SLINGSBY & WRIGHT EYE CARE CENTER
NOTICE OF PRIVACY PRACTICES
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 understand that your health information is personal to you,
and we are committed to protecting the information about you.
This Notice of Privacy Practices describes how we will use and
disclose protected information and data that we receive or create
related to your health care.
Our
Duties
We are required by law to maintain the privacy of your health
information, and to give you this Notice describing our legal
duties and privacy practices. We are also required to follow the
terms of the Notice currently in effect.
How
We May Use and Disclose Health Information About You
We will not use or disclose your health information without your
authorization, except in the following situations:
Treatment: We will use and disclose your health information
while providing, coordinating or managing your health care. For
example, information obtained by a nurse, technician, physician,
medical student or other members of your healthcare team will
be recorded in your record and used to determine the course of
treatment that should work best for you. Your physician will put
in your record his or her expectations of the members of your
healthcare team. Members of your healthcare team will then record
the actions they took and their observations. In that way, the
physician will know how you are responding to treatment. We may
also provide other healthcare providers with your information
to assist him or her in treating you.
Payment: We will use and disclose your medical information
to obtain or provide compensation or reimbursement for providing
your health care. For example, we may send a bill to you or your
health plan. The information on or accompanying the bill may include
information that identifies you, as well as your diagnosis, procedures,
and supplies used. As another example, we may disclose information
about you to your health plan so that the health plan may determine
your eligibility for payment for certain benefits.
Health Care Operations: We will use and disclose your health
information to deal with certain administrative aspects of your
health care, and to manage our business more efficiently. For
example, members of our medical staff may use information in your
health record to assess the quality of care and outcomes in your
case and others like it. This information will then be used in
an effort to improve the quality and effectiveness of the healthcare
and services we provide. We may also disclose information to doctors,
nurses, technicians, medical students, and other clinic and hospital
personnel for review and educational purposes. We may use and
disclose this information to further the training of healthcare
and non-healthcare professionals.
Business Associates: There are some services provided in
our organization through contracts with business associates. We
may disclose your health information to our business associate
so they can perform the job we’ve asked them to do. However,
we require the business associate to take precautions to protect
your health information.
Facility Directory: Unless you notify us that you object,
we will use your name, location in the facility, and general condition,
for directory purposes. This information may be provided to other
people who ask for you by name.
Notification of Family: We may use or disclose information
to notify or assist in notifying a family member, personal representative,
or other persons responsible for your care of your location and
general condition.
Communication With Family: We may disclose to a family member,
other relative, close personal friend or any other person you
identify, health information relevant to that person’s involvement
in your care.
Research: Consistent with applicable law, we may disclose
information to researchers when their research has been approved
by an institutional review board that has reviewed the research
proposal and established protocols to ensure the privacy of your
health information.
Funeral Director, Coroner, and Medical Examiner: Consistent
with applicable law, we may disclose health information to funeral
directors, coroners, and medical examiners to help them carry
out their duties.
Organ
Procurement Organizations:
Consistent with applicable law, we may disclose health information
to organ procurement organizations or other entities engaged in
the procurement, banking, or transplantation of organs for the
purpose of tissue donation and transplant.
Fundraising: We may use certain information for purposes
of raising funds.
Food and Drug Administration (FDA): We may disclose to
the FDA health information relative to adverse events, product
defects, or post marketing surveillance information to enable
product recalls, repairs, or replacement.
Public Health: As required by law, we may disclose your health
information to public health or legal authorities charged with
preventing or controlling disease, injury, or disability, including
child abuse and neglect.
Victims of Abuse, Neglect or Domestic Violence: We may
disclose your health information to appropriate governmental agencies,
such as adult protective or social services agencies, if we reasonably
believe you are a victim of abuse, neglect, or domestic violence.
Health Oversight: In order to oversee the health care system,
government benefits programs, entities subject to governmental
regulation and civil rights laws for which health information
is necessary to determine compliance, we may disclose your health
information for oversight activities authorized by law, such as
audits and civil, administrative, or criminal investigations.
Court Proceeding: We may disclose your health information
in response to requests made during judicial and administrative
proceedings, such as court orders or subpoenas.
Law Enforcement: Under certain circumstances, we may disclose
your health information to law enforcement officials. The circumstances
include reporting required by certain laws (such as the reporting
of certain types of wounds), pursuant to certain subpoenas or
court orders, reporting limited information concerning identification
and location at the request of a law enforcement official, reports
regarding suspected victims of crimes at the request of a law
enforcement official, reporting death, crimes on our premises,
and crimes in emergencies.
