Privacy Notice
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NOTICE OF PRIVACY PRACTICES
Effective: March 1, 2003 Revised: September 23, 2013 FISHERS FAMILY VISION CENTER Shawn Sigler, Optometrist [email protected] 9536 East 126th Street Fishers, IN 46038 Office 317-578-2020/Fax 317-578-7148 www.fishersfamilyvisioncenter.com |
THIS NOTICE DESCRIBES HOW PROTECTED AND PERSONAL INFORMATION ABOUT YOU MAY BE USED, COLLECTED, AND DISCLOSED. IT ALSO OUTLINES YOUR RIGHTS AND HOW YOU CAN ACCESS YOUR INFORMATION.
PLEASE REVIEW IT CAREFULLY.
We respect our legal obligation to keep protected health information (PHI) and personally identifiable information (PII) private. We are obligated by law to give you our Notice of Privacy Practices. This notice describes how we protect your information and your rights regarding it.
TREATMENT, PAYMENT & HEATH CARE OPERATIONS
The most common reasons we disclose your PHI and PII are for treatment, payment or health care operations. Examples of how we use or disclose information for treatment are: setting up an appointment for you testing or examining your eyes prescribing glasses, contact lenses or eye medications and transmitting them to be filled referring you to another doctor or clinic for eye care or consultation or getting copies of your information from another professional that you may have seen before us.
Examples of how we use or disclose your information for payment purposes are: asking you about your health or vision care plans, or other source of payment preparing and sending bills or claims and collection of unpaid amounts, either ourselves or through a collection agency or attorney.
Health care operations are those administrative and managerial functions that we do in order to run our office. Examples of how we use or disclose your information for health care 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 information inside our office for these purposes without any special permission. If we need to disclose your PHI or PII outside of our office for these reasons, we usually will not ask for special written permission.
USES & DISCLOSURES WITHOUT CONSENT OR AUTHORIZATION
In some limited situations, the law allows or requires us to disclose your PHI or PII without your permission. Such disclosures may include:
OTHER DISCLOSURES
We will not make any other uses or disclosures of PHI or PII unless you give written authorization. If we initiate this process and ask you to sign an authorization, you do not have to sign it. If you sign one, you may revoke it at any time unless we have already acted in reliance upon it.
Revocations must be in writing and submitted to our office. We do not sell or use your personal and protected information for marketing or fundraising without your written permission.
HOW WE COMMUNICATE WITH YOU
We may call, text, email or write to remind you of scheduled appointments or that it is time to make a routine appointment. We may also notify you that materials ordered for you have arrived or of other treatments or services available at our office that might help you.
You may ask us to communicate with you in a confidential way, such as phoning you at work rather than home, by mailing information to a certain address, or by sending email or text messages to a specific address or number. We will accommodate these request, if they are reasonable. If you wish to ask for confidential communication, send a written request to our office
PATIENT RIGHTS REGARDING PROTECTED AND PERSONAL INFORMATION
For more information contact: HHS.gov
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
PLEASE REVIEW IT CAREFULLY.
We respect our legal obligation to keep protected health information (PHI) and personally identifiable information (PII) private. We are obligated by law to give you our Notice of Privacy Practices. This notice describes how we protect your information and your rights regarding it.
TREATMENT, PAYMENT & HEATH CARE OPERATIONS
The most common reasons we disclose your PHI and PII are for treatment, payment or health care operations. Examples of how we use or disclose information for treatment are: setting up an appointment for you testing or examining your eyes prescribing glasses, contact lenses or eye medications and transmitting them to be filled referring you to another doctor or clinic for eye care or consultation or getting copies of your information from another professional that you may have seen before us.
Examples of how we use or disclose your information for payment purposes are: asking you about your health or vision care plans, or other source of payment preparing and sending bills or claims and collection of unpaid amounts, either ourselves or through a collection agency or attorney.
Health care operations are those administrative and managerial functions that we do in order to run our office. Examples of how we use or disclose your information for health care 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 information inside our office for these purposes without any special permission. If we need to disclose your PHI or PII outside of our office for these reasons, we usually will not ask for special written permission.
USES & DISCLOSURES WITHOUT CONSENT OR AUTHORIZATION
In some limited situations, the law allows or requires us to disclose your PHI or PII without your permission. Such disclosures may include:
- When state or federal law mandates that certain health information is reported for a specific purpose.
