NOTICE OF PRIVACY PRACTICES
Minnesota Eye Associates
Effective Date: 01/01/2023
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
We understand the importance of privacy and are committed to maintaining the confidentiality
of your health information. We make a record of the optometry care that we provide and may
receive such records from others. We use these records to provide or enable other health care
providers to provide quality optometry care, to obtain payment for services provided to you as
allowed by your health plan and to enable us to meet our professional and legal obligations to
operate this optometry practice properly. We are required by law to maintain the privacy of
protected health information, to provide individuals with notice of our legal duties and privacy
practices with respect to protected health information, and to notify affected individuals following
a breach of unsecured protected health information. This notice describes how we may use and
disclose your health information. It also describes your rights and our legal obligations with
respect to your health information. If you have any questions about this Notice, please contact
Matheus Ozbek OD via email at info@minnesotaeyeassociates.com.
TABLE OF CONTENTS
A. How This Optometry Practice May Use or Disclose Your Health Information.
B. When This Optometry Practice May Not Use or Disclose Your Health Information
C. Your Health Information Rights
Right to Request Special Privacy Protections
Right to Request Confidential Communications
Right to Inspect and Copy
Right to Amend or Supplement
Right to an Accounting of Disclosures
Right to a Paper or Electronic Copy of this Notice
D. Changes to this Notice of Privacy Practices
E. Complaints
A. How This Optometry Practice May Use or Disclose Your Health Information
This optometry practice collects health information about you and stores it in an electronic
health record/personal health record. This is your health record. The health record is the
property of this optometry practice, but the information in the health record belongs to you. The
law permits us to use or disclose your health information for the following purposes:
1. Treatment.
We use health information about you to provide your optometry care. We disclose health
information to our employees and others who are involved in providing the care you
need. For example, we may share your health
information with physicians or other health care providers who will provide services that
we do not provide. Or we may share this information with a pharmacist who needs it to
dispense a prescription to you. We may also disclose health information to members of
your family or others who can help you when you are sick or injured, with your written
consent.
2. Payment.
We use and disclose health information about you to obtain payment for the services we
provide. For example, we give your health plan the information it requires before it will
reimburse claims. We may also disclose information to other health care providers to
assist them in obtaining payment for services they have provided to you.
3. Health Care Operations.
We may use and disclose health information about you to operate this optometry
practice. For example, we may use and disclose this information to review and improve
the quality of care we provide, or the competence and qualifications of our professional
staff. Or we may use and disclose this information to get your health plan to authorize
services or referrals. We may also use and disclose this information as necessary for
medical reviews, legal services and audits, including fraud and abuse detection and
compliance programs and business planning and management. We may also share
your health information with our "business associates," such as our billing service, that
perform administrative services for us. We may have a written contract with each of
these business associates that contains terms requiring them and their subcontractors
to protect the confidentiality and security of your protected health information. We may
also share your information with other health care providers, health care clearinghouses
or health plans that have a relationship with you, when they request this information to
help based efforts to improve health or reduce health care costs, their protocol
development, case management or care- coordination activities, their review of
competence, qualifications and performance of health care professionals, their training
programs, their accreditation, certification or licensing activities, or their health care
fraud and abuse detection and compliance efforts. We may also share health
information about you with other health care providers and with health care
clearinghouses.
4. Appointment Reminders.
We may use and disclose health information to contact and remind you about
appointments. If you are not home, we may leave this information on your answering
machine or in a message left with the person answering the phone. We will receive your
consent in order to send SMS messages to your cellular phone and reminders of your
appointments to the email that you provide.
5. Notification and Communication with Family
In the event of a disaster, we may disclose information to a relief organization so that
they may coordinate these notification efforts. We may also disclose information to
someone who is involved with your care or helps pay for your care with your written
consent. If you are able and available to agree or object, we will give you the opportunity
to object prior to making these disclosures, although we may disclose this information in
a disaster even over your objection if we believe it is necessary to respond to the
emergency circumstances. If you are unable or unavailable to agree or object, our
health professionals will use their best judgment in communication with your family and
others.
6. Marketing
Provided we do not receive any payment for making these communications, we may
contact you to give you information about products or services related to your treatment,
case management or care coordination, or to direct or recommend other treatments,
therapies, health care providers or settings of care that may be of interest to you. We
may similarly describe products or services provided by this practice and tell you which
health plans this practice participates in. We will not otherwise use or disclose your
health information for marketing purposes or accept any payment for other marketing
communications without your prior written authorization.
7. Sale of Health Information
We will not sell your health information.
8. Required by Law.
As required by law, we will use and disclose your health information, but we will limit our
use or disclosure to the relevant requirements of the law. When the law requires us to
report abuse, neglect or domestic violence, or respond to judicial or administrative
proceedings, or to law enforcement officials, we will further comply with the requirement
set forth below concerning those activities.
9. Public Health
We may, and are sometimes required by law, to disclose your health information to
public health authorities for purposes related to: injury or disability; reporting child, elder
or dependent adult abuse or neglect; reporting domestic violence. When we report
suspected elder or dependent adult abuse or domestic violence, we will inform you or
your personal representative promptly unless in our best professional judgment, we
believe the notification would place you at risk of serious harm or would require
informing a personal representative we believe is responsible for the abuse or harm.
10. Health Oversight Activities
We may, and are sometimes required by law, to disclose your health information to
health oversight agencies during the course of audits, investigations, inspections,
licensure and other proceedings, subject to the limitations imposed by law.
