Notice
of Privacy Practices
Effective Date: April 14, 2003
This notice describes how medical information about you may
be used and
disclosed and how you may access this information. Please
review it carefully.
If you have any questions about this notice, please contact
the Administrator for Southwest Michigan Eye Center (SWMEC)
at (269) 979-6383.
Your medical information is personal. We are committed to
protecting your medical information. A record is created of
the care and services you receive at this office. We need
this record to provide you with quality care and to comply
with certain legal requirements. This Notice applies to all
of the records of your care generated by this office whether
made by your personal physician or one of the office’s
employees.
This Notice will tell you the ways in which we may use and
disclose your medical information. This Notice will also describe
your rights and certain obligations we have regarding the
use and disclosure of your medical information.
By law, this office is required to:
- make
sure that medical information that identifies you is kept
private;
- give
you this Notice of our legal duties and privacy practices
with respect to medical information about you; and
- follow
the terms of the Notice that is currently in effect.
How this
Office May Use and Disclose your Medical Information
The following describes the different ways that your medical
information may be used or disclosed by this office. For clarification
we have included some examples. Not every possible use or
disclosure is specifically mentioned. However, all of the
ways we are permitted to use and disclose your medical information
will fit within one of these general categories:
For Treatment. We will use medical information about you to
provide you with medical treatment and services. We may disclose
medical information about you to doctors, nurses, technicians,
pharmacies and other office personnel who are involved in
providing you medical care. For example, we may send information
about you to another physician’s office that is treating
you, to assure that your treatment is coordinated. In our
professional judgment, we may also disclose information about
you to your family members and friends who are involved in
caring for you.
For Payment. We may use and disclose medical information about
you so that the treatment and services you receive at this
office may be billed to and collected from you, an insurance
company or a third party. For example, we may need to give
your health plan information regarding treatment you received
here for reimbursement to us or to you. We may also tell your
health plan about treatment you are going to receive to obtain
prior approval or to determine whether your plan will cover
the treatment.
For Health Care Operations. We may use and disclose medical
information about you for our office operations. These uses
and disclosures are necessary to run our office and make sure
that all of our patients receive quality care. For example,
we may use medical information to review our treatment and
services and to evaluate the performance of our staff in caring
for you. We may also combine medical information about many
of our patients to decide what additional services the office
should offer, what services are not needed, and whether certain
new treatments are effective. We may also disclose information
to doctors, nurses, technicians, and other office personnel
for review and learning purposes. We may remove information
that identifies you from this set of medical information so
others may use it to study health care and health care delivery
without learning the identity of a specific patient.
Appointment Reminders. We may use and disclose medical information
to contact you as a reminder that you have an appointment
for treatment or medical care at this office. This may be
done in writing or by telephone.
Glasses, Contacts, Samples Pick-up. We may use and disclose
medical information to contact you, informing you that your
glasses, contacts, and samples are ready for pick-up.
Treatment Alternatives. We may use and disclose medical information
to tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose
medical information to tell you about health-related benefits
or services that may be of interest to you.
Surveys. We may use and disclose medical information to contact
you for information that may better help us care for you.
Research. Under certain circumstances, we may use and disclose
medical information about you for research purposes. For example,
a research project may involve comparing the health and recovery
of all patients who received one medication to those who received
another for the same condition.
As Required by law. We will disclose medical information about
you when required to do so by federal, state and local law.
For example, disclosure may be required by Workers’
Compensation statutes and various public health statutes in
connection with required reporting of certain diseases, child
abuse and neglect, domestic violence, adverse drug reactions,
etc.
To Avert a Serious Threat to Health or Safety. We may disclose
medical information to a governmental or other oversight agency
for activities authorized by law. For example, disclosures
of your medical information may be made in connection with
audits, investigations, inspections, and licensure renewals,
etc.
Health Oversight Activities. We may disclose medical information
to a governmental or other oversight agency for activities
authorized by law. For example, disclosures of your medical
information may be made in connection with audits, investigations,
inspections, and licensure renewals, etc.
