NOTICE OF PRIVACY PRACTICES FOR
SHELLEY I. CUTLER, OD, FAAO
THIS
NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND
DISCLOSED
AND WHAT RIGHTS YOU HAVE
TREATMENT,
PAYMENT, AND HEALTH CARE OPERATIONS
By
law, we are allowed to use or disclose your protected health
information (PHI) without your
written consent for the purpose of treatment, payment or health care
operations. Examples include scheduling appointments;
examinations; prescribing corrective lenses, vision aids, or
medications and providing prescription information to suppliers;
referrals for other medical care; getting copies of past records;
acquiring guarantor/insurance information; processing bills or claims;
financial or billing audits; internal quality assurance; personnel
decisions; credentialing; legal defense; business planning and record
storage.
USES
AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In
some other limited situations, the law allows us to use or disclose
your PHI without your
permission. Examples include disclosures required by law, subpoenas or
court orders; reporting threats to health or safety; suspected abuse or
neglect; knowledge relating to a crime; public health oversight; organ
procurement; worker’s compensation disclosures; incidental disclosures;
de-identified information;
"limited
data sets" for research and disclosures to "business associates" who
are under contractual obligation to respect the privacy of your PHI. Any information that is
disclosed will be limited to the minimum information required and will
only be given to parties with the proper authorization to obtain this
information.
Unless
you object, we will also share relevant information about your care
with family or friends helping with your care.
APPOINTMENT
REMINDERS/ NOTIFICATIONS
We
may call, write or email you to notify you of routine examinations due,
appointment confirmation, order status or services available at our
office. Unless you tell us otherwise, we will mail you an
appointment reminder on a post card and/or call you at the number you
have given us. We may leave a message if you are not available.
OTHER
USES AND DISCLOSURES
We
will not make any other uses or disclosures of your PHI unless you sign a written
"authorization form" the content of which is determined by federal
law. The authorization may be revoked at any time by writing to
the contact given in the office.
YOUR
RIGHTS REGARDING YOUR HEALTH INFORMATION
All
requests must be made in writing and will be responded to within the
time allowed by law (usually 30 days).
- You
may ask us to restrict our uses and disclosures for purposes of
treatment (except emergency treatment), payment or health care
operations. We do not have to agree to this, but if we do, we
must honor the restrictions that you want.
- You
may ask us to communicate with you in a confidential way, such as using
a specific phone number or address. We will accommodate
reasonable requests. There may be a charge for any extra cost
involved with the request.
-
You
may ask to see or to get photocopies of your PHI. You may have to pay for
photocopies in advance. By law, there are a few limited
situations in which we can refuse to permit access or copying. If
we deny your request, we will send you a written explanation, and
instructions about how to get an impartial review of our denial if one
is legally available.
- You
may ask us to amend PHI that
you think is incorrect. If we do not agree, a statement of your
position and any rebuttal statement that we may write will be included
in your PHI and will be
included any time we disclose your PHI.
- You
may request a list of our disclosures of your PHI. By law, the list will not
include: disclosures for purposes of treatment, payment or health care
operations; disclosures with your authorization; incidental
disclosures; disclosures required by law; and some other limited
disclosures. You are entitled to one such list per year without
charge.
- You
can receive additional paper copies of this Notice of Privacy Practices
upon request.
OUR
NOTICE OF PRIVACY PRACTICES (NPP)
We
are obligated by law to protect the your PHI and to abide by the terms of
this NPP. We reserve the
right to change this notice at any time as allowed by law. Any
changes in our NPP will posted
in our office and on our website and will apply to any PHI that we already have as well any
that we may generate in the future.
COMPLAINTS
If
you think we have not properly respected the privacy of your PHI, you
may contact our office or the U.S. Dept. of Health and Human Services,
Office for Civil Rights to discuss your complaint without fear of
retaliation.
CONTACT INFORMATION:
For
more information about our privacy practices you may call, write or
visit our office at the address below. All requests concerning
your PHI must be made in
writing to:
Shelley
I. Cutler, OD, FAAO
PO
Box 181
Springhouse,
Pa 19477
Phone:
(215) 646-4459
Fax:
(215) 646-4459 (w/
notification)
Patient
care located in the office of:
David,
Koch, OD
858
Welsh Road
Maple
Glen, Pa 19002