Privacy Notice
PROVIDING TREATMENT:
Your health information will be used within my office to provide you with the best optometric care possible. This information may be used by my office staff to optimize scheduling for your particular health related issues. In addition, your information may be shared with physicians and other healthcare professionals providing treatment to you.
OBTAINING PAYMENT:
Your health information may be included with an invoice used to collect payment for optometric services or materials you received at our office. This information is often necessary for filing insurance claims that are sent through the mail or electronically. I will negotiate only with companies who are also HIPAA compliant.
HEALTH CARE OPERATIONS:
Your health information may be used and disclosed during healthcare operations, which may include the following: quality assessment and improvement activities, reviewing the competency or qualifications of healthcare professionals, evaluating provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities. I will not use your health information for marketing communications without your written authorization.
PATIENT REMINDERS:
I believe regular optometric care is essential to the preservation of healthy eyes and good vision. As a courtesy, you may receive a reminder with respect to a scheduled appointment or a suggested time for a subsequent examination (generally every two years). Additionally, you may be contacted as a follow-up to your specific eye care or to inform you or your family about treatment options or services that may be relevant. These communications are an important part of my partnership with you as a patient to ensure that you receive the best optometric care my office can provide. These communications may be in the form of postcards, letters, e-mails, or telephone reminders.
ABUSE, NEGLECT OR THE LAW:
To the extent necessary to avert a serious threat to you or other people's health or safety, your health information may be disclosed to appropriate authorities if I reasonably believe that you are a possible victim of abuse, neglect, domestic violence, or the victim of other crimes. Your health information may be used or disclosed if I am required to do so by State or Federal law.
FAMILY, FRIENDS, AND CAREGIVERS:
With your permission, your health information may be shared with those persons that you tell us are assisting you with your home care, treatment, medications, or payment. Utilizing my best professional judgment without your permission in the case of your incapacity or emergency situation, your health information may be disclosed to a family member or another person responsible for your care. Only health information that is directly relevant to those participating in your care will be disclosed.
NATIONAL SECURITY:
Health information of Armed Forces personnel to military authorities may be disclosed under certain circumstances. I may disclose health information to authorized federal officials required for lawful intelligence, counter-intelligence and other national security activities. Also, under certain circumstances, health information of inmates or patients may be disclosed to the appropriate authorities.
PATIENT RIGHTS:
You have the right to restrict the disclosure of your protected health information a written authorization (form available at our office), from you will be necessary before any protected information from our office will be released. You may also revoke that written authorization in writing at any time. The request for restriction may be denied if the information is required for treatment, payment, or specific health care operations stated earlier in this notice. You have the right to receive confidential communications regarding your protected health information and the right to inspect and have a copy of this information. I will be accommodating in updating and modifying your health information if you suspect that the records are incorrect or incomplete, although to standardize the procedure, I must have a written request from you describing your reason for the alteration of your records. You also have the right to receive an account of the disclosures of your protected health information and the right to have a copy of this notice.
LEGAL RAMIFICATIONS:
I am required by law to maintain the privacy of your protected health information and abide by the terms of this notice as it is currently stated. I do reserve the right to change the content of this notice, but the changes will not be affective until they are posted or available at my office located at:
4275 Capital Avenue SW Battle Creek, Michigan. My office phone number is (269) 979-1561 and my e-mail address is [email protected]. If you ever have any complaints regarding the way your protected health information was handled by me, please submit a complaint in writing to my office. You will not be retaliated against in any manner for a complaint.
ACKNOWLEDGMENT:
Thank you very much for taking the time to review how my office carefully uses your health information and if you have any questions about this notice, please contact me.
Dr. Craig A. Miller
April 14, 2003
Your health information will be used within my office to provide you with the best optometric care possible. This information may be used by my office staff to optimize scheduling for your particular health related issues. In addition, your information may be shared with physicians and other healthcare professionals providing treatment to you.
OBTAINING PAYMENT:
Your health information may be included with an invoice used to collect payment for optometric services or materials you received at our office. This information is often necessary for filing insurance claims that are sent through the mail or electronically. I will negotiate only with companies who are also HIPAA compliant.
HEALTH CARE OPERATIONS:
Your health information may be used and disclosed during healthcare operations, which may include the following: quality assessment and improvement activities, reviewing the competency or qualifications of healthcare professionals, evaluating provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities. I will not use your health information for marketing communications without your written authorization.
PATIENT REMINDERS:
I believe regular optometric care is essential to the preservation of healthy eyes and good vision. As a courtesy, you may receive a reminder with respect to a scheduled appointment or a suggested time for a subsequent examination (generally every two years). Additionally, you may be contacted as a follow-up to your specific eye care or to inform you or your family about treatment options or services that may be relevant. These communications are an important part of my partnership with you as a patient to ensure that you receive the best optometric care my office can provide. These communications may be in the form of postcards, letters, e-mails, or telephone reminders.
ABUSE, NEGLECT OR THE LAW:
To the extent necessary to avert a serious threat to you or other people's health or safety, your health information may be disclosed to appropriate authorities if I reasonably believe that you are a possible victim of abuse, neglect, domestic violence, or the victim of other crimes. Your health information may be used or disclosed if I am required to do so by State or Federal law.
FAMILY, FRIENDS, AND CAREGIVERS:
With your permission, your health information may be shared with those persons that you tell us are assisting you with your home care, treatment, medications, or payment. Utilizing my best professional judgment without your permission in the case of your incapacity or emergency situation, your health information may be disclosed to a family member or another person responsible for your care. Only health information that is directly relevant to those participating in your care will be disclosed.
NATIONAL SECURITY:
Health information of Armed Forces personnel to military authorities may be disclosed under certain circumstances. I may disclose health information to authorized federal officials required for lawful intelligence, counter-intelligence and other national security activities. Also, under certain circumstances, health information of inmates or patients may be disclosed to the appropriate authorities.
PATIENT RIGHTS:
You have the right to restrict the disclosure of your protected health information a written authorization (form available at our office), from you will be necessary before any protected information from our office will be released. You may also revoke that written authorization in writing at any time. The request for restriction may be denied if the information is required for treatment, payment, or specific health care operations stated earlier in this notice. You have the right to receive confidential communications regarding your protected health information and the right to inspect and have a copy of this information. I will be accommodating in updating and modifying your health information if you suspect that the records are incorrect or incomplete, although to standardize the procedure, I must have a written request from you describing your reason for the alteration of your records. You also have the right to receive an account of the disclosures of your protected health information and the right to have a copy of this notice.
LEGAL RAMIFICATIONS:
I am required by law to maintain the privacy of your protected health information and abide by the terms of this notice as it is currently stated. I do reserve the right to change the content of this notice, but the changes will not be affective until they are posted or available at my office located at:
4275 Capital Avenue SW Battle Creek, Michigan. My office phone number is (269) 979-1561 and my e-mail address is [email protected]. If you ever have any complaints regarding the way your protected health information was handled by me, please submit a complaint in writing to my office. You will not be retaliated against in any manner for a complaint.
ACKNOWLEDGMENT:
Thank you very much for taking the time to review how my office carefully uses your health information and if you have any questions about this notice, please contact me.
Dr. Craig A. Miller
April 14, 2003
