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Notice of Privacy Practices for Vision Therapy Studio



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.



The most common reason why we use or disclose your health information is for treatment, payment, or health care operations.  Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; vision therapy sessions; prescribing glasses, contact lenses, or eye medications and faxing them to be filled; showing you vision therapy aids; referring you to another professional who 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 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 do in order to run our office.  Examples of how we use or disclose your health information for health care operations are defense of legal matters; business planning; and outside storage of our 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 will (if necessary) ask you for special written permission.



In some limited situation, the law allows or requires us to use or disclose your that’ll information without your permission.  Not all 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 or 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 or 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 protections of the president or high-ranking government officials; for the lawful national intelligence activities, for military purposes, or for the evaluation and health of members for the foreign service;

  • Disclosures of de-identified information;

  • Disclosures relating to worker’s compensation programs;

  • Disclosures to “business associates” who perform health care operations for us and who commit to respect privacy of your health information;

  • Disclosures of a “limited data set” for research, public health, or health care operations;

  • Incidental disclosures that are an unavoidable by-produce of permitted uses or disclosures;

  • Any uses and disclosures affected by state law.


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



We may call, email or text to remind you of scheduled appointments, or that it is time to make an appointment.  We may also call or write to notify you of other treatments or services available at our office that might help you.  Unless you tell us otherwise, we will text you an appointment reminder, email you an appointment reminder, and/or leave a message on your voice mail or with someone who answers your phone if you are not available.



We will not make any other uses or disclosures of your health information unless you sign a written “authorization form” as determined by federal law.  Sometimes we may initiate the authorization process if the use or disclosure is ours.  Typically, in this situation, you will give us a properly completed authorization form, or you can use one of ours.  If we initiate the process and ask you to sign an authorization form, you do not have to sign it.  If you do not sign the authorization form, we cannot make the use or disclosure.  If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it.  Revocations must be in writing.  Send them to the office named at the beginning of this Notice.



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 the office at the address or fax shown 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 email to your personal email 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 the office at the address or fax at the beginning of this Notice.

  • Ask to see or to get photocopies of our 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 (or 60 days if the information is stored off-site). You may ave to pay for photocopies in advance.  If we deny your request, we will send you a written explanation, and instructions about how to get and impartial review of our denial is legally available.  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 the office at the address or fax 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, 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 records and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your 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 the office or fax shown at the beginning of this Notice.

  • Get a list of the disclosures that we have made of your health information which in the past six years (or shorter period if you want).  By lay, the list will not include disclosures for purposes of treatment, 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 office at the address or fax shown at the beginning of this Notice.

  • 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 office at the address or fax shown at the beginning of this Notice.



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 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 website.



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 US 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 at the address or fax shown at the beginning of this Notice.  If you prefer, you can discuss your complaint in person or by phone.

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