Notice of Privacy Practices
Effective
date of notice:
This notice describes how medical information about you may be used and
disclosed,
And how you can obtain access to this information. Please review it
carefully.
We respect
our legal obligation to keep health information, that identifies you, private.
The law obligates us to give you notice of our privacy practices. Generally, we can only use your health
information in our office or disclose it outside of our office, without your
written permission, for purposes of treatment, payment or healthcare
operations. In most other situations, we will not use or disclose your health
information unless you sign a written authorization form. In some limited
situations, the law allows or requires us to disclose your health information
without written authorization.
Examples of how we use
information for treatment purposes:
· When we set up an appointment for you.
· When our technician or doctor tests your eyes.
· When the doctor prescribes glasses, contact lenses, or medications.
· When our staff helps you select and order glasses or contact lenses.
We may disclose your health
information outside of our office for treatment
purposes, for example:
· If we refer you to another doctor or clinic for eye care or low vision
aids or services.
· If we send a prescription for glasses or contacts to another eyecare
professional to be filled.
· When we provide a prescription for medication to a pharmacist.
· When we phone to let you know that your glasses or contact lenses are
ready to be picked up.
Sometimes we may ask for copies
of your health information from another professional that you may have seen
before.
We may
use your health information within our office or disclose your health
information outside of our office for payment
purposes. Some examples are:
· When our staff asks you about insurance plans that you may belong to or
about other sources of payment for our services.
· When we prepare bills to send to you or your health or vision care plan.
· When we process payment by credit card and when we try to collect unpaid
amounts due.
· When bills or claims for payment are mailed, faxed, or sent by computer
to you or your health or vision plan.
· When we occasionally have to ask a collection agency or attorney to help
us with unpaid amounts due.
We use and disclose your health
information for healthcare operations
in a number of ways. Healthcare operations means those administrative and
managerial functions that we have to do in order to run our office. We may use
or disclose your health information, for example, for financial or billing
audits, for internal quality assurance, for personnel decisions, to enable our
doctors to participate in managed care plans, for the defense of legal matters,
to develop business plans, and for outside storage of our records.
We may call to remind you of
scheduled appointments. We may also call to notify you of other treatments or
services available at our office that might help you.
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 happen at our office at all. Such uses or
disclosures are:
· A state or federal law that mandates certain health information be
reported for a specific purpose.
· Public health purposes, such as contagious disease reporting,
investigation or surveillance; and notices to and from the 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, audits by Medicare or Medicaid, or investigation of possible
violations of healthcare laws.
· 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; or to funeral directors to aid in burial; 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.
· Uses or disclosures for specialized government functions, such as for
the protection of the president or high-ranking government officials; for
lawful national intelligence activities; or for military purposes.
· Disclosures relating to workers’ compensation programs.
· Disclosures to business associates who perform healthcare operations for
us and who agree to keep your health information private.
We will not make any other uses
or disclosures of your health information unless you sign a written authorization form. You do not have to
sign such a form. If you do sign one, you may revoke it at any time unless we
have already acted in reliance upon it.
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 Christina Davila, Privacy
Officer at the address, fax or e-mail shown at the beginning of this
notice.
· You can
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 e-mail to your personal email address. We will accommodate these
requests if they are reasonable, and if you pay us for any extra cost. If you
want to ask for confidential communications, send a written request to Christina
Davila, Privacy Officer at the address, fax or e-mail shown at the
beginning of this notice.
· You can
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.
Primarily, however, you will be able to review or have a copy of your health
information within 30 days of asking us. 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 required. By law, we can have one 30-day extension of the time for us
to give you access or photocopies if we sent you a written notice of the
extension. If you want to review or get photocopies of your health information,
send a written request to Christina Davila, Privacy Officer at the
address, fax or e-mail shown at the beginning of this notice.
· You can
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 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. If you want
to ask us to amend your health information, send a written request, including
your reasons for the amendment, to Christina Davila, Privacy Officer at
the address, fax or e-mail shown at the beginning of this notice.
· You can
get a list of the disclosures that we have made of your health information
within the past six years (or a shorter period if you want), except disclosures
for purposes of treatment, payment or health care operations, disclosures made
in accordance with an authorization signed by you, 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. If you want a list, send a written request to Christina Davila,
Privacy Officer at the address, fax or e-mail shown at the beginning of
this notice.
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 in compliance with and 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 www.lagunaeyes.com.
If you think that we have not
properly respected the privacy of your health information, you are free to
complain to us or to 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 Linda Harrison,
Contact Person at the address, fax or e-mail shown at the beginning of this
notice. If you prefer, you can discuss your complaint in person or by phone.
If you want more information
about our privacy practices, call or visit Christina Davila, Privacy Officer
at the address or phone number shown at the beginning of this notice.