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Privacy Statement
THE VISION CENTER
Dr. Thomas Cassidy & Dr. Brian Pierce
43050 Ford Road, Suite 170
Canton, MI 48187
734-981-2700
734-981-0198 fax
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 respect our legal obligation to keep private health information that
identifies you. 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 this information.
TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS.
The most common reason why we use or disclose your health information is
for treatment, payment or health care operations. Examples of how we use
or disclose information for treatment purposes are: setting up an
appointment for you; testing or examining your eyes; prescribing glasses,
contact lenses, or eye medications and faxing them to be filled; referring
you to another doctor or clinic for eye care or services; or getting
copies of your health information from another professional that you may
have seen before us. Examples of how we use or disclose your health
information for payment purposes are: asking you about your health or
vision care plans, or sources of payment; 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 health information for
health care operations are: financial or billing audits; internal quality
assurance; patient surveys to monitor quality of services and products;
personnel decisions; participation in managed care plans; defense of legal
matters; business planning; and outside storage of our records.
We routinely use your health information inside our office for these
purposes without any special permission. If we need to disclose your
health information outside of our office for these reasons we will usually
not ask you for special written permission.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
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 come up at our office at all.
Such uses or disclosers are:
* 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 for 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 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 services;
* 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: who perform health care operations
for us and who commit to respect the privacy of your health information;
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.
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 mail you an appointment
reminder on a post card, and /or leave a message on your home answering
system or with someone who answers your phone if you are not home.
OTHER USES AND DISCLOSURES
We will not make any other 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 an authorization, you may
revoke it at any time unless we have already acted in reliance upon it.
Revocations must be in writing. Send them to this office at Attention:
Privacy Officer.
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 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, via mail,
fax or e-mail, to this office at Attention: Privacy Officer.
* 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
E-mail address. We will accommodate these requests if they are reasonable,
and if you pay us for any extra costs. If you want to ask for confidential
communications, send a written request, via mail, fax or E-mail, to this
office at Attention: Privacy Officer.
* Ask to see or get photocopies of your health information. By law, there
are 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 60 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 you access or photocopies if we send
you a written notice of the extension. If you want to review or get
photocopies of your health information, send a written request, via mail,
fax or E-mail, to our office at Attention: Privacy Officer.
* 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 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, via mail,
fax, or E-mail, including your reasons for the amendment, to our office at
Attention: Privacy Officer.
* Get a list of the disclosures that we have made of your health
information within the past six years (or a shorter period of time 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, via mail, fax or
E-mail, to our office at Attention: Privacy Officer.
* 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, send a written request
to our office at Attention: Privacy Officer.
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 your
health information, 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 our office, via mail, fax or E-mail at
Attention: Privacy Officer. 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
our office at the phone number or address shown at the beginning of this
notice.
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