This notice describes how medical information about you may be used or disclosed, and how you can get access to this information.

\tWe respect our legal obligation to keep personal and medical information that identifies you as private. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your health information and the rights you have regarding it.

Treatment, Payment, and Health Care Operations
\tThe most common reason why we use or disclose your health information is for treatment, payment, or health care operations. Examples of how we use information for treatment purposes are: setting an appointment for you; examining your eyes; prescribing glasses, contact lenses, or eye medications and faxing them to be filled; referring you to another doctor for specialized care; or getting copies of previous health evaluations from another doctor. Examples of how we use your health information for billing purposes are: Asking you about your vision care plan, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency). ?Health care operations? mean those administrative functions we perform to run our office. Examples of how we use your health information for health care operations are: financial or billing audits; participation in managed care plans; defense of legal matters; business planning; and outside storage of records.
We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.

Uses and Disclosures for other reasons without permission
In some limited situations, the law allows us to use or disclose your health information without your permission. Not all of these situations will apply to us; some will never come up at our office at all. Examples of such disclosures are:
 When a state or federal law mandates health information be reported for specific purpose
 For public health purpose, such as contagious disease reporting, and notices to and from the Food and Drug Administration regarding drugs or medical devices.
 Disclosures to government authorities about victims of suspected abuse, neglect or domestic violence
 Uses for health oversight activities, such as licensing of doctors, audits by Medicare or Medicaid, or for investigation of possible health care law violation.
 Disclosures for judicial proceedings, such as subpoenas or orders of court.
 Disclosures for law enforcement purposes, such as providing information on criminal suspects, or to report a crime at our office.
 Disclosure to medical examiner to identify deceased, or to determine cause of death
 Uses or disclosures for health related research
 Uses or disclosures to prevent a serious threat to health or safety.
 Uses or disclosures for special government function, such as military purposes.
(over)

 Disclosures relating to worker?s compensation programs
 Disclosures to ?business associates? who perform health care operations for us, who commit to respect the privacy of your health information.
 Use to remind you of scheduled appointments, or that it is time for a routine evaluation.
 Unless you object, we will also share relevant information about your care with your family.

Other Uses and Disclosures
\tWe will not make any other uses or disclosures of your health information unless you sign a written ?authorization form?. Federal law determines the content of the authorization form. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. You may initiate the process if you would like us to send your information to someone else.
\tIf we initiate the authorization request, you do not have to honor it. If you do not sign the authorization, we cannot use or disclose your information. If you do sign one, you have the right to revoke it at any time. Revocations must be in writing, sent or given directly to the person named at the beginning of this Notice.

Your Health Information Rights
You have the following rights regarding your health information:
 Request a restriction on certain uses and disclosures (except emergency treatment). We are not required to agree to this, but if we do, we must honor the agreed upon restrictions.
 Inspect and obtain a copy of your health information. To inspect or obtain a copy of your health information, send a written request to the address above. We may charge a fee to cover copying or postage, and will require this in advance. We may deny your request in certain limited circumstances. If we deny your request, you will be sent a written explanation and instructions on how to request a review of the denial.
 Ask us to communicate with you by alternate confidential means. For example, you may request that we contact you about medical matters only in writing to a certain address, by phoning you at work rather than home, or by using email. We will accommodate all reasonable requests, which must be submitted in writing to the address above.
 Request an amendment to your health information. You have the right to request an amendment to health information that is wrong or incomplete. Requests must be submitted in writing to the above address, along with the specific reason for request. We are not required to change your health information, and will provide you with information on how to address any disagreement with a denial.
 Receive an accounting of disclosures of your health information. By law, this list will not include disclosures for the purpose of treatment, payment, health care operations, disclosures of your authorization, and certain government functions. You must specify the time period, and may not be longer than six years. We will notify you of any cost involved. Requests must be submitted in writing to the address above.
 Receive additional copies of the Notice of Privacy Practices. Requests must be submitted in writing to the above address.

Changes to this Notice of Privacy Practices
\tWe reserve the right to amend this notice at any time as allowed by law. If we amend our Notice of Privacy Practices, we will post the new notice in our office, and have copies available.

For more information or to report a problem
\tIf you have questions or would like additional information, contact the privacy officer, Dr. Lianne Pino. If you believe your privacy rights have been violated, you can file a complaint with the privacy officer, or with the U.S. Department of Health and Human Services, Office of Civil Rights.