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NOTICE OF PRIVACY PRACTICES
Barry M. Kay, O.D.
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 HEALTH CARE OPERATIONS
The most common reason why 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. Examples of how we use or disclose your health
information for payment purposes are: asking you about your
health or vision care plans, or other sources of payment;
preparing and sending bills or claims; and collecting unpaid
amounts (either ourselves or through a collection agency or
attorney). “Health care operations” mean those
administrative and managerial functions that we have to do
in order to run our office. Examples of how we use or disclose
your health information for health care 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.
Not all of these situations will apply to us; some may never
come up at our office at all. 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 for 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 for 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 health care 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 who commit to respect
the privacy of your health information;
Unless you object, we will also share relevant information
about your care with your family or friends who are helping
you with your eye care.
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 post card, and/or leave you a reminder message on your home
answering machine or with someone who answers your phone if
you are not home.
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 may initiate the
authorization process if the use or disclosure is our idea.
Sometimes, you may initiate the process if it’s your
idea for us to send your information to someone else. Typically,
in this situation you will give us a properly completed authorization
form, 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 sign it. If you do not sign the authorization,
we cannot make the use or disclosure. If you do sign one, you
may revoke it at any time unless we have already acted in reliance
upon it. Revocations must be in writing. Send them to the office
contact person named 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 uses and disclosures for purposes
of treatment (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 that you want. To
ask for a restriction, send a written request to the office
contact person at the address, fax or E Mail shown at the
beginning of this Notice.
- 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 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 the office contact person at the
address, fax or E mail shown at the beginning of this Notice.
- 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. For the most part, however,
you will be able to review or have a copy of your health information
within 30 days of asking us (or sixty days if the information
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 of the time for us 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 E mail shown
at the beginning of this Notice.
- 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 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 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 the
office contact person at the address, fax or E mail shown
at the beginning of this Notice.
- 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). By law, the list will 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.
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 the office contact
person at the address, fax or E mail shown 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 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 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 Web site.
COMPLAINTS
If you think that we have not properly respected the privacy
of your health information, 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 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 the office contact person at the address or phone
number shown at the beginning of this Notice.
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