form, you may revoke it at any time unless you have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person listed on 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 healthcare operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to the office contact person via regular mail, fax or email.
· ask us to communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing health information to a different address or by using fax or email. We will accommodate these requests if they are reasonable and if you pay additional fees for these services. If you want to ask for confidential communications, please send a written request to the office contact person via mail, fax or email.
· 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. In most cases, however, you will be able to review or have a copy of your health information within 30 days of your request. There are fees associated with obtaining copies of your health information and an authorization form must be completed. If we deny your request, we will send you a written explanation and instructions on how to get an impartial review of our denial if one is legally available. By law, we can have one 30 day extension of time for us to give you copies of your health information. We will provide you with written notice of the extension if necessary. If you want to review or get copies of your health information, please come in to the office to complete the authorization form and pay the required fees.
· 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 your request. We will send the corrected information to persons who we know received the incorrect information and others that you specify. If we do not agree, you can write a statement on 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 with your health information 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. If you want to request us to amend your health information, send a written request, including the reasons for the amendment, to the office contact person via mail, fax or email.
· get a list of the disclosures that we have made of your health information within the past 6 years or shorter period of time. By law, the list will note include disclosures for purposes of treatment, payment or healthcare operation, disclosures with your authorization, incidental disclosures, disclosures required by law, and other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, fee will apply and must be paid in advance. We will respond to your request within 60 day of receiving it but by law we can have one 30 day extension of time if we notify you of the extension in writing. If you would like to request this list, send a written request to the office contact person via mail, fax or email.
· get additional paper copies of the Notice of Privacy Practices upon request. It does not matter whether you receive one electronically or in paper form. If you would like additional paper copies, send a written request to the contact person via mail, fax or email.
NOTICE OF OUR PRIVACY PRACTICES
By law, we must abide by the terms of the 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 Privacy Practices, we will post the new notice in our office, have copies in our office and post it on our website.
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 our office, please send a written complaint to the office contact person via mail, fax, or email.
FOR MORE INFORMATION
If you would like additional information about our privacy practices, please send a written request to our office contact person via mail, fax or email.
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