Privacy Policy - Brainerd Eyecare Center
S.T. Monda, O.D.
J.J. Hankse, O.D.
A.M. Archibald Swanson O.D.
T.J. Swanson O.D.
M.K. Monda O.D.
506 Laurel Street
Brainerd, MN 56401
(218) 829-1279 Fax
Email: bec@brainerdeyecare.com Effective date of notice: April 14, 2003 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 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 we use or disclose your health information is for treatment, payment, or health care operations. Examples of how we use or disclose information for treatment purposes are setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses, or eye medications and faxing them to be filled; showing you low vision aids; referring you to another doctor or clinic for eye care or low vision aids or services; or getting copies of your health information from another professional that you may have seen before us. We use or disclose your health information for payment purposes by asking about
your health or vision care plans or other payment sources, preparing and sending bills or claims, and collecting unpaid amounts (either ourselves or through a collection agency or attorney). Healthcare operations are the administrative and managerial functions we must perform to run our office. Examples of how 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 matters, 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 usually will not ask you for special written permission.
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. Only some of these situations apply to us; some may never come to our office. 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 notices to and 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 investigation of possible violations of health care 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; for military purposes; or 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 or disclosures;
- Disclosures to business associates who perform health care operations for us and commit to respecting your health information's privacy.
Unless you object, we will share relevant information about your eye care with your family or friends.
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 tell us otherwise, we will mail you an appointment reminder on a postcard and leave you a reminder message on your home answering machine or with someone who answers your phone if you are away.
Other Uses And Disclosures
We will not make any other uses or disclosures of your health information unless you sign a written authorization form. The content of an authorization form is determined by federal law. Sometimes, we initiate the authorization process if the use or disclosure is our idea. Sometimes, you may begin the process if it's your idea for us to send your information to someone else. Typically, you will give us a properly completed authorization form in this situation, or you can use one of ours. If we initiate the process and ask you to sign an authorization form, you do not have to. We cannot use or disclose if you do not sign the authorization. If you sign one, you may revoke it at any time unless we have already acted based on it. Revocations must be in writing. Please send them to the office address listed 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 use and disclosures for treatment purposes (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 you want. To ask for a restriction, send a written request to the office contact person at the address, fax, or Email shown at the beginning of this notice.
- ask us to communicate with you confidentially, such as by phoning you at work rather than at home, mailing health information to a different address, or using Email to your personal Email address. We will accommodate these requests if reasonable, and you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the office contact person at the address, fax, or Email shown at the beginning of this notice.
- Ask to see or get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. For the most part, however, you can review or have a copy of your health information within 30 days of asking us (or 60 days if the data 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 to give you access or photocopies if we send you a written notice of the extension. If you want to review or get photocopies of your health information, send a written request to the office contact person at the address, fax, or Email shown at the beginning of this notice.
- ask us to amend your health information if you think it needs to be corrected or completed. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to people we know who got the wrong information and others you specify. If we disagree, you can write a statement of your position, and we will include it with your health information along with any rebuttal statement we may write. Once your statement of position and 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 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 the office contact person at the address, fax, or Email at the beginning of this notice.
- get a list of the disclosures we have made of your health information within the past six years (or a shorter period if you want). By law, the list will not include disclosures for treatment, payment, or health care operations, disclosures with your authorization, incidental disclosures, disclosures required by law, or other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you must 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 if we notify you of the extension in writing. If you want a list, send a written request to the office contact person at the address, fax, or Email at the beginning of this notice.
- 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. If you want additional paper copies, send a written request to the office contact person at the address, fax, or Email at the beginning of this notice.
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 anytime, as the law allows. If we change this notice, the new privacy practices will apply to your health information that we already have and 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, and post them on our Website.
Complaints
If you think that we need to respect the privacy of your health information correctly, 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 person at the address, fax, or Email 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 or visit the office contact person at the address or phone number shown at the beginning of this notice.