NOTICE OF PRIVACY PRACTICES

Visionary Optometry Inc.

1200 Artesia Blvd. #1

Hermosa Beach, CA 90254 Effective date 1/1/2006

Federal legislation, the Health Insurance Portability and Accountability Act (HIPAA), has required health care providers to develop a formal Notice of Privacy Practices and ask you to sign a form that we have given you a copy. If we don't, the Department of Health and Human Services Office for Civil Rights will fine us heavily. You may address comments to your U. S. Congressperson and Senator. Here you go:

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. This Notice describes how we protect your health information and what rights you have regarding it. We will never provide your personal or health information to any third party marketing company.

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

The most common reason why we use or disclose your personal or health information is for purposes of treatment, payment, and health care operations of this office.

Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses or medication; showing you low vision aids; referring you to another health care professional; getting copies of your health information from another health care provider you may have seen before us; sending a prescription for glasses or contacts to another to be filled; providing a prescription for medication to a pharmacist; or when we phone to let you know that your glasses or contact lenses are ready to be dispensed.

Examples of how we use or disclose information for payment purposes are: asking you about health or vision care plans that you may belong to, or about other sources of payment for our services; preparing bills to send to you or your health or vision care plan; processing payment by credit card; and when we try to collect unpaid amounts due through a collection agency or attorney.

Health care operations means those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose 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 for outside storage of our records.

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 our office that might help you.

USES AND DISCLOSURES WITHOUT CONSENT OR AUTHORIZATION

In some limited situations, the law allows or requires us to use or disclose your personal or 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 notice to and from the 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 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 tissue donation;
Uses of 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 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.

Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your health care.

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 that you want. To ask for a restriction, send a written request to Dr. Barr at the address at the beginning of this Notice.
Ask us to communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing health information to a different address, or by using e-mail to your personal e-mail address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to Dr. Barr at the address shown at the beginning of this Notice.
Ask to see or to get photocopies of your 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 the time for us to give you access or photocopies if we send you a written notice of the extension. If you want to review or get photocopies of your health information, send a written request to Dr. Barr at the address shown at the beginning of this 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 us. We will send the corrected information to persons who we know got the wrong information, and others that you specify. If we do not agree, you can write a statement of your position and we will include it with you 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 you in writing of the extension. If you want to ask us to amend your health information, send a written request, including your reasons for the amendment, to Dr. Barr at the address shown at the beginning of this Notice.
Get a list of disclosures that we have made of your health information within the past six years (or a shorter period if you want), except disclosures for purposes of treatment, payment or health care operations and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent 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 Dr. Barr at the address shown at the beginning of this Notice.
Get additional paper copies of this 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 Dr. Barr at the address shown at the beginning of this 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 Web site.

COMPLAINTS

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 Dr. Barr at the address shown at the beginning of this Notice.

FOR MORE INFORMATION

If you want more information about our privacy practices, call Dr. Barr at (310) 372-5213