John L. Bonner Eye Clinic, LTD.

Notice of Privacy Practices 2013


During your treatment at Bonner Eye Clinic, doctors, nurses, and other caregivers may gather information about your medical history and your current health. This notice will explain how such information may be used and shared with others. It will also explain your privacy rights regarding this kind of information.

Your medical information will be used and disclosed for the following purposes:

  • Treatment: We will use your information to provide, coordinate, and manage your care and treatment. For example, a BEC physician or staff member may share your medical information with another physician for a consultation or a referral. This may include electronic and facsimile methods.
  • Payment: We will use your information to receive payment for the services we provide. For example, we will disclose information in order to submit bills or claims to insurance companies and/or Medicare or Medicaid.
  • Health Care Operations: We will use your information for certain activities related to the functioning of BEC. For example, we may use or disclose information for quality assurance activities, legal services, underwriting, and other business management and administrative activities.
  • Appointment Reminders and Other Health Information: We may use your medical information to send you reminders about future appointments. Your medical information may also be used to provide you with information about new or alternative treatments or other health care services.
  • We may call your home or work to remind you of an appointment. We may leave this reminder on your answering machine or with the person who answers the telephone.
  • Your chart may be transported to another BEC facility where you are being seen, or where your information is needed for insurance or medical reasons.

BEC may also use or disclose your information for the following purposes:

  • To people who will be taking care of you or helping to pay your medical bills, such as family members or close friends. BEC will only disclose medical information that these people need to know. We may also use your medical information to let family members or other responsible people know where you are and what your general medical condition is. If you are able to make your own health decisions, BEC will ask your permission before using your medical information for these purposes. If you are unable to make health care decisions, BEC will disclose relevant medical information to family members or other responsible people if we feel it is in your best interest to do so. For example, we may disclose your health care information to nursing home staff.
  • BEC may also disclose or use your information without your consent in the following cases: when required by law; for public health activities; relating to victims of abuse/neglect/domestic violence, if required/authorized by law and/or if you agree; for health oversight activities; for judicial and administrative proceedings to the extent permitted by law; for law enforcement purposes, as permitted or required by law; to coroner/medical examiners/funeral directors, as permitted by law; for organ donation purposes; for research purposes under certain circumstances; to avert a serious threat to health or safety; for certain specialized government function, such as military discharge, and national security and intelligence, and for workers’ compensation purposes.

BEC will not use or disclose your medical information in any other way unless you allow us to do so in writing. If you do give us permission to use or disclose your medical information for another purpose, you have the right to change your mind and revoke the permission at any time.

Your Privacy Rights:

  • You may request that BEC not use your medical information in certain ways or for certain purposes. You may also request that BEC not provide your medical information to certain people. However, BEC has the right to refuse your request, and BEC may use or disclose your medical information in situations requiring emergency treatment, in which case we will ask the persons(s) who receive the information not to further use or disclose the information.
  • You may request that BEC provide you with your medical information in a confidential manner. For example, you can request that we send your appointment reminders, bills, and other mailings to a different address, or that we notify you of this kind of information in another way. You must make this request in writing and specify another address or means of communication. We may also ask you to give us information on how you will pay your bills.
  • You may ask to see and copy your medical records, unless law protects that information. You must make these requests in writing. If your request to look at or copy your medical records is denied, you have the right to have the denial reviewed by a health care professional. We will act upon your request within 30 days, and we may charge you a legally acceptable amount for copying costs.
  • You may ask us about your protected health information.
  • You can ask to inspect and copy information used to make decisions about care or payment.
  • You can receive a summary or explanation which will be provided to you or within 30 days.
  • You can receive an electronic copy which is provided through our secure patient portal.
  • You can request amendments.
  • You will receive a notice of breach.
  • You may ask to pay-out-of- pocket for a procedure, service or visit, and request that the practice does not disclose this    information to a health plan, the BEC will accommodate this request, unless required by law to disclose the information. A form will be provided for you.
  • You may ask us to provide you with information about certain disclosures of your medical information in the past. You may request an accounting of disclosures made in the past six years, but this accounting will only cover disclosures made after April 14, 2003.
  • If you have received this notice of your medical information privacy rights electronically, you may ask us to provide you with a paper copy.
  • If you feel your medical information privacy rights have been violated, you may file a complaint with the Secretary of Health and Human Services, and/or with the BEC contact person listed below. Filing a complaint will not affect the quality of the services you receive from BEC and you will not be retaliated against for filing a complaint.

You can contact the designated privacy official at BEC:
Name: Mark Riehle or current manager
Title: Manager
Phone Number: 218-326-7286

The effective date of this notice is September 2013. BEC is required by law to maintain the privacy of protected health information and to provide individuals with this notice of its legal duties and privacy practices with respect to health information. BEC is required to abide by the terms of the notice currently in effect. BEC reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information maintained by BEC. If there is a significant change in this policy BEC will provide individuals with a revised notice upon request to our privacy officer, and by posting the revised notice in designated locations at BEC and at our website.