Dr. William B. Hutcheson & Associates

Effective Date: October 1, 2002 

NOTICE OF PRIVACY PRACTICES 

GENERAL RULE 
We respect our legal obligation to keep health information that identifies you private. We cannot disclose your health information outside of our office without your written permission. Sometimes the written permission will be called a consent form, and sometimes it will be called an authorization form.  The type of permission form will depend upon the kinds of uses or disclosures that are involved.  In some limited situations, the law allows or requires us to disclose your health information without either a written consent or authorization. 

USES OR DISCLOSURES WITH CONSENT 
We will ask you to sign a consent form allowing us to use and disclose your health information for purposes of treatment, payment, and health care operations of this office.  We are allowed to refuse to treat you if you do not sign the consent form. 

We use information for treatment purposes, when, for example, we set up an appointment for you, when our technician or doctor tests your eyes, when the doctor prescribes glasses or contact lenses, when the doctor prescribes medication and when our staff helps you select and order glasses or contact lenses. We may disclose your health information outside of our office for treatment purposes if, for example, we refer you to another doctor or clinic for eye care or low vision aids or services, if we send a prescription for glasses or contacts to another to be filled, when we provide a prescription for medication to a pharmacist, or when we phone to let you know that your glasses or contact lenses are ready to be picked up. 

We use your health information for payment purposes when, for example, our staff asks you about health or vision care plans that you may belong to, when we prepare bills to send to you or your health or vision care plan, when we process payment by credit card, and when we attempt to collect unpaid amounts due.  We may disclose your health information outside of our office for payment purposes when, for example, bills or claims for payment are mailed, faxed, or sent by computer to you or your health or vision plan, or when we occasionally have to ask a collection agency or attorney to help us with unpaid amounts due. 

We use and disclose your health information for health care operations in a number of ways. Office operations refers to those administrative and managerial functions that are necessary in order to run our office.  We may use or disclose your health information, for example, for financial or billing audits, for internal quality assurance, for personnel decisions, to enable our doctors to participate in managed care plans, for the defense of legal matters, to develop business plans, and for outside storage of our records. 

USES AND DISCLOSURES WITHOUT CONSENT OR AUTHORIZATION 
In some limited situations, the law allows or requires us to use or disclose your health information without your permission.  Not all of these situations will apply to us; some may never come up at our office at all.  Such uses or disclosures are: 
· for public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the 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 Medicare or Medicaid; 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 courts 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; 
· 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 relating to worker’s compensation programs; 
· disclosures to business associates who perform health care operations for us and who agree to keep your health information private. 
· when a state or federal law mandates that certain health information be reported for a specific purpose. 

APPOINTMENT REMINDERS 
We may call to remind you of scheduled appointments.  We may also call to notify you of other treatments or services available at our office that might help you. 

OTHER DISCLOSURES 
We will not make any other uses or disclosures of your health information unless you sign a written authorization form.  You do not have to sign such a form.  If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. 

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION 
The law gives you many rights regarding your health information.  To make any of the following requests, please do so by writing to our office at the address, fax or E mail address listed at the beginning of this document.  You may: 

· ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations.  We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. 
· ask us to communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing health information to a different address, or by using E mail to your personal E Mail address.  We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. 
· ask to review or get photocopies of your health information. 
· ask us to amend your health information if you think that it is incorrect or incomplete. 
· get additional paper copies of this Notice of Privacy Practices upon request, no matter whether you got one electronically or in paper form already. 

OUR NOTICE OF PRIVACY PRACTICES 
We reserve the right to change this notice at any time in compliance with and as allowed by law.  If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future.  If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site. 

COMPLAINTS 
If you think that we have not properly respected the privacy of your health information, you are entitled to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. If you wish to make a complaint with our office, send a written complaint to the address, fax or E mail shown at the beginning of this Notice.  If you prefer, you can discuss your complaint in person or by phone. 
 
FOR MORE INFORMATION 
If you want more information about our privacy practices, visit or call our office at the address or phone number shown at the beginning of this Notice. 

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