Notice of Privacy Practices
Dr. Henry A. Hull, Optometrist, Inc.
147 Fredericksburg Rd. New Braunfels, TX 78130
830-625-5716 henryhull.com
Barbara
Burwick, Privacy Official
We respect
our legal obligation to keep health information that might identify you private. We are obligated by law to provide you with notice
of our privacy practices. This notice
describes how we protect your health information and what rights you have regarding it.
Setting up or changing appointments
including leaving messages with those at your home or office who may answer the phone or
leaving messages on answering machines, voice mails or emails; prescribing glasses,
contact lenses, or medications as well as relaying this information to suppliers by phone,
fax or other electronic means including initial prescriptions and requests from suppliers
for refills; notifying you that your ophthalmic goods are ready, including leaving
messages with those at your home or office who may answer the phone, or leaving messages
on answering machines, voice mails or emails; referring you to another doctor for care not
provided by this office; obtaining copies of health information from doctors you have seen
before us; discussing your care with you directly or with family or friends you have
inferred or agreed may listen to information about your health; sending you postcards or
letters or leaving messages with those at your home who may answer the phone or on
answering machines, voice mails or emails reminding you it is time for continued care.
Examples of
how we might use or disclose health information for payment purposes might include:
Asking you about your vision or
medical insurance plans or other sources of payment; preparing and sending bills to your
insurance provider or to you; providing any information required by third party payors in
order to insure payment for services rendered to you; collecting unpaid balances either
ourselves or through a collection agency, attorney, or district attorney’s office.
Examples of
how we might use or disclose health information for business operations might include:
Financial or billing audits; internal
quality assurance programs; participation in managed care plans; defense of legal matters;
business planning; certain research functions; informing you of products or services
offered by our office; compliance with local, state, or federal government agencies
request for information; oversight activities such as licensing of our doctors; Medicare
or Medicaid audits.
When a state or federal law mandates
that certain health information be reported for a specific purpose
For public health reasons, such as
reporting of a contagious disease, investigations or surveillance, and notices to and from
the federal Food and Drug Administration regarding drugs or medical devices
Disclosures to government or law
authorities about victims of suspected abuse, neglect, domestic violence, or when someone
is or suspected to be a victim of a crime
Disclosures for judicial and administrative
proceedings, such as in response to subpoenas or orders of courts or administrative
hearings
Disclosures to a medical examiner to
identify a deceased person or determine cause of death or to funeral directors to aid in
burial
Disclosures to organizations that
handle organ or tissue donations
Uses or disclosures for health
related research
Uses or disclosures to prevent a
serious threat to health or safety of an individual or individuals
Uses or disclosures to aid military
purposes or lawful national intelligence activities
Disclosures of de-identified
information
Disclosures related to a workman’s
compensation claim
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 and disclosures
Disclosures to business associates
who perform health care operations for Dr. Henry A. Hull, Optometrist, Inc. and who commit
to respect the privacy of your information
Unless you object, disclosure of
relevant information to family members or friends who are helping you with your care or by
their allowed presence cause us to assume you approve their exposure to relevant
information about your health
USES OR DISCLOSURES TO PATIENT
REPRESENTATIVES
It is the
policy of Dr. Henry A. Hull, Optometrist, Inc. for our staff to take phone calls from
individuals on a patients behalf requesting information about making or changing an
appointment; the status of eyeglasses, contact lenses, or other optical goods ordered by
or for the patient. Dr. Henry A. Hull,
Optometrist, Inc. staff will also assist individuals on a patient’s behalf in the
delivery of eyeglasses, contact lenses, or other optical goods. During a telephone or in person contact, every
effort will be made to limit the encounter to only the specifics needed to complete the
transaction required. No information about
the patient’s vision or health status may be disclosed without proper patient
consent. Dr. Henry A. Hull, Optometrist, Inc.
staff and doctors will also infer that if you allow another person in an examination or
treatment room with you while testing is performed or discussions held about your vision
or health care that you consent to the presence of that individual.
