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This Notice of Privacy Practices ("Notice") describes how we may use or
disclose your health information and how you can get access to such
information. Please read it carefully. Your "health information," for
purposes of this Notice, is generally any information that identifies you
and is created, received, maintained or transmitted by us in the course of
providing health care items or services to you (referred to as "health
information" in this Notice).

We are required by the Health Insurance Portability and Accountability Act
of 1996 ("HIPAA") and other applicable laws to maintain the privacy of your
health information, to provide individuals with this Notice of our legal
duties and privacy practices with respect to such information, and to abide
by the terms of this Notice. We are also required by law to notify affected
individuals following a breach of their unsecured health information.


The most common reasons why we use or disclose your health information are
for treatment, payment or health care operations. Examples of how we use or
disclose your health information for treatment purposes are: setting up an
appointment for you; testing or examining your eyes; prescribing glasses,
contact lenses, or eye medications and faxing them to be filled; showing
you low vision aids; referring you to another doctor or clinic for eye care
or low vision aids or services; or getting copies of your health
information from another professional that you may have seen before us.
Examples of how we use or disclose your health information for payment
purposes are: asking you about your health or vision care plans, or other
sources of payment; preparing and sending bills or claims; and collecting
unpaid amounts (either ourselves or through a collection agency or
attorney). "Health care operations" mean those administrative and
managerial functions that we must carry out in order to run our office.
Examples of how we use or disclose your health information for health care
operations are: financial or billing audits; internal quality assurance;
personnel decisions; participation in managed care plans; defense of legal
matters; business planning; and outside storage of our records.

Other Disclosures and Uses We May Make Without Your Authorization or

In some limited situations, the law allows or requires us to use or
disclose your health information without your consent or authorization. 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 federal Food and
Drug Administration regarding drugs or medical devices;

-disclosures to governmental authorities about victims of suspected abuse,
neglect or domestic violence;

-uses and disclosures for health oversight activities, such as for the
licensing of doctors; for audits by Medicare or Medicaid; or for
investigation of possible violations of health care laws;

-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 directors to aid in burial; or to
organizations that handle organ or tissue donations;

-uses or disclosures for health related research;

-uses and disclosures to prevent a serious threat to health or safety;

-uses or 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 the foreign service;

-disclosures of de-identified information;

-disclosures relating to worker’s compensation programs;

-disclosures of a "limited data set" for research, public health, or health
care operations;

-incidental disclosures that are an unavoidable by-product of permitted
uses or disclosures;

-disclosures to "business associates" and their subcontractors who perform
health care operations for us and who commit to respect the privacy of your
health information in accordance with HIPAA;

[specify other uses and disclosures affected by state law].

Unless you object, we will also share relevant information about your care
with any of your personal representatives who are helping you with your eye
care. Upon your death, we may disclose to your family members or to other
persons who were involved in your care or payment for health care prior to
your death (such as your personal representative) health information
relevant to their involvement in your care unless doing so is inconsistent
with your preferences as expressed to us prior to your death.


The following are some specific uses and disclosures we may not make of
your health information without your authorization:

Marketing activities. We must obtain your authorization prior to using or
disclosing any of your health information for marketing purposes unless
such marketing communications take the form of face-to-face communications
we may make with individuals or promotional gifts of nominal value that we
may provide. If such marketing involves financial payment to us from a
third party your authorization must also include consent to such payment.

Sale of health information. We do not currently sell or plan to sell your
health information and we must seek your authorization prior to doing so.

Psychotherapy notes. Although we do not create or maintain psychotherapy
notes on our patients, we are required to notify you that we generally must
obtain your authorization prior to using or disclosing any such notes.


Other uses and disclosures of your health information that are not
described in this Notice will be made only with your written authorization.

You may give us written authorization permitting us to use your health
information or to disclose it to anyone for any purpose.

We will obtain your written authorization for uses and disclosures of your
health information that are not identified in this Notice or are not
otherwise permitted by applicable law.

We must agree to your request to restrict disclosure of your health
information to a health plan if the disclosure is for the purpose of
carrying out payment or health care operations and is not otherwise
required by law and such information pertains solely to a health care item
or service for which you have paid in full (or for which another person
other than the health plan has paid in full on your behalf).

Any authorization you provide to us regarding the use and disclosure of
your health information may be revoked by you in writing at any time. After
you revoke your authorization, we will no longer use or disclose your
health information for the reasons described in the authorization.
However, we are generally unable to retract any disclosures that we may
have already made with your authorization. We may also be required to
disclose health information as necessary for purposes of payment for
services received by you prior to the date you revoked your authorization.


You have many rights concerning the confidentiality of your health
information. You have the right:

To request restrictions on the health information we may use and disclose
for treatment, payment and health care operations. We are not required to
agree to these requests. To request restrictions, please send a written
request to us at the address below.

To receive confidential communications of health information about you in
any manner other than described in our authorization request form. You must
make such requests in writing to the address below. However, we reserve the
right to determine if we will be able to continue your treatment under such
restrictive authorizations.

To inspect or copy your health information. You must make such requests in
writing to the address below. If you request a copy of your health
information we may charge you a fee for the cost of copying, mailing or
other supplies. In certain circumstances we may deny your request to
inspect or copy your health information, subject to applicable law.

To amend health information. If you feel that health information we have
about you is incorrect or incomplete, you may ask us to amend the
information. To request an amendment, you must write to us at the address
below. You must also give us a reason to support your request. We may deny
your request to amend your health information if it is not in writing or
does not provide a reason to support your request. We may also deny your
request if the health information:

was not created by us, unless the person that created the information is no
longer available to make the amendment,

is not part of the health information kept by or for us,

is not part of the information you would be permitted to inspect or copy, or

is accurate and complete.

To receive an accounting of disclosures of your health information. You
must make such requests in writing to the address below. Not all health
information is subject to this request. Your request must state a time
period for the information you would like to receive, no longer than 6
years prior to the date of your request and may not include dates before
April 14, 2003. Your request must state how you would like to receive the
report (paper, electronically).

To designate another party to receive your health information. If your
request for access of your health information directs us to transmit a copy
of the health information directly to another person the request must be
made by you in writing to the address below and must clearly identify the
designated recipient and where to send the copy of the health information.

Contact Person:

Our contact person for all questions, requests or for further information
related to the privacy of your health information is: Doctor Bradly Larson
Complaints: Doctor Bradly Larson

If you think that we have not properly respected the privacy of your health
information, you are free to complain to us or 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 complaint to the office contact person at the address, fax or E
mail shown above. If you prefer, you can discuss your complaint in person
or by phone.

Changes to This Notice:We reserve the right to change our privacy practices
and to apply the revised practices to health information about you that we
already have. Any revision to our privacy practices will be described in a
revised Notice that will be posted prominently in our facility. Copies of
this Notice are also available upon request at our reception area. Notice
Effective: 04/27/2015

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