VISION ENHANCEMENT CENTER OF OPTOMETRY
Duong Nguyen, O.D.
5051 Canyon Crest Drive, Suite #102, Riverside, CA 92507
Telephone and Facsimile: (951) 686-3937

NOTICE OF PRIVACY PRACTICES

Date of Last Revision: 3/31/03 Effective Date: 4/14/03

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.

This notice describes our Practice­s policies which extend to :

• Any health care professional authorized to enter information into your chart (including optometrists, assistants/technicians, trained volunteers, etc.);
• All areas of the Practice (front desk, administration, billing, collection, etc.);
• All employees, staff, and other personnel that work for or with our Practice;
• Our business associates (including a billing service or facilities to which we refer patients), psychologists, on-call or relief optometrists, etc.

I. What is "Protected Health Information"?

Your protected health information (PHI) is health information that contains identifiers, such as your name, social security number, or other information that reveals who you are. For example, your optometric record is PHI because it includes your name and other identifiers.

II. About our responsibility to protect your PHI.

We are required by law to:

1) protect the privacy of your PHI,

2) tell you about your rights and our legal duties with respect to your PHI,

3) tell you about our privacy practices and follow our NPP currently in effect.

We understand that your health information is personal to you and we are committed to protecting the information about you.

III. How we may use and disclose your PHI.

Your confidentiality is important to us. Our optometrists, business associates, and employees are required to maintain the confidentiality of the PHI of our patients, and we have policies, procedures, and other safeguards to help protect your PHI from improper use and disclosure. Sometimes we are allowed by law to disclose certain PHI without your written permission. We briefly describe these uses and disclosures below and give you some examples.

How much PHI is used or disclosed without your written permission will vary depending, for example, on the intended purpose of the use or disclosure. Sometimes we may only need to use or disclose a limited amount of PHI, such as to send you an appointment reminder or to confirm insurance eligibility. At other times, we may need to use or disclose more PHI such as when we are providing optometric treatment.

The following categories describe different ways that we use and disclose PHI that we have and share with others. Each category of uses or disclosures provides a general explanation and provides some examples of uses. Not every use or disclosure in a category is either listed or actually in place. The explanation is for your general information only.

Treatment: We use current and previously given PHI to provide you with current or prospective optometric and medical treatment or services. Therefore, we may, and most likely will, disclose medical information about you to doctors, assistants, and volunteers who are involved in taking care of you. For example, a doctor to whom we refer you for ongoing or further care may need your medical record. Our staff will use and disclose your PHI in order to provide and coordinate the care and services you need, for example, ordering spectacle lenses, contact lenses, and medical lab work. We also may disclose medical information about you to people outside the Practice who may be involved in your medical care after you leave the Practice; this may include your family members or other personal representatives authorized by you or by a legal mandate (a guardian or other person who has been named to handle your medical decisions should you become incompetent). During the course of your visit, we will provide the utmost privacy, however, under certain circumstances, information may be overheard, such as during a discussion in our open dispensary and vision therapy treatment areas, or an exam room door may be left open.

Payment: We may use and disclose PHI about you for services, procedures, and prescription goods (such as glasses) so they may be billed and collected from you, an insurance company, or any other third party. For example, we may need to give your PHI about treatment you received at the Practice to obtain payment or reimbursement for the care. We may also tell your health plan and/or referring doctor about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment, to facilitate payment of a referring doctor, or the like.

Health Care Operations: We may use and disclose your PHI so that we can run our Practice more efficiently and make sure that all of our patients receive quality care. These uses may include reviewing our treatment and services to evaluate the performance of our staff, deciding what services to add or delete, and whether certain new treatments are effective. We may also disclose information to doctors, staff, and volunteers for review and learning purposes. We may disclose your PHI for external quality assurance, such as to auditors of your vision insurance plan.

Business associates: We may contract with business associates to perform certain functions on our behalf, such as additional and/or combined services for our vision therapy patients, payment, and health care operations. These business associates must agree to safeguard your PHI.

Appointment and Patient Recall Reminders: We may use and disclose your PHI to contact you as a reminder that you have an appointment for optometric care with the Practice or that you are due to receive periodic care from the Practice. This contact may be made by telephone, in writing (for example, a mailed postcard), e-mail, or otherwise, and may involve a situation, such as leaving a message on an answering machine, which could potentially be received or intercepted by others.

Communication with family and others when you are present: Sometimes a family member or other person involved in your care will be present when we are discussing your PHI with you. If you object, please tell us and we will excuse the other person from the discussion.

Communication with family and others when you are not present: There may be times when it is necessary to disclose your PHI to a family member or other person involved in your care because there is an emergency, you are not present, or you lack the decision making capacity to agree or object. In those instances, we will use our professional judgement to determine if it is in your best interest to disclose your PHI. If so, we will limit the disclosure to the PHI that is directly relevant to the person's involvement with your health care. For example, we may allow someone to pick up a prescription for you.

Disclosure in case of disaster relief: We may disclose your PHI to a public or private disaster relief organization to assist disaster relief efforts and/or so that your family can be notified about your condition, unless you object at the time.

Disclosure to parents as personal representatives of minors: To facilitate an understanding of the diagnosis and treatment options of your minor child, we generally mail a summary report to you following the visual examination and/or extended visual and related testing of that child. Reports can also be sent to other professionals such as teachers and pediatricians, but we will not do so without your separate signed authorization. If you do not want a report sent to you, please let us know at the time of the applicable testing.

