Privacy Notice
Effective Date of Notice: April 2003
NOTICE OF PRIVACY PRACTICES
J. Kyle Smith, O.D.
450 N. McPherson St.
Fort Bragg, CA 95437
[email protected]
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.
By consenting that you have received our Notice of Privacy Practices, you are giving the practice of J. Kyle Smith, OD authorization to disclose your protected information for the following purposes:
1. To diagnose and treat you
2. To get treatment for you that this office cannot provide. We will share your protected health information with potential specialty doctors, your preferred pharmacy, and or your primary care physician for treatment purposes.
3. To obtain durable medical equipment. (glasses or contacts)
4. Billing purposes with you, your insurance co, and possibly collection agencies to facilitate payment in your behalf.
5. To train our staff, or other doctors.
6. To manage the practice through audits, internal quality assurance, defense of legal matters, business planning, and records storage.
The following are a few reasons that we will disclose your protected information without your permission
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled appointments, or that it is the time to make a routine appointment. We may also 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 postcard, and/or leave you a reminder message on your home answering machine, or with someone who answers your phone if you are not home. We will also use text, and email to contact you
OTHER USES AND DISCLOSURES
We will not make any other identifiable 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:
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 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 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.
We will not sale any of your information without your written consent.
We will not use your personal or personal health information for fundraising purposes and will only use your personal information to inform you of items, procedures, or medication that is specifically related to your condition.
If you want an electronic copy of your records you may have one. Simply ask.
If you pay cash, we will not bill your insurance or otherwise inform your insurance.
Any business associated with access to protected health information with have a formal agreement confirming compliance.
NOTICE OF PRIVACY PRACTICES
J. Kyle Smith, O.D.
450 N. McPherson St.
Fort Bragg, CA 95437
[email protected]
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.
By consenting that you have received our Notice of Privacy Practices, you are giving the practice of J. Kyle Smith, OD authorization to disclose your protected information for the following purposes:
1. To diagnose and treat you
2. To get treatment for you that this office cannot provide. We will share your protected health information with potential specialty doctors, your preferred pharmacy, and or your primary care physician for treatment purposes.
3. To obtain durable medical equipment. (glasses or contacts)
4. Billing purposes with you, your insurance co, and possibly collection agencies to facilitate payment in your behalf.
5. To train our staff, or other doctors.
6. To manage the practice through audits, internal quality assurance, defense of legal matters, business planning, and records storage.
The following are a few reasons that we will disclose your protected information without your permission
- 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 of 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, court orders 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 and tissue donations
- Uses or disclosures for health related research
- Uses and disclosures to prevent a serious threat to health or safety
- Uses and disclosures for specialized government functions, such as for the purpose of the president or high ranking government officials for lawful national intelligence activities for military purposes or for the evaluation of members of the foreign service.
- Disclosures of de-identified information
- Disclosures of 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 of disclosure
- Disclosure to "business associates" who perform health care operations for us and who commit to respect the privacy of your PHI
- Unless you object, we will share relevant information about you with your family or friends directly helping you with your eye care.
- Ways we communicate with other HIPPA regulated organizations (you, your insurance company, labs, and other doctors) include: telephone, fax, text, email, conventional mail, and computer generated medication prescriptions, and electronic billing processes,
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled appointments, or that it is the time to make a routine appointment. We may also 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 postcard, and/or leave you a reminder message on your home answering machine, or with someone who answers your phone if you are not home. We will also use text, and email to contact you
OTHER USES AND DISCLOSURES
We will not make any other identifiable 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 in 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 email 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 the office contact person at the address, fax or email 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 access or photocopies if we send you a written notice of 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 email 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 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 address, fax or e-mail address shown above.
- Get a list of the disclosures that we may 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, just ask. We have plenty.
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 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 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.
We will not sale any of your information without your written consent.
We will not use your personal or personal health information for fundraising purposes and will only use your personal information to inform you of items, procedures, or medication that is specifically related to your condition.
If you want an electronic copy of your records you may have one. Simply ask.
If you pay cash, we will not bill your insurance or otherwise inform your insurance.
Any business associated with access to protected health information with have a formal agreement confirming compliance.