NOTICE OF PRIVACY PRACTICES:

Effective 08/27/2013

Lisa Stafford, OD PC  2070 S St Rd 39, Frankfort, IN 46041.  765-659-2020; Fax 765-654-4668 Kirsten Conway is office contact. This notice describes how medical information about you may be used & disclosed & how you can get access to this information.  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 & your rights.

TREATMENT, PAYMENT, & HEALTH CARE OPERATIONS

The most common reason why we use or disclose your health information is for treatment, payment, or health care operations.  Treatment examples are:  setting up an appointment for you; examining your eyes; prescribing glasses, contact lenses, or eye medications & faxing them to be filled; showing you low vision aids; referring you to another doctor for eye care or low vision aids or services; or getting copies of your protected health information(PHI) from another professional that you may have seen before us.  Payment examples are:  asking you about your health or vision care plans or other sources of payment, preparing & sending bills or claims, & collecting unpaid amounts(either ourselves or through a collection agency or attorney).  “Health care operations” mean administrative & managerial functions that we have to do in order to run our office.  Examples are:  financial  or billing audits; internal quality assurance, personnel decisions, participation in managed care plans, defense of legal matters; business planning; & outside storage of our records.  We will not sell your PHI or use it for marketing without your authorization.   You may ask us to withhold disclosure to your health insurer of PHI related to a service if you pay out of pocket for the service.

USES & DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION

In some limited situations, the law allows or requires us to use or disclose your PHI without your permission.  Not all of these situations will apply to us, & some may never come up.  Examples:  When a state or federal law mandates certain health information be reported for a specific purpose; for public health purposes, such as contagious disease reporting, investigation or surveillance; & notices to & from the federal Food & Drug Administration regarding drugs or medical devices.

disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence; uses & disclosures for health oversight, such as doctor licensing, Medicare or Medicaid audits, or investigation of possible violations of health care laws.

disclosures for judicial  administrative proceedings, 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 or to prevent a serious threat to health or safety

uses & disclosures for specialized government functions, such as the protection of the president or high ranking government officials; for lawful nation intelligence activities, military purposes, or the evaluation & 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” performing health care operations for us,who respect the privacy of your PHI.

We may share PHI with a person involved in your medical care/payment of your care, such as your family or a close friend if appropriate.

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 email or mail you an appointment reminder on a postcard, &/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 & DISCLOSURES

We will not make any other uses or disclosures of your PHI 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 &    ask you to sign an authorization form, you do not have to sign it.  If you do not sign the authorization, we can not make use of    the 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 & 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 or fax 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 PHI to a different address, or by using a fax to your fax machine.  We will accommodate these requests if they are reasonable, & 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 or fax shown at the beginning of this notice.

Ask to see or to get photocopies of your PHI.  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 PHI 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, & 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 PHI, send a written request to the office contact person at the address or fax shown at the beginning of this notice.  You may also ask for an electronic copy of your health record. ask us to amend your PHI if you think that it is incorrect or incomplete.  If we agree, we will amend it within 60 days from when you ask us.  We will send the corrected information to persons we know got the wrong information, & others that you specify.  If we do not agree, you can write a statement of your position, & we will include it with your PHI along with any rebuttal statement that we may write.  Once your statement of position &/or our rebuttal is included in your PHI, we will send it along whenever we make a permitted disclosure of your PHI.  By law, we can have one 30 day extension to consider a request for amendment if we notify you in writing of the extension.  If you want to ask us to amend your PHI, send a written request, including your reasons  for the amendment, to the office contact person at the address or fax shown at the beginning of this notice.get a list of the disclosures that we have made of your PHI within the past 6 years(or a shorter period if you want).  By law, the   list will not include:  disclosures for the purposes of treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; & some other limited disclosures.  You are entitled to 1 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 a 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 at the address or fax shown at the beginning of this notice. get additional paper copies of our Notice of Privacy Practices by request.  It does not matter if you got one already.  If you want additional paper copies, send a written request to the contact person at the address at the beginning of this notice.   You have the right to be notified if there is a breach of privacy such that your PHI is disclosed or used improperly or in an unsecured way.

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.

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 US Department of Health & 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 or fax shown at the beginning of this notice. If you prefer, you can discuss your complaint in person or by phone.

FOR MORE INFORMATION

For more information on our privacy practices, call the contact person at the address or phone # at the beginning of this notice.