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.
This Notice describes our practices and those of:
Uses and Disclosures of Your Health Information
Treatment. Your health information may be used by our physicians and staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, your health information may be disclosed to a corrective lens provider to obtain appropriate corrective lenses for you.
Payment. Your health information may be used to seek payment from your health plan, other sources of coverage such as an automobile insurer, or credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Health Care Operations. Your health information may be used as necessary to support the day-to-day activities and management of Andersen Eye Associates, PLC. For example, information on the services you received may be used to support budgeting and financial reporting, activities to evaluate and promote quality and to insure that our practice is meeting various legal requirements.
Law Enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.
Public Health Reporting. Your health information may be disclosed to public health and government agencies as required by law. For example, our practice is required to report certain communicable diseases to the Michigan Department of Public Health.
Other Uses and Disclosures. Disclosures or uses of your health information for a purpose other than those listed above require your specific written authorization. Such uses and disclosures include, but are not limited to, uses and disclosures for marketing purposes or the sale of protected health information. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before we received the written revocation.
Your Rights Regarding Your Medical Information.
You have the following rights regarding your protected health information:
The right to receive confidential communications concerning your medical condition and treatment.
The right to inspect and copy your protected health information.
The right to request an amendment or submit corrections to your protected health information.
The right to receive an accounting of how and to whom your protected health information has been disclosed.
Requests to Inspect Protected Health Information. We require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records from the office manager or other designated office personnel. If you request a copy, we may charge a fee.
Andersen Eye Associates, PLC Duties
We are required by law to (1) maintain the privacy of your protected health information (2) provide you with this notice of our duties and privacy practices with respect to protected health information, and (3) notify you if you are affected by a breach of unsecured protected heath information. We are also required to abide by the privacy policies and practices that are outlined in this notice.
This Notice May be Amended At Any Time
We may change the terms of this Notice at any time. Any revised Notice will be effective for all health information that we maintain. The effective date of a revised Notice will be noted. A copy of the current Notice in effect will be posted. You may request a copy of the current Notice at any time.
Comments, Questions and Complaints
If you would like to submit a comment or complaint about our privacy practices, or obtain additional information about our privacy practices, you can do so by sending a letter outlining your concerns to the address listed below. You may also file a complaint with office staff if you believe your privacy rights have been violated. You will not be penalized or otherwise retaliated against for filing a complaint.
Andersen Eye Associates
5161 Cardinal Park Drive
P.O.. Box 5649
Saginaw, MI 48603
This notice is effective on or after September 20, 2013.