PRIVACY
Effective date of notice: April 14, 2003
Granite Pointe
Eye Care, Inc.
1411 Secret Ravine Pkwy., Suite 120
Phone
(916) 797-6747
Fax (916)797-6728
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 also call to notify you of 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 Granite Pointe Eye Care, Inc. 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 Granite Pointe Eye Care, Inc. 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 Granite Pointe Eye Care,
Inc. 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 Granite Pointe Eye
Care, Inc. 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 Granite Pointe Eye Care, Inc. 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, have
copies available in our office and (post it on our website).
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 Granite Pointe Eye Care, Inc. 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 Granite
Pointe Eye Care, Inc at the address or phone number shown at the
beginning of this
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