Lawsuits and Disputes. If you are involved in a lawsuit or
a dispute, we may use your medical information to defend the
office or to respond to a subpoena or court order.
Law Enforcement. We may release medical information about
you in connection with certain law enforcement or national
security investigations or activities.
Coroners and Medical Examiners. We may release medical information
to a coroner or medical examiner to identify a deceased person
or determine the cause of death.
Your Rights Regarding Your Medical Information:
You have the following rights regarding the medical information
this office maintains about you:
Right to Inspect and Copy. You have the right to inspect and
copy your medical information with certain limited exceptions.
To inspect and copy your medical information, you must submit
your request in writing to the Medical Records Department
in our office. If you request a copy of the information, we
may charge a reasonable fee for the costs of copying, mailing,
or other supplies associated with your request.
We may deny your request to inspect and copy in certain limited
circumstances. If you are denied access to your medical information,
you may request that the denial be reviewed. For information
regarding such a review please contact the Administrator of
SWMEC at (269) 979-6383.
Right to Amend. If you feel that medical information we have
in our records concerning you is incorrect or incomplete,
you may ask us to amend the information. You have the right
to request an amendment for as long as the information is
kept by this office.
To request an amendment, your request must be made in writing
and submitted to the Administrator of SWMEC at (269) 979-6383.
In addition, you must provide a reason that supports your
request.
We may deny your request for an amendment if it is not in
writing or does not include a reason to support the request.
In addition, we may deny your request if you ask us to amend
information that:
a) a) was not created by us;
b) b) is not part of the medical information kept by this
office
c) c) is not part of the information which you would be permitted
to inspect and copy; or
d) d) is accurate and complete.
Right to an Accounting of Disclosures. You have the right
to request an “accounting of disclosure.” This
is a list of certain disclosures this office has made of your
medical information.
To request this accounting of disclosures, you must submit
your request in writing to the Administrator of SWMEC. Your
request must state a time period, which may not be longer
than six years and may not include dates before April 14,
2003.
Right to Request Restrictions. You have the right to request
certain further restrictions or limitations on our use or
disclosure of your medical information. For example, you might
request that we not share medical information with another
physician that is treating you.
We are not required to agree to your request for a restriction.
If we do agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
To request a restriction, you must make your request in writing
to the Administrator of SWMEC.
Right to Request Confidential Communications. You have the
right to request that we communicate with you only in a certain
manner. For example, you could request that our office contact
you only on a cell telephone, rather than at your home telephone
number.
To request confidential communications, you must make your
request in writing to the Administrator of SWMEC. We will
accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have the right to
a paper copy of this Notice. Even if you have agreed to receive
this Notice electronically, you are still entitled to a paper
copy of this Notice.
You may
obtain a paper copy of this Notice at the front desk of our
offices.
Revisions to This Notice
We reserve the right to revise this Notice. Any revised Notice
will be effective for medical information we already have
about you as well as any information we receive in the future.
We will post a copy of any revised Notice in this office.
Any revised Notice will contain on the first page, in the
top right-hand corner, the effective date. In addition, each
time you visit the office you may request a copy of the Privacy
Notice.
Complaints
If you believe your privacy rights have been violated, you
may file a complaint with this office or with the Secretary
of the Department of Health and Human Services. To file a
complaint with this office, contact the Administrator for
SWMEC at (269) 979-6383. All complaints must be in writing.
This office will not penalize you in any way for filing a
complaint.
Other
uses and disclosures of your medical information not covered
by this Notice of Privacy Practices will be made only with
your written authorization. If you provide us such an authorization
in writing to use or disclose medical information about you,
you may revoke that authorization, in writing, at any time.
If you revoke your authorization, we will no longer use or
disclose medical information about you for the reasons covered
by your written authorization.
Southwest
Michigan Eye Center
3600 Capital Avenue S.W., Suite 203
Battle Creek, Michigan 49015
800.274.6699
269.979.6381 (FAX)
info@swmeyecenter.com
|
