PRIVACY POLICY

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 eye; prescribing glasses, contact lenses, or eye medication and faxing or electronically submitting them to be filled; referring you to another doctor or clinic for additional service;. or getting copies of your health information from another professional you may have seen prior to us. Examples of how we use or disclose your health information for payment purposes are: asking you about your medical or vision care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid balances( either ourselves or through a collection agency). “Health care operations” mean those managerial and administrative 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 billing audits; internal quality assurance projects; personnel decisions; participation in managed care plan;, defense of legal matters; business planning and outside storage of our records as needed. 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 usually will not ask you for special written permission. We will ask for special written permission when it is required by law.

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. Some uses or disclosures are:

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, or to notify you that your order is ready for pickup. Unless you tell us otherwise, we will contact you via mail and/or leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.

If you would like to authorize us to disclose your protected health information to another person you may indicate this by including the name and relationship of the person you authorize disclosure to on the signature form below. You must also indicate the date you wish the authorization to expire.

We will not make any other uses or disclosures of your health information unless you sign a written “authorization form”. Federal law determines the content of an “authorization form”. Sometimes, we may initiate the authorization process if the use of 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 and authorization form, you do not have to sign it. If you do not sign the authorization form, 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 made in writing. Send them to the contact person named at the end of this notice.

The law gives you rights regarding your health information. You can:

Ask us to restrict our uses and disclosures for purpose 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 named at the end 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 health information to a different address, or by sending Email to your personal Email address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost that follows the Nebraska law. If you want to ask for confidential communications, send a written request to the office contact person named below.

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. For the most part, however, you will be able to review or have ­a copy of your health information within 30 days of asking. You may be asked to pay for your 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 of your health information, send a written request to the office contact person named below .

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 the date you requested the change. We will send the corrected information to persons who we know got the wrong information and others you may 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. To request an amendment to your health information, send a written request to the person named below.

Get a list of the disclosures that we have made of your health information within the past seven years (or shorter period if you request). By law, the lists will not include: disclosures for purposes of treatment, payment or health care operations, disclosures with your authorization; incidental 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 need 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, please send a request to the person listed below.

You have the right to request that we not disclose your PHI to a health plan for payment or healthcare operations purposes, if that PHI pertains to a health care item or service for which we have been involved and which has been paid out of pocket in full. We are required to comply with your request for this type of restriction.

You may get additional paper copies of the Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form.

In the event of any Breach of Unsecured PHI, Eye Specialists shall fully comply with the HIPAA/HITECH breach notification requirements, which will include notification to you of any impact that Breach may have had on you and/or your family member(s) and actions Eye Specialists undertook to minimize any impact the Breach may or could have on you previously. If you would like additional copies, send a written request to the person named below.

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, new privacy practices will apply to your health information that we already have as well as any information 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.

If you think that not properly respected the privacy of your health information, you may contact us or the U.S. Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you if you make a complaint. To send a complaint to this office, send a written statement to the person named below. If you prefer, it may also be discussed in person or by phone.

If you desire more information about our privacy practices, call the main office number (402-292-6514) or visit our office to speak with our HIPAA Privacy Officer, Angie Bothwell.