Insight-Eyecare

Dr. Jeanne F. Klopfenstein

"See the difference."

Notice of privacy practices

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.

 

We respect our legal obligation to keep health information that identifies you

private. We are obligated by law to give you notice of our privacy practices. This

Notice describes how we protect your health information and what rights you have

regarding it.

TREATMENT, PAYMENT, AND

HEALTH CARE OPERATIONS

The most common reason why we use or disclose your health information is for

treatment, payment or health care operations. Examples of how we use or disclose

information for treatment purposes are: setting up an appointment for you; testing or

examining your eyes; prescribing glasses, contact lenses, or eye medications and faxing

them to be filled; showing you low vision aids; referring you to another doctor or clinic

for eye care or low vision aids or services; or getting copies of your health information

from another professional that you may have seen before us. 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). "Health care operations" mean 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; participation in managed care

plans; defense of legal matters; business planning; notification of appointments through

the use of recall postcards or voice mail; notification by postcard of referral credit

through "Share the Care" program; and outside storage of our records.

 

We routinely use your health information inside our office for these purposes

without any special permission. If we need to disclose your health information outside

of our office for these reasons, we ask you for special written permission.

Jeanne F. Klopfenstein, O.D., F.A.A.O.

3246 Kimball Avenue

Office: 785-776-2255

Fax: 785-776-2266

Email: drk@insightseyecare.kscoxmail.com

 

 

OTHER USES AND DISCLOSURES

We will not make any other uses or disclosures of your health information unless

you sign a written "authorization form." The content of an "authorization form" is

determined by federal law. Sometimes, we may initiate the authorization process if the

use or disclosure is our idea. Sometimes, you may initiate the process if it's your idea

for us to send your information to someone else. Typically, in this situation you will

give us a properly completed authorization form, or you can use one of ours.

 

If we initiate the process and ask you to sign an authorization form, you do not have

to sign it. If you do not sign the authorization, we cannot make the use or disclosure.

If you do sign one, you may revoke it at any time unless we have already acted in

reliance upon it. Revocations must be in writing. Send them to the office contact

person named at the beginning of this Notice.

OUR NOTICE OF PRIVACY PRACTICES

By law, we must abide by the terms of this Notice of Privacy Practices until we

choose to change it. We reserve the right to change this notice at any time 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.

If you think that we have not properly respected the privacy of your health

information, you are free to complain to us or the U.S. Department of Health and

Human Services, Office for Civil Rights. We will not retaliate against you if you make

a complaint. If you want to complain to us, send a written complaint to the office

contact person at the address, fax, or email shown at the beginning of this Notice. If

you prefer, you can discuss your complaint in person or by phone.

COMPLAINTS

If you want more information about our privacy practices, call or visit the office contact

person at the address or phone number shown at the beginning of this Notice.

FOR MORE INFORMATION

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