Notice of Privacy Practices
Dr. Den=
nis E.
Cowley, P.C.
Ph. (574) 946-3944
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOU= T YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.<= span style=3D'mso-spacerun:yes'> PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices describes how =
we
may use and disclose your protected health information to carry out treatm=
ent,
payment or health care operations and for other purposes that are permitte=
d or
required by law. It also describes your rights to access and control your
protected health information. “Protected health information” is
information about you, including demographic information, that may identif=
y you
and that relates to your past, present or future physical or mental health=
or
condition and related health care services.
1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
We use and disclose your protected health informat= ion for treatment, payment, and healthcare operations. For example:
Trea=
tment: We will use and disc=
lose
your protected health information to provide, coordinate, or manage your h=
ealth
care and any related services. This includes the coordination or managemen=
t of
your health care with a third party.
For example, we use your health information when our technician or
doctor tests your eyes, when the doctor prescribes glasses or contact lens=
es,
when we provide a prescription for medication to a pharmacist, and when we
notify you that your glasses are ready to be dispensed. Your protected health information=
may
also be provided to a doctor to whom you have been referred to ensure that=
the
doctor has the necessary information to diagnose or treat you.
Paym=
ent: Your protected health
information will be used, as needed, to obtain payment for your health care
services. For example, we use your health information when our staff asks =
you
about health or vision care plans that you may belong to, or about other
sources of payment for our services, and when we prepare bills to send to =
you
or your vision care plan.
Heal=
thcare
Operations: We may use or disclose, as needed, your protected health informat=
ion
for administrative and managerial functions that we have to do in order to=
run
our office. These activities include, but are not limited to, financial and
billing audits, internal quality assurance, personnel decisions, and
participation in managed care plans.
We may also call you by name in the waiting room when your doctor is
ready to see you. Unless you object, we may use or disclose your protected
health information, as necessary, to provide you with appointment or recall
reminders (such as voicemail messages, postcards, or letter).
Your
Authorization: In addition to our use of your health information for treatment,
payment, or healthcare operations, you may give us written authorization t=
o use
your health information or to disclose it to anyone for any purpose. If you give us this authorization=
, you
may revoke it in writing at anytime.
Your revocation will not affect any use or disclosure permitted by =
your
authorization while it was in effect.
To Y=
our
Family and Friends: We must disclose yo=
ur
health information to you, as described in the Patient Rights section of t=
his
Notice. We may disclose your=
health
information to a family member, friend, or other person to the extent nece=
ssary
to help with your healthcare or with payment for your healthcare, but only=
with
your approval.
Other Uses and Disclo=
sures: We may use or disclose your prote=
cted
health information in the following situations without your authorization.
These situations include: as Required By Law, Public Health issues as requ=
ired
by law, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and
Drug Administration requirements, Legal Proceedings, Law Enforcement, Coro=
ners,
Funeral Directors, and Organ Donation, Research, Criminal Activity, Milita=
ry
Activity and National Security, Workers’ Compensation, Inmates, Requ=
ired
Uses and Disclosures.
You =
have
the right to inspect and copy your protected health information. Except for a few limited
situations in which we can legally refuse to permit access or copying, you=
may
review or copy your health information within 30 days of your written requ=
est. You may have to pay for photocopi=
es in
advance.
You have the right to
request a restriction of your protected health information.=
This means you may a=
sk us
in writing not to use or disclose any part of your protected health inform=
ation
for the purposes of treatment, payment or healthcare operations. You may a=
lso
request that any part of your protected health information not be disclose=
d to
family members or friends who may be involved in your care or for notifica=
tion
purposes as described in this Notice of Privacy Practices. Your written re=
quest
must state the specific restriction requested and to whom you want the
restriction to apply. Your d=
octor
is not required to agree to a restriction that you may request. If your do=
ctor
believes it is in your best interest to permit use and disclosure of your
protected health information, your protected health information will not be
restricted. You then have the right to use another Healthcare Professional=
.
You =
have
the right to request to receive confidential communications from us by alt=
ernative
means or at an alternative location. =
We will
accommodate these written requests if they are reasonable, and if you pay =
us
for any extra cost.
You =
may
have the right to have your doctor amend your protected health information=
. If we deny your writ=
ten
request for amendment, you have the right to file a statement of disagreem=
ent
with us and we may prepare a rebuttal to your statement and will provide y=
ou
with a copy of any such rebuttal.
You =
have
the right to receive an accounting of certain disclosures we have made, if=
any,
of your protected health information. &=
nbsp;
You have a right to receive a list of instances in which we disclos=
ed
your health information for purposes other than treatment, payments, healt=
hcare
operations and certain other activities, for the last 6 years (or a shorter
period if you want), but not before April 14, 2003. If you request this accounting mo=
re than
once in a 12-month period, we may charge you a reasonable, cost-based fee =
for responding
to these additional requests.
We reserve the right to change the terms of this
notice and will inform you by mail of any changes. You then have the right to object=
or
withdraw as provided in this notice.
3. QUESTIONS AND COMPLAINTS
If
you want more information about our privacy practices or have
questions or concerns, please contact us.=
If you are concerned that we may have violated your privacy rights,=
or
you disagree with a decision we made regarding your privacy rights, you may
submit a written complaint to our office or to the U.S. Department of Health and
Human Services. We support y=
our
right to the privacy of your health information. We will not retaliate against you=
for
filing a complaint.
This notice was published and becomes effective
on/or before April 14, 2003. We are required by law to maintain the privacy =
of,
and provide individuals with, this notice of our legal duties and privacy
practices with respect to protected health information.