OTHER USES AND DISCLOSURES
We will not
make any other uses or disclosures of your health information unless you sign a written Authorization for Release of Identifying Health
Information. The content of this
authorization is determined by federal law. The
request for signing an authorization may be initiated by Dr. Henry A. Hull, Optometrist,
Inc.or by you as the patient. We will comply
with your request if it is applicable to the federal policies regarding authorizations. If we ask you to sign an authorization, you may
decline to do so. If you do not sign the
authorization, we may not use or disclose the information we intended to use. If you do elect to sign the authorization, you may
revoke it at any time. Revocation requests
must be made in writing to the Privacy Officer named at the beginning of this Notice.
YOUR RIGHTS REGARDING YOUR HEALTH
INFORMATION
The law
gives you many rights regarding your personal health information.
You may ask
us to restrict our uses and disclosures for purposes of treatment (except in emergency
care), payment, or business operations. This
request must be made in writing to Privacy Officer named at the beginning of this Notice. We do not have to agree to your request, but if we
agree, must honor the restrictions you ask for.
You may ask
us to communicate with you in a confidential manner.
Examples might be only contacting you by telephone at your home or using
some special email address. We will
accommodate these requests if they are reasonable and if you agree to pay any additional
cost, if any, incurred in accommodating your request.
Requests for special communication requests must be made to the Privacy
Officer named at the beginning of this Notice.
You may ask
to review or get copies of your health information. There
are a very few limited situations in which we may refuse your access to your health
information. For the most part we are happy
to provide you with the opportunity to either review or obtain a copy of your medical
information. All requests for review or copy
of medical information must be made in writing to the Privacy Officer named at the
beginning of this Notice. While we usually respond to these requests in just a day or so,
by law we have fifteen (15) days to respond to your request. We may request an additional thirty (30) day
extension in certain situations.
You may ask
us to amend or change your health care information if you think it is incorrect or
incomplete. If we agree, we will make the
amendment to your medical record within thirty (30) days of your written request for
change sent to the Privacy Officer named at the beginning of this Notice. We will then send the corrected information to you
or any other individual you feel needs a copy of the corrected information. If we do not agree, you will be notified in
writing of our decision. You may then write a
statement of your position and we will include it in your medical record along with any
rebuttal statement we may wish to include.
You may
request a list of any non-routine disclosures of your health information that we might
have made within the past six (6) years (or a shorter period if you wish). Routine disclosures would include those used your
treatment, payment, and business operations of Dr. Henry A. Hull, Optometrist, Inc.. These routine disclosures will not be included in
your list of disclosures. You are entitled to
one such list per year without charge. If you
want more frequent lists, you must pay for them in advance at a fee of {$0.00} per list. We will usually respond to your written request
(made to the Privacy Officer named at the beginning of this Notice) within thirty (30)
days but we are allowed one thirty (30) day extension if we need the time to complete your
request.
You may
obtain additional copies of this Notice of Privacy Practices from our business office or
online at our website address shown at the beginning of this Notice.
CHANGING OUR NOTICE OF PRIVACY
PRACTICES
By law, we
must abide by the terms of this Notice of Privacy Practices until we choose to change the
Notice. We reserve the right to change this
Notice at any time. If we change this Notice,
the new privacy practices will apply to your existing health information as well as any
additional information generated in the future. If
we change this Notice, we will post a new Notice in our office and on our website.
COMPLAINTS
If you think
that anyone at Dr. Henry A. Hull, Optometrist, Inc. has not respected the privacy of your
health information, you are free to complain to the Privacy Officer named at the beginning
of this Notice. We are more than happy to try
to resolve any concern you may have in writing or by phone.
You may also file a complaint with the U.S. Department of Health and Human
Services, Office of Civil Rights. We will not
retaliate against you if you make such a complaint.