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Notice of Privacy Practices April 1, 2003
Palmer
Family Eye Care 21 Corporate Drive Easton, PA 18045
610-258-5337 Fax: 610-258-7961 Email: pfec@rcn.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,
which 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. 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. 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. Health 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 leave a message on your
answering machine or leave a message with a family member.
We may contact you by letter or postcard. We may also
contact you regarding 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: · A state or
federal law that mandates certain health information be
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
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. · 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 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: Hazel Macklin 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 Hazel Macklin at
the address, fax or e-mail shown at the beginning of this
notice. · 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 Hazel Macklin
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 Hazel Macklin 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 Hazel Macklin 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, and we
will have copies available in our office.
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 Hazel Macklin 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 Hazel Macklin at the address or
phone number shown at the beginning of this notice.
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