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Please read through our "Notice of Privacy Practices". Click here if you would like to download a copy.
Notice of Privacy Practices
As required by the Privacy Regulations created as a result of Health Insurance Portability and Accountability Acct of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU
(A PATIENT AT THE OFFICE OF DRS. GUNDERSEN AND ZUKER)
MAY BE USED AND DISCLOSED, AND HOW YOU CAN GAIN ACCESS
TO YOUR INDIVIDUAL IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS DOCUMENT CAREFULLY.
A. Our office is committed to the privacy of your health information.
We are dedicated to maintaining the privacy and confidentiality of your personal health information (PHI). In caring for your eye health, we maintain records containing information on you and your health that identifies you. We are required by law to maintain your information in a confidential way. We are also required by law to provide you with this notice of our legal duties and the way we protect your personal health information. By federal and state law, we are to follow the terms of this notice of privacy practice.
These laws are complicated, but we must provide you with the following important information:
1. How we intend to use and disclose your PHI.
2. Your privacy rights in regard to your PHI.
3. Our obligations regarding the use and disclosure of your PHI.
The terms of this notice apply to all records containing your PHI that are created or maintained by Drs. Gundersen and Zuker. We reserve the right to amend or revise this Notice of Privacy Practice. Any amendment or revision to the Notice of Privacy Practice will be effective for all of your records that are maintained at our office: past, present and future records. We will make available a current Notice of Privacy Practice and you may request a copy at any time.
B. If you have any questions or comments regarding this notice, please contact:
Donna Berger Pam Gillan Angie Rayment
442 W. Western Ave. 1030 S. Mears Ave. 24 S. Michigan Ave.
Muskegon, MI 49440 Whitehall, MI 49461 Shelby, MI 49455
(231) 722-3556 (231) 893-5671 (231) 861-5417
C. The ways your Personal Health Information may be used or disclosed.
1. Treatment: Drs. Gundersen and Zuker may use your PHI to treat you. For example, we may obtain results from tests or information from other practitioners to assist in obtaining a diagnosis. We might disclose your PHI to a pharmacy or laboratory when we order a prescription for you. Many of the people who work for our practice – including, but not limited to our doctors and assistants – may use or disclose your PHI in order to treat you or assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as spouse, children or parents. Finally, we may also disclose your PHI to other health care professionals for purposes related to your treatment.
2. Payment: Drs. Gundersen and Zuker may use or disclose your PHI in order to bill and collect payment for the services and items you may receive from our practice. Also, we may use your PHI to bill you directly for services and goods. We may disclose your PHI to other health care providers and entities to assist in their billing and collection.
3. Health Care Operations: Drs. Gundersen and Zuker may use and disclose your PHI to operate our business. We may disclose your PHI to other providers and entities to assist in their health care operations.
4. Appointment Reminders and Recall Notices: Drs. Gundersen and Zuker may use and disclose your PHI to contact you and remind you of an appointment or next suggested date for an eye-health examination.
5. Treatment Options: Drs. Gundersen and Zuker may use and disclose your PHI to inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services: Drs. Gundersen and Zuker may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
7. Release of Information to Family/Friends/Teachers: Drs. Gundersen and Zuker may use and release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you, or to a child’s teacher who may benefit from information regarding your child’s vision.
8. Disclosures Required by Law: Drs. Gundersen and Zuker will use and disclose your PHI when federal, state or local law requires us to do so.
D. Use and disclosure of your PHI in special circumstances.
1. Public Health Risk: Drs. Gundersen and Zuker may disclose your PHI to public health authorities that are authorized by law to collect such information.
2. Health Oversight Activities: Drs. Gundersen and Zuker may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include inspections, audits, surveys, licensure, civil, administrative, or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings: Drs. Gundersen and Zuker may use and disclose your PHI in response to a court or administrative order, if you involved in a lawsuit or similar proceeding.
4. Military: Drs. Gundersen and Zuker may disclose your PHI if required to the appropriate authorities.
5. Inmates: Drs. Gundersen and Zuker may disclose your PHI to correctional institutions if you are an inmate or are under custody of law enforcement.
6. Workers’ Compensation: Drs. Gundersen and Zuker may disclose your PHI for workers’ compensation and similar programs.
E. Your rights regarding your PHI.
1. Confidential Communication: You have the right to request that Drs. Gundersen and Zuker communicate with you about your health-related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home rather that at work. In order to request this type of confidential communication, you must make a written request to Dr. David Gundersen, HIPAA officer at Dr. Gundersen and Zuker, specifying your request. We will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions: You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or healthcare operations. We are not required to agree to your request, however if we do agree, we are bound by our agreement except when otherwise required by law. In order to request this type of confidential communication, you must make a written request to Dr. David Gundersen, HIPAA officer at Drs. Gundersen and Zuker, specifying your request. We will accommodate reasonable requests. You do not need to give a reason for your request.
Again, if you have any questions regarding this notice or our personal health information policies, please contact the person assigned to the office location that appears in Section B of this document.
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