WEST METRO OPHTHALMOLOGY NOTICE OF PRIVACY PRACTICES

During your treatment at West Metro Ophthalmology, doctors, technicians, and other caregivers will gather information about your medical history and your current health.   This notice will explain how such information may be used and shared with others.  It will also explain your privacy rights regarding this kind of information.

Your medical information will be used and disclosed for the following purposes:

Treatment:  We will use your information to provide, coordinate, and manage your care and treatment.  For example, a clinic physician may share your medical information with another physician for a consultation.

Payment:  We will use your information to receive payment for the services we provide.  For example, we will disclose information in order to submit bills and claims to insurance companies and /or Medicare or Medicaid.

Health Care Operations:  We will use your information for certain activities related to the functioning of our clinic.  For example, we may use or disclose information for quality assurance activities, legal services, underwriting, and other business management and administrative activities.

Appointment Reminders and Other Health Information:  We will use your medical information to remind you about future appointments by phone or by mail.  Your medical information may also be used to provide you with information about new or alternative treatments or other health care services. 

Our clinic may also use or disclose your health information for the following purposes:

To coordinate your care with people who help take care of you, or help you pay your medical bills, such as family members or close friends.  Our clinic will only disclose medical information that these people need to know.

To let family members or other responsible people know where you are and what your general medical condition is.

Our clinic may disclose relevant medical information to family members or other responsible people if we feel it is in your best interest to do so.  For example, we may provide limited medical information to allow a family member or friend to pick up a prescription, explain medications, or help with preoperative or postoperative instructions.

Under emergency conditions, or to government or other groups that assist in emergencies or disasters.

By law, our clinic may disclose or use your information without your consent in the following cases:  when required by law; for public health activities; relating to victims of abuse/neglect/domestic violence, if required/authorized by law and /or if you agree; for health oversight activities; for judicial and administrative proceedings to the extent permitted by law; for law enforcement purposes, as permitted or required by law; to coroners/medical examiners/funeral directors, as permitted by law; for organ donation purposes; for research purposes under certain circumstances; to avert a serious threat to health or safety; for certain specialized government functions, such as military discharge, and national security and intelligence; and for workers' compensation purposes.

Our clinic will not use or disclose your medical information in any other way unless you allow us to do so in writing.  If you do give us permission to use or disclose your medical information for another purpose, you have the right to change your mind and revoke the permission at any time.

Your Privacy Rights:

You have the right to authorize any use or disclosure of information that is not part of the process of your treatment, getting paid for those services, or in operating our clinic.  For example, you may request that our clinic not use your medical information in certain ways or for certain purposes.  You may also request that the clinic not provide your medical information to certain people.  However, our clinic has the right to refuse your request.  Our clinic may use or disclose your medical information in situations requiring emergency treatment (in which case we will ask the person(s) who receive the information not to further use or disclose the information).

You may request that the clinic provide you with your medical information in a confidential manner.  For example, you can request that we send your appointment reminders, bills, and other mailings to a different address, or that we notify you of this kind of information in another way, such as by a phone call.  You must make this request in writing.  We may also ask you to give us information on how you will pay your bills.

You may ask to see and copy your medical records, unless that information is protected by law.  You must make these requests in writing.  If your request to look at or copy your medical records is denied, you have the right to have the denial reviewed by a health care professional.  We will act upon your request within 30 days, and we may charge you a legally acceptable amount for copying costs.

You may ask us to change information in your medical records.  If your request is denied, you can write a statement of disagreement with the denial that we will keep with your medical information.

You may ask us to provide you with information about disclosures of your medical information.  You may request an accounting of disclosures made in the past 6 years, but this accounting will only cover disclosures made after April 14, 2003.

If you have received this notice of your medical information privacy rights electronically, you may ask us to provide you with a paper copy.

If you feel your medical information privacy rights have been violated, you may file a complaint with the Secretary of Health and Human Services, and/or with our clinic contact person listed below.  Filing a complaint will not affect the quality of the services you receive from our clinic and you will not be retaliated against for filing a complaint.

You can contact the designated privacy official at our clinic: Dorothy J. Alseth, Clinic Manager, at 763.546.8422

The effective date of this notice is April 14, 2003.  Our clinic reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information maintained by the clinic.  If the terms of this notice are changed, our clinic will provide individuals with a revised notice upon request and by posting the revised notice in designated locations at our clinic and Website.