NOTICE OF PRIVACY PRACTICES
King Family Eye Care, LLC
Dr. Matthew King & Associates
|This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Health providers are obligated by Federal law to provide our patients with our notice of privacy practices. This describes how we protect your personal health information and the rights you have regarding it. Please review it carefully.|
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
Most common uses for disclosing your health information are for treatments, purposes of payment (preparing claim forms), or health care operations such as referrals to another health care provider. If you are being referred, we will normally send a fax to the practitioner’s office with your name and phone number and pertinent health data. Since we typically work late hours we will seek your verbal permission to send along your personal or work phone number so the referred practitioners office staff can contact you in order to make your appointment. If you prefer we can mail it or you can schedule your own appointment. Your health information is also used to set up an appointment, verify your insurance coverage and benefits, testing and examining your eye health; prescribing treatments; faxing or emailing to fill prescriptions; referring you to another health care office; or getting copies of your health information from another professional that you have seen before us; and for collecting unpaid amounts (either through this office or through an attorney). Other examples of administrative / managerial disclosures of your health information include: financial and billing audits; internal quality assurance; appointment reminders; personnel decision; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.
We routinely bill insurance companies on our patient’s behalf. We do this electronically via computer, secure internet sights, and if your insurance company does not accept electronic claims then we file by mail. Our computers are protected by antiviral software and with firewall protection.
We routinely use your health information inside our office for these purposes without your permission. We will ask for special written permission if you desire to have medical records sent from our office to another medical office of your choosing. The note can be written or typed and must have the addressee’s name and address or fax number. Finally the request must have your printed name and signature.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some situations, the law allows us to use or disclose your health information without your permission. 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: 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 other insurance audits; or for investigations 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 should it occur at our office; or to report a crime that occurred elsewhere;
Uses or disclosures from health related research;
Uses and disclosures to prevent a serious threat to health or safety;
Disclosures of de-identified information;
Disclosures relating to worker’s compensation programs;
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;
Other disclosures required by state law.
Unless you object, we will also share health information about your care with your family or friends who are helping you with your eye care.
We may call or write to remind you of scheduled appointments or to schedule an appointment. We may also write, call or email to notify you of other treatments or services available at our offices that may help you. Unless you tell us otherwise, we will mail you an appointment reminder on a postcard, and/or leave a message on you home answering machine or with someone who answers your phone if you are not at 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.” Federal law determines the content of the “authorization form”. Sometimes, we may initiate the authorization preprocess if the use or disclosure is our idea 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 for, 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 and signed with your name. Send them to Dr. King at the address on the front page.
We also utilize an outside vendor to help with recall. Your post cards are organized and mailed by our vendor. We are assured your information is not sold for marketing or any other purposes.
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 (Except in 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 you want. To ask for a restriction, send a written request to Dr. King at the address on the front of this form.
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 email 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 Dr. King.