NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
K.C. Eye Specialists, M.D.’s, P.C. (Office) understands that your health information is personal to you, and we are committed to protecting the information about you. This Office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations.
Protected Health Information (PHI) is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services. Office may deny an individual’s request to inspect and copy PHI in certain circumstances.
YOUR HEALTH INFORMATION RIGHTS
The health record we maintain and billing records are the physical property of the Office. The information in it, however, belongs to you. You have a right to:
* Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our Office.
* Obtain a paper copy of this Notice of Privacy Practices (Notice) by making a request to our Office.
* Request that you be allowed to inspect and copy your health record and billing record. You may exercise this right by delivering the request in writing to our Office using the form we provide you upon request.
* Appeal a denial of access to your PHI except in certain circumstances.
* Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our Office using the form we provide to you upon request.
* File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your PHI.
* Obtain an accounting of disclosures of your PHI as required to be maintained by law by delivering a written request to our Office using the form we provide to you upon request. An accounting will not include internal uses of information for treatment, payment, office operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care.
* Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.
OUR RESPONSIBILITIES
The Office is required to:
* Maintain the privacy of your PHI as required by law.
* Provide you with a notice of our Office’s duties and privacy practices as to the information we collect and maintain about you.
* Abide by the terms of this Notice.
* Notify you if we cannot accommodate a requested restriction or request.
* Accommodate your reasonable requests regarding methods to communicate PHI with you.
OTHER DISCLOSURES AND USES
* Family Communication. We may disclose to a family member, other relative, close personal friend, or any other person you identify, your PHI relevant to that person’s involvement in your care.
* Business Associates. We have business associates with whom we may share your PHI in the course of doing everyday business. These business associates can be but are not limited to the following: Optical Vendors, Contact Lens Vendors, Accounting Firms, and Consultants.
* Court Proceeding. We may disclose your PHI in response to requests made during judicial and administrative proceedings, such as court orders or subpoenas.
* Workers’ Compensation. We may disclose you PHI when authorized and necessary to comply with laws relating to workers compensation or other similar programs.
* Other Uses. We may also use and disclose your PHI for the following purposes:
* To contact you to remind you of an appointment for treatment;
* To describe or recommend treatment alternatives to you;
* To furnish information about health-related benefits and services that may be of interest to you.
* Health Oversight. In order to oversee the health care system, government benefits programs, entities subject to governmental regulation and civil rights laws for which health information is necessary to determine compliance, we may disclose your health information for oversight activities authorized by law, such as audits and civil, administrative, or criminal investigations.
REQUEST INFORMATION TO FILE A COMPLAINT
* If you want to exercise any of the above rights, have any questions, would like additional information, or would like to report a problem regarding the handling of your PHI, please contact the office manager in person or in writing, during normal business hours. The office manager will provide you with assistance on the steps to take to exercise your rights. Please see contact information below.
* If you believe your privacy rights have been violated, you may file a written complaint at our Office by personally delivering it or mailing it to the contact information below. You may also file a complaint to the Secretary of Health and Human Services.
CONTACT INFORMATION
Letticia Perry, Office Manager, 9009 Roe Avenue, Prairie Village, KS 66207
Tel. (913) 385-9009, Fax (913) 385-3005