11. Judicial and Administrative Proceedings
We may, and are sometimes required by law, to disclose your health information in the
course of any administrative or judicial proceeding to the extent expressly authorized by
a court or administrative order. We may also disclose information about you in response
to a subpoena, discovery request or other lawful process if reasonable efforts have been
made to notify you of the request and you have not objected, or if your objections have
been resolved by a court or administrative order.
12. Law Enforcement.
We may, and are sometimes required by law, to disclose your health information to a
law enforcement official for purposes such as identifying or locating a suspect, fugitive,
material witness or missing person, complying with a court order, warrant, grand jury
subpoena and other law enforcement purposes.
13. Public Safety
We may, and are sometimes required by law, to disclose your health information to
appropriate persons in order to prevent or lessen a serious and imminent threat to the
health or safety of a particular person or the general public.
14. Specialized Government Functions
We may disclose your health information for military or national security purposes or to
correctional institutions or law enforcement officers that have you in their lawful custody.
15. Workers’ Compensation
We may disclose your health information as necessary to comply with workers’
compensation laws. For example, to the extent your care is covered by workers'
compensation, we will make periodic reports to your employer about your condition. We
are also required by law to report cases of occupational injury or occupational illness to
the employer or workers compensation insurer.
16. Change of Ownership
In the event that this optometry practice is sold or merged with another organization,
your health information/record will become the property of the new owner, although you
will maintain the right to request that copies of your health information be transferred to
another individual or group.
17. Breach Notification
In the case of a breach of unsecured protected health information, we will notify you as
required by law. If you have provided us with a current e-mail address, we may use e-
mail to communicate information related to the breach. In some circumstances our
business associate may provide the notification. We may also provide notification by
other methods as appropriate.
B. When This Optometry Practice May Not Use or Disclose Your Health
Information Except as described in this Notice of Privacy Practices
This optometry practice will, consistent with its legal obligations, not use or disclose health
information which identifies you without your written authorization. If you do authorize this
optometry practice to use or disclose your health information for another purpose, you may
revoke your authorization in writing at any time.
C. Your Health Information Rights
1. Right to Request Special Privacy Protections
You have the right to request restrictions on certain uses and disclosures of your health
information by a written request specifying what information you want to limit, and what
limitations on our use or disclosure of that information you wish to have imposed. We
reserve the right to accept or reject any other request, and will notify you of our decision.
2. Right to Request Confidential Communications.
You have the right to request that you receive your health information in a specific way
or at a specific location. For example, you may ask that we send information to a
particular e-mail account or to your work address. We will comply with all reasonable
requests submitted in writing which specify how or where you wish to receive these
communications.
3. Right to Inspect and Copy.
You have the right to inspect and copy your health information, with limited exceptions.
To access your health information, you must submit a written request detailing what
information you want access to, whether you want to inspect it or get a copy of it, and if
you want a copy, your preferred form and format. We will provide copies in your
requested form and format if it is readily producible, or we will provide you with an
alternative format you find acceptable, or if we can’t agree and we maintain the record in
an electronic format, your choice of a readable electronic or hardcopy format. We will
also send a copy to any other person you designate in writing. We will charge a
reasonable fee which covers our costs for labor, supplies, postage, and if requested and
agreed to in advance, the cost of preparing an explanation or summary. We may deny
your request under limited circumstances. If we deny your request to access your child
records or the records of an incapacitated adult you are representing because we
believe allowing access would be reasonably likely to cause substantial harm to the
patient, you will have a right to appeal our decision.
4. Right to Amend or Supplement.
You have a right to request that we amend your health information that you believe is
incorrect or incomplete. You must make a request to amend in writing, and include the
reasons you believe the information is inaccurate or incomplete. We are not required to
change your health information, and will provide you with information about this
optometry practice’s denial and how you can disagree with the denial. We may deny
your request if we do not have the information, if we did not create the information
(unless the person or entity that created the information is no longer available to make
the amendment), if you would not be permitted to inspect or copy the information at
issue, or if the information is accurate and complete as is. If we deny your request, you
may submit a written statement of your disagreement with that decision, and we may, in
turn, prepare a written rebuttal. All information related to any request to amend will be
maintained and disclosed in conjunction with any subsequent disclosure of the disputed
information.
5. Right to an Accounting of Disclosures.
You have a right to receive an accounting of disclosures of your health information
made by this optometry practice, except that this optometry practice does not have to
account for the disclosures provided to you or pursuant to your written authorization, or
as described in paragraphs treatment, payment, health care operations,
notification and communication with family and specialized government functions
of Section A of this Notice of Privacy Practices or disclosures for purposes of or which
are incident to a use or disclosure otherwise permitted or authorized by law, or the
disclosures to a health oversight agency or law enforcement official to the extent this
optometry practice has received notice from that agency or official that providing this
accounting would be reasonably likely to impede their activities.
6. Right to a Paper or Electronic Copy of this Notice.
You have a right to notice of our legal duties and privacy practices with respect to your
health information, including a right to a paper copy of this Notice of Privacy Practices,
even if you have previously requested its receipt by e-mail. If you would like to have a
more detailed explanation of these rights or if you would like to exercise one or more of
these rights, contact our Privacy Officer listed at the top of this Notice of Privacy
Practices.
D. Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until
such amendment is made, we are required by law to comply with the terms of this Notice
currently in effect. After an amendment is made, the revised Notice of Privacy Protections will
apply to all protected health information that we maintain, regardless of when it was created or
received. We will keep a copy of the current notice available with our front desk receptionist.
E. Complaints
Complaints about this Notice of Privacy Practices or how this optometry practice handles your
health information should be directed to our Clinic Director, Matheus Ozbek. If you are not satisfied
with the manner in which this office handles a complaint, you may submit a formal complaint to:
Minnesota Department of Health