NOTICE
OF PRIVACY PRACTICES
Park Rapids Walker Eye Clinic, O.D., P.A.
206 Pleasant Avenue
Park Rapids, MN 56470
218 732 3389
Fax:
218 732 5994
107 6th St.
S P.O. Box 219
Walker, MN 56484
218 547 3666
Fax:
218 547 6073
prec@unitelc.com
Nancy McDowell, Privacy Officer
nancym@prweyeclinic.com
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;
other uses and disclosures affected by state law.
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.