In most cases, we may disclose your minor child's PHI to you. In some situations, however, we are permitted or even required by law to deny your access to your minor child's PHI. An example of when me must deny such access based on type of health care is when a minor who is twelve or older seeks care for a communicable disease or condition. Another situation when we must deny access to parents is when minors have adult rights to make their own health care decisions. These minors include, for example, minors who were or are married or who have a declaration of emancipation from a court.

Research: Under certain circumstances, we may use and disclose medical information about you for research purposes regarding medications, efficiency and effectiveness of treatment protocols and the like. All research projects are subject to an approval process, which evaluates a proposed research project and its use of medical information. Before we use or disclose medical information for research, the project will have been approved though this research approval process. We will obtain an authorization from you before using or disclosing your individually identifiable health information unless the authorization requirement has been waived. If possible, we will make the information non-indentifiable to a specific patient. It the information has been sufficiently de-identified, an authorization for the use or disclosure is not required.

Organ and tissue donation: We may use or disclose PHI to organ-procurement organizations to assist with organ, eye, or tissue donation and transplantation.

Public health risks: Law or public policy may require us to disclose your PHI to promote and protect the public's health. These activities are generally:

• to prevent or control disease, injury, or disability;
• to report suspected child/elder abuse or neglect, or to identify suspected victims of abuse, neglect, or domestic violence;
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using;
• to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

To avert a serious threat to health or safety: We may use and disclose your PHI if we believe it is necessary to avoid a serious threat to your health or safety or to someone else's.

Health oversight: We may disclose PHI to a local, state, or federal agency for activities authorized by law. These agencies may conduct audits of our operations and activities and in that process, they may review your PHI.

Worker's compensation: In order to comply with worker's compensation laws, we may use and disclose your PHI. For example, we may communicate your medical information regarding a work-related injury or illness to claims administrators, insurance carriers, and others responsible for evaluating your claim for worker's compensation benefits.

Required by law: We will disclose PHI when required to do so by federal, state, or local law. For example, the secretary of the Department of Health and Human Services may review our compliance efforts, which may include seeing your PHI.

Law enforcement: We may disclose PHI to authorized officials for law enforcement purposes, for example, to respond to a search warrant, report a crime on our premises, or help identify or locate someone.

Lawsuits and other legal disputes: We may use and disclose PHI in responding to a court or administrative order, a subpoena, or a discovery request. We may also use and disclose PHI to the extent permitted by law without your authorization, for example, to defend a lawsuit or arbitration.

Marketing: We may use and disclose your PHI to contact you about new procedures, services, goods or supplies that may be of benefit to you. We may disclose minimal PHI in acknowledging a referral to our practice.

Coroners, medical examiners, and funeral directors: We may disclose PHI to a coroner or medical examiner to permit identification of a body, determine the cause of death, or for other official duties. We may also disclose PHI to funeral directors as necessary to carry out their duties.

Inmates: If you are an inmate of a correctional institution, or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This would be for certain purposes, such as enabling the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

Other uses and disclosures: Other uses and disclosures not covered by this notice or the laws that apply to use will be made only with your written permission, unless those uses can be reasonably inferred from the intended uses above. If you have provided us with your permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we provided to you.

Changes to this notice: We reserve the right to right to change this Notice at any time 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.

PATIENT RIGHTS

THIS SECTION DESCRIBES YOUR RIGHTS AND THE OBLIGATIONS OF THIS PRACTICE REGARDING THE USE AND DISCLOSURE OF YOUR PERSONAL HEALTH INFORMATION.

Right inspect and copy: You have the right to receive a copy and inspect medical information that may be used to make decisions about your care. This includes your own medical and billing records but does not include psychotherapy notes. Upon proof of an appropriate legal relationship, records of others related to you or under your care (guardian or custodial) may also be disclosed.

To inspect and receive a copy of your medical record, you must submit your request in writing to our Public Information Officer. Ask at the front desk for the name of the Public Information Officer. If you request a copy of the information, we charge a fee for the costs of copying, mailing, or other supplies (tapes, disks, etc.) associated with your request. This fee must be paid in advance.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you are entitled to one review of that decision. You may submit a written request to Dr. Kohn to review the decision.

Right to amend: If you feel the health information in your record is incorrect or incomplete, you may ask us to amend the information. 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 received 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. If you want us to amend your health information, send a written request, including your reasons for the amendment, to the Public Information Officer at the address or fax shown at the beginning of this Notice.

Right to an accounting of disclosures: You have the right to get a list of the disclosures that we have made of your health information within the past seven years (or a shorter period if you want). The request may not include dates before April 14, 2003. By law, the list will not include: disclosures for purposes of treatment, payment or health care operations, disclosures with your authorization, incidental disclosures, disclosures required by law, 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 the Public Information Officer at the address or fax shown at the beginning of this Notice.

Right to request restrictions: You have the right to request a restriction on the health information we use or disclose about you for 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 request restrictions, send a written request to the Public Information Officer at the address or fax shown at the beginning of this Notice.

Right to request confidential communications: You have the right to ask us to communicate with you in a confidential way, such as phoning you at work rather than at home, by mailing health information to a different address, or that we not leave voice mail. 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 the Public Information Officer at the address or fax shown at the beginning of this Notice.

Right to a paper copy of this notice: You have the right to get additional paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already. If you want additional paper copies, send a written request to the Public Information Officer at the address or fax shown at the beginning of this Notice.

Complaints: If you think that we have not properly respected the privacy of your health 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 request to the Public Information Officer at the address or fax shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by telephone.

Further information: If you want more information about our privacy practices, call or visit our Public Information Officer at the telephone number or address shown at the beginning of this Notice.