THIS NOTICE DESCRIBES HOW MEDICAL INFORMATIO ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We understand that your health information is personal to you, and we are committed to protecting the information about you. This Notice of Privacy Practices describes how we will use and disclose protected information and data that we receive or create related to your health care.
1. USE / DISCLOSURE OF HEALTH INFORMATION.
A. Permitted Uses / Disclosures
1. Treatment. Great Plains Eye Specialistsmay use and disclose your health information for the provision, coordination, and/or management of health care and related services, including consultations and referrals. For example, information obtained by members of your healthcare team is recorded in your medical record and used to determine the course of your treatment.
2. Payment. Great Plains Eye Specialistsmay use or disclose your health information when carrying out activities to obtain reimbursement for services provided. For example, Great Plains Eye Specialistsmay bill your or your health plan, and the bill may contain your health information.
3. Heath Care Operations. Great Plains Eye Specialistsmay use or disclose your health information for routine activities such as quality assurance, case management, credentialing, accreditation, education of staff, business planning, and customer services. For example, Great Plains Eye Specialistsmay use your health information to assess the quality of care and outcomes in your case and others like it.
4. Fundraising. Great Plains Eye Specialistsmay use or disclose your health information for certain fundraising purposes. You have the right to opt out of receiving fundraising communications in writing (letter or postcard) or by telephone at the contact provided in Section 5 of this Notice.
5. Business Associates. Great Plains Eye Specialistsprovides some services through contracts with business associates. Great Plains Eye Specialistsmay disclose your health information to a business associate, and may allow a business associate to create, receive, maintain, or transmit health information, so long as Great Plains Eye Specialistsobtains satisfactory assurance through a written agreement that the business associate will appropriately safeguard the health information.
6. Your Family / Close Friends / Personal Representative. Great Plains Eye Specialistsmay disclose your health information to your family or personal representative to notify them of your location and general condition, with some limitations.
7. Facility Directory. Great Plains Eye Specialistsmay use or disclose your name, location in the facility, your general condition, and your religious affiliation to maintain a facility directory, or to update clergy members, or persons who ask for you by name. Great Plains Eye Specialistsmust inform you in advance of the use of disclosure, so that you have an opportunity to object to it.
8. Public Health Activities. Great Plains Eye Specialistsmay use or disclose your health information for certain public health activities, including disease and injury control, Food and Drug Administration research, reporting of child abuse or neglect, and other reporting requirements.
9. Health Oversight Activities. Great Plains Eye Specialistsmay use or disclose your health information for certain health oversight activities, including audits, investigations, inspections, disciplinary actions, or legal proceedings.
10. Judicial and Administrative Proceedings. Great Plains Eye Specialistsmay use or disclose your health information in the course of any judicial or administrative proceeding in response to a court order, subpoena, discovery request, or other lawful process.
11. Law Enforcement. Great Plains Eye Specialistsmay use or disclose your health information for a law enforcement purpose to law enforcement officials, including when required by law to report certain injuries or pursuant to a court order, subpoena, or administrative request.
12. Decedents. Great Plains Eye Specialistsmay disclose your health information to a coroner, medical examiner, or funeral director for the purpose of identifying you, determining your cause of death, or other duties as authorized by law.
13. Organ Procurement. Great Plains Eye Specialistsmay use or disclose your health information for cadaveric organ, eye, or tissue donation purposes.
14. Research. Great Plains Eye Specialistsmay use or disclose your health information for research (regardless of the research funding source) so long as the research has been approved as required by law.
15. Serious Threat to Health / Safety. Great Plains Eye Specialistsmay use or disclose your health information,
consistent with applicable law and ethical conduct standards, if it in good faith believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat or is necessary to apprehend or identify an individual.
16. Specialized Government Functions. Great Plains Eye Specialistsmay use or disclose your health information for military and veterans activities, national security and intelligence activities, protective services, medical suitability determinations, correctional institutions and
other law enforcement custodial situations, and for government programs providing public benefits. Great Plains Eye Specialistsis also permitted to use or disclose your health information to a correctional institution or law enforcement official having lawful custody of you as an inmate if the disclosure is necessary to: (1) provide health care to you; (2) protect health and safety of you or other inmates; or (3) protect safety and security of the correctional institution.
17. Workers’ Compensation. Great Plains Eye Specialistsmay use or disclose health information as authorized and required by law to comply with workers’ compensation or other similar programs established by law that provide benefits for work-related injuries or illness without regard to fault.
B. Required Uses / Disclosures
Generally, Great Plains Eye Specialistsmust disclose your health information: (1) to you, when you request to copy or inspect it, or when you request an accounting of disclosures; and (2) to assist in an investigation regarding Great Plains Eye Specialists’s compliance with the law.