Inmates: If you are an inmate of a correctional institution
or under the custody of a law enforcement official, we may release
health information about you to the correctional institution or
law enforcement official. This release would be necessary (1)
for the institution to provide you with health care; (2) to protect
your health and safety or the health and safety of others; or
(3) for the safety and security of the correctional institution.
Threats to Public Health or Safety: We may disclose or
use health information when it is our good faith belief, consistent
with ethical and legal standard, that it is necessary to prevent
or lessen a serious and imminent threat or is necessary to identify
or apprehend an individual.
Specialized Government Functions: Subject to certain requirements,
we may disclose or use health information for military personnel
and veterans, for national security and intelligence activities,
for protective services for the President and others, for medical
suitability determinations for the Department of State, for correctional
institutions and other law enforcement custodial situations, and
for government programs providing public benefits.
Workers Compensation: We may disclose health information
when authorized and necessary to comply with laws relating to
workers compensation or other similar programs.
Other Uses: We may also use and disclose your personal health
information for the following purposes:
To contact you to remind you of an appointment for treatment;
To describe or recommend treatment alternatives to you;
To furnish information about health-related benefits and services
that may be of interest to you; or
For certain charitable fundraising purposes.
Prohibition
on Other Uses or Disclosures
We may not make any other use or disclosure of your personal health
information without your written authorization. Once given, you
may revoke the authorization by writing to the contact person
listed below. Understandably, we are unable to take back any disclosure
we have already made with your permission.
Individual
Rights
You have many rights concerning the confidentiality of your health
information. You have the right:
To request restrictions on the health information we may use and
disclose for treatment, payment, and health care operations. We
are not required to agree to these requests. To request restrictions,
please send a written request to the address below.
To receive confidential communications of health information about
you in a certain manner or at a certain location. For instance,
you may request that we only contact you at work or by mail. To
make such a request, you must write to us at the address below,
and tell us how or where you wish to be contacted.
To inspect or copy your health information. You must submit your
request in writing to the address below. If you request a copy
of your health information, we may charge you a fee for the cost
of copying, mailing or other supplies. In certain circumstances
we may deny your request to inspect or copy your health information.
If you are denied access to your health information, you may request
that the denial be reviewed. Another licensed health care professional
will then review your request and the denial. The person conducting
the review will not be the person who denied your request. We
will comply with the outcome of the review.
To amend health information. If you feel that health information
we have about you is incorrect or incomplete, you may ask us to
amend the information. To request an amendment, you must write
to us at the address below. You must also give us a reason to
support your request. We may deny your request to amend your health
information if it is not in writing or does not provide a reason
to support your request. We may also deny your request if:
The information was not created by us, unless the person that
created the information is no longer available to make the amendment,
The information is not part of the health information kept by
or for us,
Is not part of the information you would be permitted to inspect
or copy, or
Is accurate and complete
To
receive an accounting of disclosures of your health information.
You must submit a request in writing to the address below. Not
all health information is subject to this request. Your request
must state a time period, no longer than 6 years and may not include
dates before April 14, 2003. Your request must state how you would
like to receive the report (paper, electronically). The first
accounting you request within a 12-month period is free. For additional
accountings, we may charge you the cost of providing the accounting.
We will notify you of this cost and you may choose to withdraw
of modify your request before charges are incurred.
To
receive a paper copy of this Notice upon request, even if you
have agreed to receive the Notice electronically. You may also
obtain a copy of this notice at our website, www. yourvisioncare.net.
You must submit a request for a paper notice in writing to the
address below.
All
requests to restrict use of your health information for treatment,
payment, and health care operations, to inspect and copy health
information, to amend your health information, or to receive an
accounting of disclosures of health information must be made in
writing to the contact person listed below.
Complaints
If you believe that your privacy rights have been violated, a
complaint may be made to our privacy officer at (605) 719-9499
or the address listed below. You may also submit a complaint to
the Secretary of the Department of Health and Human Services.
We will not retaliate against you for filing a complaint.
Contact
Person
Our contact person for all questions, requests or for further
information related to the privacy of your health information
is:
Slingsby & Wright Eye Care
Attn: Deana Thompson, Privacy Officer
240 Minnesota Street
Rapid City SD 57701
Changes
to This Notice
We reserve the right to change our privacy practices and to apply
the revised practices to health information about you that we
already have. Any revision to our privacy practices will be described
in a revised Notice that will be posted prominently in our facility.
Notice
Effective Date: April 1, 2003
