HIPAA NOTICE OF PRIVACY PRACTICESBluffton Family Eye Care 105 W Harvest Rd. Bluffton, IN 46714260-824-3424
Your Information. Your Rights. Our Responsibilities.This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Ask us for a copy of your recordsYou can ask to see or receive a paper copy of your medical record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Choose someone to act for you If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
Request confidential communicationsYou can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
Ask us to limit what we use or shareYou can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Your ChoicesFor certain health information, you can tell us your choices about what we share. If you have a specific preference for how we share your information let us know.
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
Our Uses and Disclosure
TreatmentWe can use your health information and share it with other providers who are treating you.
Run our organizationWe can use and share your health information to run our practice, improve your care, and contact you when necessary.
Bill for your servicesWe can use and share your health information to bill and receive payment from health plans or other entities.
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Help with public health and safety issuesWe can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
Comply with the lawWe will share information about you if state or federal laws require it, including with the Department of Health and Human Services.
Respond to organ and tissue donation requestsWe can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral directorWe can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requestsWe can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actionsWe can share health information about you in response to a court or administrative order, or in response to a subpoena.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time and notify us in writing.
File a complaint if you feel your rights are violatedIf you feel we have violated your rights you can complain to our office by contacting Allison White by mail at 105 W Harvest Rd, Bluffton, IN 46714, phone at 260-824-3424, or by emailing firstname.lastname@example.org. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mail at 200 Independence Avenue, S.W. Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you if you make a complaint.
Get a copy of this privacy noticeYou can ask for a paper copy of this notice at any time
Changes to the Terms of this Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.