Privacy Policy

NOTICE OF PRIVACY PRACTICES 6-15-2015

Dotson Eyecare

2211 S.E. 29th Street 

Topeka, KS     66605

(785) 266-3240

Contact Person: Dr. Kyle Dotson

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Your “health information” or “protected health information”, for purposes of this Notice, is generally any information that identifies you and is created, received, maintained, or transmitted by us in the course of providing health care items or services to you.

We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), and other applicable laws to maintain the privacy of your health information, to provide individuals with this Notice of our legal duties and privacy practices with respect to such information, and to abide by the terms of the current version of this Notice.  We are also required by law to notify affected individuals following a breach of their unsecured health information.

USES AND DISCLOSURES OF HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION:

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

Examples of how we use or disclose health information for treatment purposes are: 

Setting up or changing appointments or reminding you of an upcoming appointment, including leaving messages with those at your home or office who may answer the phone or leaving messages on answering machines, voice mails, texts or emails, or sending you postcards or letters; calling your name out and/or discussing the reason for your visit, in a reception room environment; testing or examining your eyes; prescribing glasses, contact lenses, or medications, and delivering such prescriptions to laboratories or pharmacies to be filled by phone, fax or other electronic means including initial prescriptions and requests from suppliers for refills; notifying you that your ophthalmic goods are ready, or of any problems or changes regarding your order for ophthalmic goods, including leaving messages with those at your home or office who may answer the phone, or leaving messages on answering machines, voice mails, texts or emails, or sending you postcards or letters; showing you low vision aids; referring you to another doctor or clinic; or getting copies of your health information from, or giving copies of your health information to, another health care professional that you have seen before us or after us.  This includes a professional with whom you have made an appointment, but have not yet seen.  

Examples of how we use or disclose your health information for payment purposes are: asking you about your health or vision care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney).  However, if your bill has been paid in full, for the services you received in our office, and you want to restrict the information that we give your health care plan about you, we will do so as required by HIPAA.  If you want to limit the information that we give your health care plan, we expect you to notify us in writing in advance, and once your bill has been paid, we will honor that request.

The term “health care operations” means those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; reporting of information pertinent to a personal injury claim to our insurer, participation in managed care plans; defense of legal matters; business planning; and storage of our records.  

We routinely use your health information inside or outside of our office for these purposes without any special permission.  

The law allows you to request restrictions on the health information we may use and disclose for treatment, payment, and health care operations.  However, we are not required to agree to these requests, unless the request is to restrict disclosure to your health care plan, as described above.  Such requests must be in writing, to Dr. Dotson, at the above address.

USES AND DISCLOSURES FOR OTHER REASONS WITHOUT YOUR AUTHORIZATION

In addition to this, the law allows or requires us to use or disclose your health information without your authorization in some other situations. Not all of these situations will apply to us; some may never come up at our office at all. Such uses of disclosures are:

  • when a state or federal law mandates that certain health information be reported for a specific purpose; 
  • for public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices;
  • disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
  • uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by insurance companies or Medicare; or for investigation of possible violations of health care laws;
  • disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of court or administrative agencies;
  • disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;
  • disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
  • uses or disclosures for health related research if approved by an authorized institutional review board or a privacy board;
  • uses and disclosures to prevent a serious threat to health or safety;
  • uses or disclosures for specialized government functions, such as for the protection of the president or high ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service;
  • disclosures of de-identified health information;
  • disclosures relating to worker’s compensation programs;
  • disclosures of a “limited data set” for research, public health, or health care operations;
  • incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
  • disclosures to business associates and their subcontractors who perform health care operations for us and who commit in writing to protect the privacy and security of your health information as required by HIPAA.

Unless you object in advance, disclosures to family and friends who are helping with your eye care are allowed by law:

  • Unless you object in advance, we will share relevant protected health information about your eyes, health care, and/or account with your family or other people who are helping you with your eye care or who are helping with payment for your eye care.  Such disclosures could occur in person or over the phone.  
  • In addition to your family or other people who are helping you with your eye care or who are helping with payment for your eye care, we will also share such information with people who have your stated or implied consent to listen to information about your eyes, health care, and/or account.  Implied consent occurs in our office when you allow another person to be present within earshot of you in the examination room, treatment room, dispensary, or any other area within the office while testing is performed or while discussions are held about your eyes, health care, and/or your account, and you raise no objections at the time of the discussion. 
  • We will allow your family members or other people who are helping with your eye care or payment for your care to pick up prescriptions, eyeglasses, contact lenses, or other materials on your behalf.  
  • We will send a thank-you letter to the person who recommended that you come to our office for your eye care.  
  • Upon your death, we may disclose to your family members or other persons who were involved in your eye care or payment for that care, health information relevant to their involvement in your care. 
  • If you want to specify that such disclosures or dispensing of materials to family or other persons who are helping with your eye care or who are helping with payment for your eye care should not be allowed, we expect you to notify us in writing in advance.    If you are unable, for example for health reasons, to object to a disclosure, we will disclose your relevant protected health information to the people noted above based upon our professional judgment of whether the disclosure would be in your best interest.  