- For public health purposes, such as contagious disease reporting, investigation or surveillance or disclosures to prevent a serious threat to public health or safety.
- Notices to and from the Federal Food and Drug Administration regarding drugs or medical devices (such as contact lenses).
- Disclosures to governmental authorities on victims of suspected abuse, neglect or domestic violence.
- Uses 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 law.
- Disclosures for judicial and administrative proceedings, such as in response to subpoenas court orders or administrative agencies.
- Disclose information to law enforcement about someone who is suspected to be a victim of crime to provide details about a crime at our office or to report a crime that happened somewhere else.
- Disclosure to a medical examiner to identify a deceased person (health information is not considered private 50 years after death) 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 specialized government functions for lawful national intelligence activities for military purposes or for the evaluation and health of members of the foreign services.
- Disclosures of de-identified or "limited data set" information used in research, public health, or health care operations.
- Disclosures for Disability or Worker's Compensation Programs.
- Disclosure to Business Associates such as patient safety organizations, health information organizations, e-prescribing gateways and others that facilitate data transmission. These Business Associates and their subcontractors may create, receive, maintain or transmit protected health data on a covered entity's behalf.
- Unless you object, we will also share relevant information about your health with your family or friends who are helping with your care.
OTHER DISCLOSURES
We will not make any other uses or disclosures of PHI or PII unless you give written authorization. If we initiate this process and ask you to sign an authorization, you do not have to sign it. If you sign one, you may revoke it at any time unless we have already acted in reliance upon it.
Revocations must be in writing and submitted to our office. We do not sell or use your personal and protected information for marketing or fundraising without your written permission.
HOW WE COMMUNICATE WITH YOU
We may call, text, email or write to remind you of scheduled appointments or that it is time to make a routine appointment. We may also notify you that materials ordered for you have arrived or of other treatments or services available at our office that might help you.
You may ask us to communicate with you in a confidential way, such as phoning you at work rather than home, by mailing information to a certain address, or by sending email or text messages to a specific address or number. We will accommodate these request, if they are reasonable. If you wish to ask for confidential communication, send a written request to our office
PATIENT RIGHTS REGARDING PROTECTED AND PERSONAL INFORMATION
- Obtain a copy of our Notice of Privacy Practices upon request. 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 PHI and PII that we already have, as well as to any 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 them on our web site.
- Request restrictions on disclosure of PHI or PII. You may ask us to restrict our uses and disclosures of your personal and protected information for purposes of treatment (except in emergencies), payment or health care operations. If you request that personal and protected information not be shared with your insurance plan, you must pay in full for services or materials. To ask for a restriction, send a written request to our office. We will inform you within 30 days if your request will be honored.
- Right to access your PHI. You will be able to review or obtain a copy of your records with a written request to our office. 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. For the most part, however, you will be able to review or have a copy of PHI within 30 days (or 60 days if stored off-site) of the request. 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.
- Right to amend your PHI. You may ask us to amend your personal and protected information, if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days of your request. We will send the corrected information to persons who we know received the wrong information and others that you may specify. If we do not agree, you can write a statement of your position, and we will include it with your PHI along with a rebuttal statement. Once your statement of position and our rebuttal is included in your PHI, we will send it with any permitted disclosures. By law, we may have a 30 day extension of time to consider a request for amendment, if we notify you in writing of the extension. To ask for an amendment to your PHI, send a written request to our office, along with your reasons for the amendment.
- Request a list of the uses and disclosures of your PHI or PII. By law, the list may not include: disclosures for purposes of treatment payment or health care operations disclosures with your authorization incidental disclosures disclosures required by law and some other limited disclosures.
- Request an accounting of disclosures of your PHI or PII. You may obtain a list of disclosures that we have made of your personal and protected information within the past six years or less. You are entitled to one such list per year without charge. We will generally respond to your request within 30 days, but by law we can request a 30 day extension, if we notify you in writing. Send written requests for an accounting of disclosures to our office.
- Notification of breach to PHI or PII. Any impermissible use or disclosure of your personal and protected information is presumed to be a breach, unless there is a low probability that your personal information has been compromised. Notification of a breach is made without unreasonable delay and no more than 60 days after discovery.
For more information contact: HHS.gov
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201