Notice
of Privacy Practices
Effective
date of notice: April 15, 2003
Family
Eye Care of NEPA
570-253-6551
(Fax)
570-253-6553(E-Mail) perfectvision®familyeyecareofnepa.com
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
or Disclosures of Health Information
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 or contact lenses.
• When the doctor
prescribes medication.
• When our staff
helps you select and order glasses or contact lenses.
• When we show you
low vision aids.
• When a doctor or
vision therapist administers vision therapy.
• When office staff bills
an account, receives phone calls and conducts business in and around front desk
area.
• When we work with
an ophthalmologist providing care to you.
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 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.
• When we work with
an ophthalmologist providing care to you.
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 health or vision care 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. Heafth care operations mean 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.
Appointment
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. We may call you to reschedule missed appointments.
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:
• A
state or federal law that mandates certain health information is 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 any other insurance Family Eye Care
of NEPA may participate in, 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; for military purposes; or for the evaluation and
health of members of the Foreign Service.
• Disclosures
relating to workers’ compensation programs.
• A
disclosure 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 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.
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 Family Eye Care of
NEPA 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
Family Eye Care of NEPA at the address, fax or email shown at the beginning of
this notice. If no special request is made then it is to our understanding that
the patient agrees to have their care and patient health information
administered with current layout within our office.
• 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 Family
Eye Care of NEPA 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 Family Eye Care of NEPA 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 Family Eye Care of NEPA
at the address, fax or e-mail shown 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 post it on our website
(www.familyeyecareofnepa.com).
Complaints
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 Family Eye Care of NEPA 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 or visit Family Eye
Care of NEPA at the address or phone number shown at the beginning of this
notice.
Privacy
Officer is Dr. Francis Dzwieleski, OD.
Contact
Officer is Kathy Dix