NOTIFICATIONS

Unless you object, we may notify you of treatments, services, or products available at our office that might help you, or notify you of issues that apply to other aspects of your health care, or notify you of charges and payments on your account. For example, we may remind you of scheduled appointments, or notify you that it is time to make an appointment, or that there is a new type of contact lens that might benefit you, or that your glasses or contact lenses are ready to be dispensed to you, or that payment on your account is overdue.  We may contact you via a letter or postcard and/or by leaving messages with those at your home or office who may answer the phone and/or by leaving messages on answering machines, voice mails, texts or emails, including by leaving messages on your cell phone message recorder.  These messages that we leave may include protected health information.  For example, we may  send you a postcard with a reminder that it is time for your eye examination, which includes the date of your most recent eye exam in our office.  If you want to specify that communications containing your protected health information should not be transmitted to you in any of these ways, we expect you to notify us in writing in advance. 

NOTIFICATION OF YOUR RIGHTS REGARDING HEALTH INFORMATION TECHNOLOGY

Dotson Eyecare participates in electronic health information technology or HIT. This technology allows a provider or a health plan to make a single request through a health information organization or HIO to obtain electronic records for a specific patient from other HIT participants for purposes of treatment, payment, or health care operations. HIOs are required to use appropriate safeguards to prevent unauthorized uses and disclosures. 

You have two options with respect to HIT. First, you may permit authorized individuals to access your electronic health information through an HIO. If you choose this option, you do not have to do anything. Second, you may restrict access to http://www.KanHIT.org by completing and mailing a form.  You cannot restrict access to certain information only; your choice is to permit or restrict access to all of your information through an HIO (except as required by law).  If you have questions regarding HIT or HIOs, please visit http://www.KanHIT.org for additional information.  

USES AND DISCLOSURES OF HEALTH INFORMATION THAT REQUIRE YOUR WRITTEN AUTHORIZATION  

We will not make any other uses or disclosures of your health information that are not specified in this document without your written authorization.  We will not disclose your protected health information to others for marketing purposes without your written authorization, or sell it without your permission.  

If we initiate the process and ask you to sign an authorization form, you do not have to sign it.  If you do sign one, you may revoke it at any time.  A revocation must be in writing.  Send it to Dr. Dotson at our office address.  We are unable to retract any disclosures that we have already made with your authorization prior to the date that we received your written request revoking that authorization.

YOUR ADDITIONAL RIGHTS REGARDING YOUR HEALTH INFORMATION

The law gives you many rights regarding your health information. You can:

  • Receive confidential communications of health information about you in a specific manner.   You must make such requests in writing to Dr. Dotson at our office address.  However, we reserve the right to determine if we will be able to continue your treatment under such restrictions.  We may charge you for reasonable costs related to accommodating such requests, and will advise you of these costs at the time of your request.
  • Inspect or obtain copies of your health information.  You must make such requests in writing to our address.  If you request a copy of your heath information, we may charge you a fee for the cost of copying and/or mailing that information.  In certain circumstances we may deny your request to inspect or copy your health information, subject to applicable law; we will inform you of any denial in writing.
  • Obtain an electronic copy of your electronically stored health information. You must make such requests in writing to our address. We will make every effort to provide access to your health information in the form or format you request if it is readily producible. If the health information is not readily producible in the form or format you request, your record will be provided in either our standard electronic format or, if you do not want this form or format, a readable hard copy form. We reserve the right to determine the media (such as a CD, USB drive, etc.) that will be used to provide an electronic copy of your health information. If you request an electronic copy of your health information, we may charge you for reasonable costs related to preparing and/or transmitting that information. We will advise you of these costs at the time of your request. In certain circumstances we may deny your request for an electronic copy your health information, subject to applicable law; we will inform you of any denial in writing.
  • Ask us to amend your health information.  If you believe that the health information we have about you is incorrect or incomplete, you may ask us to amend the information.  To request an amendment, you must write to Dr. Dotson at our office address.  You must give us a reason to support your request.  We may deny your request to amend your health information if it is not in writing or does not provide a reason for your request.  We may also deny your request if the health information:

Was not created by us, Is not part of the health information kept by us, Is not part of the information you would be permitted to inspect or copy, or Is accurate and complete.  We will inform you of any denial in writing. If we deny your request for an amendment, you have the right to file a statement of disagreement with us; we may prepare a rebuttal to your statement and will provide you with a copy of any rebuttal.

  • Receive an accounting of disclosures which were given by our office.  Not all health information is subject to this request.  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; disclosures to family and friends who were helping with your eye care, and some other limited disclosures.  Your request must state a time period for the information you would like to receive, no longer than 6 years prior to the date of your request.  Your request must state how you would like to receive the report (paper or electronically).  Send the written request to Dr. Dotson at our office address.
  • Designate another party to receive your health information.  If your request for access of your health information directs us to transmit a copy of the health information directly to another person, the request must be made by you in writing to our address and must clearly identify the designated recipient and where to send the copy of the health information.

 CHANGES, COMPLAINTS

We have the right to change our privacy practices and to apply the revised practices to all health information about you that we already have.  Any revision to our privacy practices will be described in a revised Notice that will be posted prominently in our office.  Copies of this Notice are also available upon request at our reception area.  If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Dept. of Health and Human Services, Office for Civil Rights or the Kansas Attorney General’s Office.  We will not retaliate against you if you make a complaint.  To complain to us, send a written complaint to Dr. Dotson at our address.  If you prefer, you can discuss your concerns in person or by telephone, with Dr. Dotson.  To complain to the U.S. Dept. of Health and Human Services, Office of Civil Rights, please go to http://www.hhs.gov/ocr/privacy/hipaa/complaint.  

FOR MORE INFORMATION

If you want more information about our privacy practices, contact Dr. Dotson at our office address, shown at the beginning of this Notice.