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Notice of Privacy Practices

This notice describes how medical and/or personal information about you may be used
and disclosed and how you can get access to this information. Please read carefully.

We are required by law and committed to protecting your private personal information, which
may be personal information collected from you, information about health care we provide to
you, or payment of health care provided for you. We will only use and disclose your personal
information as necessary to provide you with health care products and services.

We are also required by law to provide you with this Notice of Privacy Practices explaining our
legal duties and privacy practices with respect to information. We are legally required to follow
the terms of this notice.

The terms of this notice may change in the future, as allowed by law. If we change this notice,
the new privacy practices will apply to your information that we already possess, as well as,
future information. If we make changes to the notice, we will post the new notice in our
reception area and website and will have copies available upon request.

Treatment, Payment and Health Care Operations
We routinely use your health information inside our office in order to provide health care,
obtain payment for that health care and operate our business optimally. Examples of how we
disclose your information include:

We may use and disclose medical information about you to provide health care, obtain
payment for that health care and related services. This may include communications
with other health care professionals regarding your treatment and findings noted
during your fitting.
We may use and disclose medical information about you to obtain payment for health
care services you receive. This may incorporate releasing medical information to your
insurance carrier, collection agencies, and consumer reporting agencies.
We may use and disclose medical information about you in performing health care
operations. Health care operations are those administrative and managerial activities
that we have to do in order to run our office. Examples of these activities may include:
financial or billing audits, internal quality assurance, personnel decisions,
participations in managed care plans, defense of legal matters, business planning,
resolving grievances within our organization, working with others who assist with
compliance of this notice (such as lawyers, accountants, etc.), significant changes in
business ownership, credentialing organizations and outside storage of our records.
We may use and disclose medical information about you to a relative, close personal
friend or any other person you identify if that person is involved in your care and the
information is relevant to your care. If the patient is a minor, we may disclose medical
information about the minor to a parent, guardian or other person responsible for the
minor except in limited circumstances. You may ask us as any time not to disclose
medical information about you to persons involved in your care. We will agree to your
request and not disclose the information except in certain limited circumstances (such
as emergencies) or if the patient is a minor.

Appointment Reminders
We may write to remind you of scheduled appointments, or that it is time to make a routine
appointment. We may also write to notify you of other treatment or services available at our
office that might help you. Unless you tell us otherwise, we will mail you an appointment
reminder.

Uses and Disclosures For Other Reasons Without Permission
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 example suspected child abuse.
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.
uses and disclosures for health oversight activities, such as 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 deceased person or to determine the
cause of death; or to a funeral director to aid in burial; or to organizations that handle
organ or tissue donations.
Uses or disclosures for health related research, if the organization has satisfied
certain conditions about protecting the privacy of medical information.
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 for evaluation and health of members of foreign services.
Disclosures relating to worker's compensation programs.
Incidental disclosures that are an unavoidable by-product of permitted uses or
disclosures.
Disclosures to business associates who perform health care operations for us and
who commit to respect the privacy of your health information.

Authorization
Other than the uses and disclosures described above, we will not use or disclose information
about you without the "authorization" or signed permission of you or your personal
representative. In some instances, we may wish to use or disclose medical information about
you and we may contact you to ask you to sign an authorization form. In other instances, you
may contact us to ask us to disclose medical information and we will ask you to sign an
authorization form.

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 t to
this, but if we agree, we must honor the restrictions that you want.
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 (it could be possible that certain confidential communication would
incur a fee.)
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. By law, we can have one 30-day extension of the time for us to
give you access or photo copies if we send you a written notice of the extension.
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 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 you in writing of the
extension.
Get a list of the disclosures that we have made of your health information within the
past six years. By law, the list will not include: disclosures for purposes of treatment,
payment or health care operations; disclosures with your authorization, incidental
disclosures, and disclosures required by law. It may be possible to incur a fee for this
list. 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.
Get additional paper copies of this Notice of Privacy Practices upon request.

To ask for a restriction, confidential communication, a review or photocopies of health
information, amendment and reasons for an amendment or list of disclosures, send a written
request to the office contact person at the address shown to the left of this notice.

Grievances
If you think that we have not properly respected the privacy of your information, you are free to
complain to us or 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 show to the left of this notice.