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In accordance with Federal Law, this Notice of Privacy Practices is posted. Effective
date of notice: 14 April 2003 NOTICE OF PRIVACY PRACTICESfor Dan C. Thieme, O.D., P.C. (doing business as) Meridian
Family Eyecare 1560
North Crestmont Drive, Ste. A Meridian,
Idaho 83642 (208)
888-2200 fax (208) 888-7623 and Payette Family Eyecare 827 Center Avenue Payette, Idaho 83642 (208) 642-4434 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 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 and what rights you have
regarding it. 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; showing you vision aids; referring you
to another doctor or clinic for eye care or vision aids 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
other 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; 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 usually will not ask you for special
written permission. We
will ask for special written permission in the following situations:
When copies of your records are requested by another doctor or outside
agency not affiliated with this office. 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 disclosures 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 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" who perform health care
operations for us and who commit to respect the privacy of your health
information; >
disclosures to other health care professionals that are in the best interest of
the patient to assist in continued and/or coordinated care. 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 you a reminder message on your home answering machine 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
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 address 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 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 to the address or fax number shown
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 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 cost. If you
want to ask for confidential communications, send a written request to the
address or fax shown at the beginning of this Notice. >
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 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, 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 to
the address or fax shown at the beginning of this Notice. >
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,
including your reasons for the amendment, to the address or fax shown at the
beginning of this Notice. >
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). 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 to the address or fax shown at the beginning of
this Notice. >
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 the office contact
person at the address or fax 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 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 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
If you want more
information about our privacy practices, call or visit the office and ask to
speak to the Privacy Officer at the address or phone number shown at the
beginning of this Notice.
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