NOTICE OF PRIVACY PRACTICES
This notice describes how health/medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Our Obligations
Oakland Ophthalmic Surgery, P.C. is required by law to protect the privacy of its health information, and to advise you of your legal rights as to how we maintain any and all records pertaining to the care and services you receive at Oakland Ophthalmic Surgery. You have a right to receive adequate notice of all uses and disclosures by the practice.
This notice is applicable to all of the records of your medical care generated by Oakland Ophthalmic Surgery, P.C., whether made by office personnel, or your personal physician at the practice. Your personal physician may have different policies or notices regarding the doctor’s use and disclosure of your medical information which have been created in the doctor’s office.
If you have any further questions about any section of this notice or if you want to receive additional information about the health privacy procedures at Oakland Ophthalmic Surgery, P.C., please contact:
Office Manager
Telephone No. 248-644-8060
Effective date of this notice: April 14, 2003
Who is subject to this Notice:
This notice describes our practices and the required privacy procedures of the following entities.
- Any health care professional with authorization to enter information into your chart or medical records.
- All employees and staff at Oakland Ophthalmic Surgery, P.C.
What we are obligated by law to do:
Follow the conditions set forth in the privacy notice currently in effect.
- Advise you of our notice of privacy practices and legal obligations with respect to your medical information at your request.
- Maintain all health information concerning your care according to the privacy requirements of the law.
How we may use or disclose your private health information:
We are describing the following categories that pertain to how we may use and disclose any medical information about you.
1. Treatment
We may use health information which concerns you to provide either medical treatment or services. We may disclose information about you to treating doctors, nurses, lab technicians who are providing treatment to you. Oakland Ophthalmic Surgery, P.C. may have to coordinate medical information about you with hospitals, laboratories, x-ray clinics, pharmacies, etc. We may also find it necessary in order to provide optimum medical care to disclose medical information about you to individuals outside our practice, such as your family members, trusted friends, clergy, or others that we may be in contact with to assist us in providing services as a part of your care and treatment.
2. Payment
We may use and disclose health information about you in order for our practice to bill for the treatment and care you receive. In order to collect fees for our services and treatment, it may be necessary to bill either you, an insurance company or a third party. For example, we may find it necessary to disclose information concerning your health care to your health plan insurer about medical treatment which you received at our office in order to obtain payment for these services. Or, we may need to disclose private medical information to your health plan which your doctor may recommend, such as cataract surgery, laser treatment, which can be scheduled in advance, in order to obtain the necessary prior approval for coverage from the insurer.
3. Health Care Operations
We may use and disclose health information pertaining to your care and treatment at our practice in order to implement our health care operations in the most productive manner. We may determine that it is necessary to utilize medical information from your records to review our staff polices concerning treatment.
4. Appointment Reminders
We may use and disclose health information in order to contact you by telephone or mail in order to confirm an appointment for treatment or to let you know you missed an appointment.
5. Treatment Alternatives
We may use and disclose health information in order to advise you of available treatment alternatives.
6. Health-related Benefits and Services
We may use and disclose health information to inform you of other health-related benefits and services that may be of interest to you.
7. Research
We may disclose your health information to researchers who are conducting research which has been approved by an Institutional Review Board. If it is necessary for the researcher to have access to your name, address or other pertinent information, we will request your specific permission.
8. Health Oversight Activities
We may disclose health information to health agencies for activities related to audits, investigations, inspections and licensure proceedings. This is required in order for the government to monitor the health care system, government programs and compliance with civil rights statutes.
9. Required by Law
We will disclose health information concerning your health information when we are required to do so by federal, state or local law.
10. Judicial and Administrative Matters
If you become involved in any judicial dispute or administrative proceeding, we may disclose health information about you when necessary to respond to a court or administrative order.
11. Workers Compensation
We may disclose health information about you in order to comply with workers compensation laws.
12. National Security/Military Issues
We may disclose health information about you to authorized federal officials for military/national security authorities.
Your Health Information Rights:
You have the right to request restrictions on certain uses and disclosures of your health information. Oakland Ophthalmic Surgery, P.C. is not required to agree to a requested restriction that you have requested.
1. Right to Request and Receive Confidential Communications
You have the right to request that we communicate with you about health information through reasonable alternative means or at a certain location. For example, you may request that we only contact you at work or by mail. In order to request this information, you must submit your request in writing to the following:
Oakland Ophthalmic Surgery, P.C.
Attention: Office Manager
800 S. Adams, Ste. 201
Birmingham, MI 48009
We will not inquire as to the reason for request. We will attempt to make all reasonable accommodations.
2. Accounting of Disclosures
You have the right to request an accounting of certain disclosures of your health information. To receive the list of accounting of disclosures, you must submit your request in writing to the following:
Oakland Ophthalmic Surgery, P.C.
Attention: Office Manager
800 S. Adams, Ste. 201
Birmingham, MI 48009
Your request must indicate a time period that may not be lengthier than six (6) years and may not include dates prior to April 13, 2003. The first list which you request within a 12-month period will be sent to you at no cost. We may charge a reasonable, cost-based fee for each subsequent request with the 12 month period provided that we inform you in advance of the fee.
You have a right to obtain an accounting of disclosures of your health information except as to those disclosures relating to treatment, payment, health care operations, information provided by you and certain government functions as indicated in the section entitled in our obligations of this Notice of Privacy Practices.
3. Right to Inspect and Copy
You have the right to inspect and copy your health information that may be used to make decisions about your care. This will apply to medical and billing records.
To inspect and copy medical information which may be used to make decisions about you, you must submit your request in writing to the following:
Oakland Ophthalmic Surgery, P.C.
Attention: Office Manager
800 S. Adams, Ste. 201
Birmingham, MI 48009
We assess a fee of $25.00 for the cost of copying, mailing.
4. Right to Amend
You have the right to request your health information be amended if you believe the information is inaccurate or incomplete. You must provide a reason which supports your request. Oakland Ophthalmic Surgery, P.C. is not required to make the requested changes, but must provide you with a timely, written denial and indicate on what basis you may complain to Oakland Ophthalmic Surgery about your disagreement with the denial.
You must provide a reason which supports your request. We may deny your request if we determine that is not part of your health records; is not information which you would be permitted to copy or inspect; or is accurate and complete.
You must submit your request in writing to the aforementioned address.
5. Right to Request Restrictions
You have the right to request (in writing) restrictions on certain uses and disclosures of your health information with regard to treatment, payment or health care operations. Oakland Ophthalmic Surgery, P.C. is not required to agree to the requested restriction. If we do agree, we will abide by your request unless the information is required to provide you with emergency treatment.
6. Right to Obtain a Paper Copy of this Notice
You have the right to receive a paper copy of this notice upon request and at any time. You must submit your request in writing to the aforementioned address.
7. Changes to this Notice of Privacy Practices
Oakland Ophthalmic Surgery, P.C. reserves the right to change the terms of its notice and to make the new notice provisions effective for all health information we already maintain on file about you or as to any information we may receive in the future.
8. Posting the Notice
We will post a copy of the current notice in our offices. Further, you will be notified when you register that a new notice is in effect.
9. Complaints
You have the right to complain to Oakland Ophthalmic Surgery, P.C. if you believe that your privacy rights have not been honored. To file a complaint with our office, you must contact the following:
Office Manager
Oakland Ophthalmic Surgery, P.C.
800 S. Adams, Suite 201
Birmingham, MI 48009
