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NOTICE OF PRIVACY PRACTICES

EYE PHYSICIANS GROUP, LLC d.b.a. BAGAN STRINDEN VISION

STEVEN M BAGAN, MD, PC * THOMAS I STRINDEN, MD, PC

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION

PLEASE READ IT CAREFULLY

The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives you, the patient, the right to understand and control how your personal health information ("PHI") is used. HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, we prepared this explanation of how we are to maintain the privacy of your health information and how we may disclose your personal information.

We may use and disclose your medical records only for each of the following purposes: Treatment, Payment and Health Care Operations. 

Treatment means providing, coordination, or managing health care and related services by one or more healthcare providers. An example of this would include referring you to a retina specialist.

Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review. An example of this would include sending your insurance company a bill for your visit and/or verifying coverage prior to a surgery.

Health Care Operations include business aspects of running our practice 

The practice may also disclose your PHI for law enforcement and other legitimate reasons although we shall do our best to assure its continued confidentiality to the extent possible. 

We may also create and distribute de-identified health information by removing all reference to individually identifiable information.

We may contact you, by phone or in writing, to provide appointment reminders or information about treatment alternatives or other health-related benefits and services, in addition to other fundraising communications, that may be of interest to you. You do have the right to "opt out" with respect to receiving fundraising communications from us. 

The following use and disclosures of PHI will only be made pursuant to us receiving a written authorization from you:

  • Most uses and disclosure of psychotherapy notes;

  • Uses and disclosure of your PHI for marketing purposes, including subsidized treatment and health care operations;

  • Disclosures that constitute a sale of PHI under HIPAA; and 

  • Other uses and disclosures not described in this notice.

You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization. 

You may have the following rights with respect to your PHI.

  • The right to request restrictions on certain uses and disclosures of PHI, including those related to disclosures of family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to honor a request restriction except in limited circumstances which we shall explain if you ask. If we do agree to the restriction, we must abide by it unless you agree in writing to remove it.

  • The right to reasonable requests to receive confidential communications of Protected Health Information by alternative means or at alternative locations.

  • The right to inspect and copy your PHI.

  • The right to amend your PHI.

  • The right to receive an accounting of disclosures of PHI.

  • The right to obtain a paper copy of this notice from us upon request.

  • The right to be advised if your unprotected PHI is intentionally or unintentionally disclosed. 

If you have paid for services "out of pocket", in full, and you request that we do not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.

We are required by law to maintain the privacy of your Protected Health Information and to provide you the notice of our legal duties and our privacy practice with respect to PHI.

This notice if effective as of September 21, 2013 and it is our intention to abide by the terms of the Notice of Privacy Practices and HIPAA Regulations currently in effect. We reserve the right to change the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI that we maintain. We will post and you may request a written copy of the revised Notice of Privacy Practice from our office.

You have recourse if you feel that your protections have been violated by our office. You have the right to file a formal, written complaint with office and with the Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you for filing a complaint.

Feel free to contact the Practice Compliance Officer for more information, in person or in writing. 

PATIENT BILL OF RIGHTS & RESPONSIBILITIES

The policy of Steven M. Bagan, MD; Thomas I. Strinden, MD; and Sarah M. Swanholm, OD, is to care for all patients with dignity, choice and self-determination. Patients' rights and responsibilities will be protected and promoted without interference or discrimination.

AS A PATIENT, YOU HAVE THE RIGHT TO: 

Receive considerate and responsible care consistent with acceptable professional standards.

Receive accurate and current information regarding the current health status, diagnosis, treatment and prognosis in understandable language. This information may also be provided to a legal guardian or representative on your behalf.

Be assured of personal privacy including confidentiality of health information.

Receive care in a safe setting.

Be fully informed of charges related to the care provided prior to or at the appointment time, including any charges for services not covered by insurance.

Participate in the planning of your medical treatment and to refuse to participate in experimental research.

Review your medical records and have them explained to you within a reasonable amount of time. You have the right to refuse the release of your medical records to an outside facility except as otherwise provided by law or third party payment contract. 

Receive care free from all forms of abuse or harassment.

Discuss any issues or concerns with your doctor or appropriate staff member.

Contact your state's Department of Health:

North Dakota Department of Health 

600 East Boulevard Avenue

Bismarck, ND 58505-02200

1-701-328-2352

AS A PATIENT, YOU HAVE THE RESPONSIBILITY TO: 

Provide accurate and current information regarding your health and report any changes to your doctor.

Ask questions until you clearly understand the proposed medical treatment plan in order to make an informed decision.

Follow the agreed upon treatment plan.

Respect others' privacy and property.