Privacy Practices

Effective date of notice April 14th, 2003   NOTICE OF PRIVACY PRACTICE THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY. GENERAL RULE We respect our legal obligation to keep health information that identifies you private.  We are obligated by law to give you notice of our privacy practices. Generally, we cannot use your health information in our offices or disclose it outside of our office without your written permission.  Sometimes the written permission will be called a consent form; sometimes it will be called an authorization form.  In some limited situations, the law allows or requires us to disclose your health information without either a written consent or authorization.   USES OR DISCLOSURES WITH CONSENT We will ask you to sign a consent form allowing us to use and disclose your health information for purposes of treatment, payment, and health care operations of this office.  We are allowed to refuse to treat you if you do not sign the consent form. We use information for treatment purposes, when, for example, we set up an appointment for you, when our technician or doctor tests your eyes, when the Doctor prescribes glasses or contact lenses, and when we phone to let you know that your glasses or contacts are ready to be picked up.  Sometimes we may ask for copies of your health information from another professional that you may have seen before us. We use your health information for payment purposes when, for example, our staff asks you about health or vision care plans that you may belong to, or about other sources of payment for our services, when we prepare bills to send to you or your health or vision care plans, when we process payment by credit card, and when we try to collect unpaid amounts due.  We may disclose your health information for health care operations in a number of ways.  Health care operations means those administrative and managerial functions that we have to do in financial or billing audits, for internal quality assurance, for personnel decisions, to enable our doctors to participate in managed care plans, for the defense of legal matters, to develop business plans, and for outside storage of our records. USES AND DISCLOSURES WITHOUT CONSENT OR AUTHORIZATION In some limited situations, the law allows or requires us to use or disclose your health information without your permission.  Not all of these situations will apply to us; some may never come up at our office at all.  Such uses or disclosures are: When a state or federal law mandates that certain health information be reported for a specific purpose; For public health purposes, such as contagious disease reporting, investigation or surveillance and notices to and from the Food and Administration regarding drug or medical devices; Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies; Disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office or to report a crime that happened somewhere else; Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral director to aid in burial; or to organizations that handle organ tissue donations; Uses or disclosures for health related research; Uses and disclosures to prevent a serious threat to health or safety; Uses and disclosures for specialized government functions, such as for the protection of the president or high ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of foreign service; Disclosures relating to worker’s compensation programs; Disclosures to business associates who perform health care operations for us and who agree to keep your health information private.

APPOINTMENT REMINDERS We may call to remind you of scheduled appointments.  We may also call to notify you of other treatments or services available at out office that might help you. OTHER DISCLOSURES We will not make any other uses or disclosures of your health information unless you sign a written authorization form.  You do not have to sign such a form.  If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION The law gives you many rights regarding your health information.  You can: Ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment) payment or health care operations.  We do not have to agree to do this, but if we agree, we must honor the restrictions you want.  To ask for a restriction, send a written request to the compliance office that the address fax or e-mail shown at beginning of notice. Ask to see or to get photocopies of you health information.  By law, there are a few limited situations in which we can refuse to permit access or copying.  For the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us.  You may have to pay for photocopies in advance.  If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally required.  By law, we can have one 30 day extension of time for us to give you access or photocopies if we send you a written notice of extension.  If you want to review or get photocopies of your health information, send a written request to the compliance officer at the address fax or e-mail shown at the beginning of the Notice. Ask us to amend your health information if you think that it is incorrect or incomplete.  If we agree, we will amend the information within 60 days from when you ask.  We will send the correct information to persons who we know got the wrong information, and other that you specify.  If we do not agree, you can write a statement of you position, and we will include it with your health information along with any rebuttal statement that we may write.  Once your statement of position and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information.  By law, we can have one 30 day extension of time to consider a request for amendment if we notify in writing of the extension.  If you want to ask us to amend your health information, send a written request to the compliance officer and the address fax or e-mail shown at the beginning of the Notice. Get a list of the disclosures that we have made of your health information with the past six years (or a shorter period if you want), except disclosures.  You are entitled to one such list per year without charge.  If you want more request lists, you will have to pay for them in advance.  We will usually respond to your request within 60 days of receiving it, but by law we can have one 30 day extension of time if we notify you of the extension in writing.  If you want a list, send a written request to the compliance officer at the address fax or e-mail shown at the beginning of the Notice. Get additional paper copies of the Notice of Privacy Practices upon request, no matter whether you got one electronically or in paper form already.  If you want additional paper copies, send a written request to the compliance officer and the address fax or e-mail shown at the beginning of the Notice. OUR NOTICE OF PRIVACY PRACTICES By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it.  We reserve the right to change this notice at any time in compliance with and as allowed by law.  If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future.  If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our website. COMPLAINTS If you think that we have not properly respected the privacy of your health information, you are free to complain to the U.S. Department of Health and Human Services, Office for Civil Rights.  We will not retaliate against you if you make a complaint.  If you want to complain to us, send a written request to the compliance officer at the address fax or e-mail shown at the beginning of the Notice.  If you prefer, you can discuss your complaint in person or by phone. FOR MORE INFORMATION If you want more information about our privacy practices, call or visit the compliance officer at the address fax or e-mail shown at the beginning of the Notice.