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.
General
Rule
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.
Uses
of Disclosures of Health Information
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Examples
of how we us information for treatment purposes:
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When
we set up an appointment for you.
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When
our technician or doctor tests your eyes.
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When
the doctor prescribes glasses or contact lenses.
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When
the doctor prescribes medication.
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When
our staff helps you select and order glasses or contact lenses.
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When
we show you low vision aids.
We
may disclose your health information outside of our office for
treatment purposes, for example:
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If
we refer you to another doctor or clinic for eye care services.
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If
we send a prescription for glasses or contacts to another
professional to be filled.
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When
we provide a prescription for medication to a pharmacist.
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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:
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When
our staff asks you about health or vision care plans that
you may belong to, or about other sources of payment for our
services.
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When
we prepare bills to send to you or your health or vision care
plan.
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When
we process payment by credit card and when we try to collect
unpaid amount due.
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When
bills or claims for payment are mailed, faxed, or sent by
computer to you or your health or vision plan.
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When
we occasionally have to ask a collection agency or attorney
to help us with unpaid amounts due.
We
use and disclose you health information for healthcare operations
in a number of ways. Health care 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.
Appointments
Reminders
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.
Uses
& Disclosures without an Authorization
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:
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A
state or federal law that mandates certain health information
be reported for a specific purpose.
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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.
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Disclosures
to governmental authorities about victims of suspected abuse,
neglect or domestic violence.
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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.
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Disclosures
for judicial and administrative proceedings, such as in response
to subpoenas or orders of courts or administrative agencies.
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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.
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Disclosures
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.
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Uses
or disclosures for health related research.
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Uses
and disclosures to prevent a serious threat to health or safety.
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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 for the evaluation and health of members
of the foreign services.
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Disclosures
relating to workers_ compensation programs.
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Disclosures
to business associates who perform healthcare operations for
us and who agree to keep your health information private.
Other
Disclosures
We
will not make any other uses or disclosures of you 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.
Your
Rights Regarding Your Health Information
The
laws gives you many rights regarding your health information.
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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 much honor the restrictions that you want. To
ask for a restriction, send a written request to Westcliff
Optometry Dr. Lou Roy Elder at the address, fax or e-mail
shown at the beginning of this notice.
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You
can ask us to communicate with you in a confidential way,
such as by phoning you at work rather then at home, by mailing
health information to a different address, or by using e-mail
to your personal e-mail 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 (Westcliff Optometry Dr. Lou Roy
Elder) at the address, fax, or e-mail shown at the beginning
of this notice.
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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 or your health information
within 30 days of asking us. You may have to pay for photocopies
in advance. If we deny you request, we will send you a written
explantion, 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 of we went you a written notice of the
extension. If you want to review or get photocopies of your
health information, send a written request to Westcliff Optometry
Dr. Lou Roy Elder, at the address, fax, or e-mail shown at
the beginning of this notice.
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You
can ask to amend you health information I you think that is
incorrect or incomplete. If we agree, we will amend the information
within 60 days form 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
you 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 Westcliff Optometry Dr. Lou Roy Elder at the address, fax,
or e-mail shown at the beginning of this notice.
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You
can get a list of the disclosures that we have made of your
health information within the past six years (or 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
Westcliff Optometry Dr. Lou Roy Elder at the address, fax
or e-mail 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 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 at www.westcliffoptometry.com.
Complaints
If you think that we have not properly respected the privacy
of you 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 Westcliff Optometry Dr. Lou Roy Elder 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.
For More Information
If you want more information about our privacy practices, call
of visit Westcliff Optometry Dr. Lou Roy Elder at the address
of phone number shown at the beginning of this notice.
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