C. Written Authorization for Certain Uses / Disclosures
Certain uses and disclosures of your health information require written authorization from you. When Great Plains Eye Specialistsobtains a written authorization from you, the use and disclosure of your health information must be consistent with the terms of the authorization. For example, Great Plains Eye Specialistsmust obtain your written consent: (1) to use or disclose psychotherapy notes, unless otherwise permitted or required by law;
(2) to use or disclose your health information for marketing purposes, unless the marketing communication is made face-to-face between Great Plains Eye Specialistsand you, or you received a promotional gift of nominal value from Great Plains Eye Specialists; and (3) to sell your health information under certain circumstances, as Great Plains Eye Specialistsmay not receive remuneration (financial otherwise) for the sale of your health information unless you provided written authorization for this use.
D. Other Uses/Disclosures
Uses and disclosures not described under Section 1 of this Notice of Privacy Practices will be made only with your written authorization.
E. Revocation of Written Authorization
You may revoke a written authorization for Great Plains Eye Specialiststo use or disclose your health information at any time, so long as you provide a written revocation to Great Plains Eye Specialistsat the address provided under Section 5 of this Notice. However, there may be an exception to your right to revoke your authorization if prior to your revocation, Great Plains Eye Specialistsrelied upon your written authorization and already used or disclosed your health information pursuant to that authorization.
2. YOUR RIGHTS.
A. Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your health information. Great Plains Eye Specialistsis not required to agree to a requested restriction, with one exception. Great Plains Eye Specialistsmust agree to your request to restrict disclosure of your health information to a health insurance plan if: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (2) the health information pertains solely to a health care item or service for which you, or someone on your behalf (other than the health plan), has paid Great Plains Eye Specialistsin full. You may submit written requests for restrictions on the disclosure of your health information to the address provided under Section 5 of this Notice.
B. Receive Confidential Communications of Health Information
You have the right to request, and Great Plains Eye Specialistsmust accommodate your reasonable requests, to receive communications of your health information from Great Plains Eye Specialistsby alternative means or locations. For example, you may request that Great Plains Eye Specialistsonly contact you at work, or by mail. You must submit a request to the address provided in Section 5 of this Notice.
C. Inspect/Copy Health Information
You have the right of access to inspect and obtain a copy of your health information, for as long as the health information is maintained, except for: (1) psychotherapy notes; and (2) information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding. You may submit a request to inspect and copy your health information at the address provided under Section 5 of this Notice. Great Plains Eye Specialistswill respond to a written request no later than 30 days after receipt of the request, or notify you regarding a delay and request an extension of time to respond. Great Plains Eye Specialistsmay deny you access to health information under certain circumstances.
D. Amend Health Information
You have the right to amend your health information under certain circumstances, for so long as Great Plains Eye Specialistsmaintains the record you wish to amend. Great Plains Eye Specialistsmay deny your request for amendment, if: (1) Great Plains Eye Specialistsdid not create the record, unless the person or entity that made the record is no longer available to make the amendment; (2) the health information is not kept by or for Great Plains Eye Specialists; (3) the health information is not available for you to inspect or copy; or (4) the health information is accurate and complete.
E. Receive an Accounting of Disclosed Health Information
You have the right to receive an accounting of disclosures of your health information made by Great Plains Eye Specialistsin the six years prior to the requested accounting, subject to exceptions. You must submit a written request for an accounting to the address listed in Section 5 of this Notice, and Great Plains Eye Specialistswill respond to the written request no later than 60 days after receipt of the request, or notify you regarding a delay and request an extension of time to respond. Your first accounting within a 12-month period is free, but Great Plains Eye Specialistsmay charge for all additional accountings. Great Plains Eye Specialistswill notify you of the cost, so that you have an opportunity to withdraw or modify your request before charges are incurred.
F. Paper Copy of this Notice
You have the right to obtain a paper copy of this Notice, even if you previously agreed to receive the Notice electronically. Please submit a request for a paper copy from Great Plains Eye Specialistsin writing at the address provided under Section 5 of this Notice.
3. Great Plains Eye Specialists’S DUTIES.
Great Plains Eye Specialistsis required by law to maintain the privacy of your health information, to provide you with notice of its legal duties and privacy practices with respect to health information, and to notify affected individuals following a breach of unsecured health information. Great Plains Eye Specialistsis required to abide by the terms of the Notice of Privacy Practices currently in effect. Great Plains Eye Specialistsreserves the right to change the terms of this Notice and to make new notice provisions effective for all health information that it maintains. A copy of any revised Notice will be posted prominently in our facility.
4. COMPLAINTS.
You may complain to either Great Plains Eye Specialistsor to the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated. To file a complaint directly with Great Plains Eye Specialists, please use the contact information in Section 5 of this Notice. Great Plains Eye Specialistswill not retaliate against you for filing a complaint.
