| Effective: | April 14, 2003 |
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NOTICE OF PRIVACY PRACTICES
VisionQuest Eyecare, P.C.
Indianapolis, IN
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 protected health information (PHI) that identifies you private. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your PHI and what rights you have regarding it. We are required to abide by the terms of this Notice.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your PHI is for treatment, payment or health care operations. Examples of how we use or disclose PHI for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses, eye medications, vision aids or services; getting copies of your PHI from another professional that you may have previously seen; or disclosing PHI to another doctor or health care provider (e.g., a specialist or laboratory) who provides assistance with your diagnosis or treatment. Examples of how we use or disclose your PHI for payment purposes are: asking you about your health/vision care plans or other sources of payment; making a determination of eligibility or coverage for insurance benefits; preparing and sending bills or claims and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “Health care operations” mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your PHI for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records. In addition, we may use a sign-in sheet at the registration desk or call you by name in the waiting room.
Your doctor and our office staff will routinely use your PHI inside our office for these purposes without any special permission. If we need to disclose your PHI outside of our office for these reasons, we usually will not ask you for special written permission. Unless you tell us otherwise, we may call or write to provide you with information about treatment alternatives or other health-related benefits and services available at our office that may be of interest to you. We may use or disclose your demographic information and the dates you received treatment from your doctor in order to contact you to provide information on your condition or to recall you for future appointments. We may mail you an appointment reminder on a post card and/or leave you a message on your home answering machine or with someone who answers your phone if you are not home. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.
USES AND 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 at our office at all. Such uses or disclosures are:
Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your eye care. If you are unable to agree or object to such disclosure, we may disclose such information as necessary if we determine it is in your best interest based on our professional judgment. We may notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. We may use or disclose PHI in an emergency treatment situation. If this happens, your doctor shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment.
OTHER USES AND DISCLOSURES
All additional requests for PHI release, other than those exempted uses listed in this document, will be made only with your written authorization. The content of an authorization form is determined by federal law. We may initiate the authorization process if the use or disclosure is our idea. You may initiate the process if it’s your idea for us to send your information to someone else. You must give us a properly completed authorization form or 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 end of this Notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding your PHI. 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 PHI 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 your PHI, you are free to complain to us or 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 end 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 end of this Notice.
Tina Johnson, c/o VisionQuest Eyecare, 9650 E. Washington St., Indianapolis, IN 46229
(317)890-5630 (317)890-5620 fax
tjohnson@visionquesteyecare.com
| Privacy Contact Officer: | Tina Johnson, Practice Manager |
|---|---|
| Office Name: | VisionQuest Eyecare East Washington |
| Telephone: | (317) 890-5548 |
| E-mail: | Email Us |
| Office Name: | VisionQuest Eyecare South Meridian |
| Telephone: | (317) 865-6829 |
| E-mail: | Email Us |
| Office Name: | VisionQuest Eyecare Glendale |
| Telephone: | (317) 475-6044 |
| E-mail: | Email Us |
