Optivision Optometric

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 IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.

Right to Notice
As a patient, you have the right to adequate notice of the uses and disclosures of your protected health information.
Under the Health Insurance Portability and Accessibility Act (HIPAA), Optivision can use your protected
health information for treatment, payment and health care operations.
a) Treatment - We may use or disclose your health information to a physician or other healthcare provider providing
treatment to you.
b) Payment - We may use and disclose your health information to obtain payment for services we provide you.
c) Health care operations - We may use and disclose your health information in connection with our healthcare
operations. Healthcare operations include quality assessment and improvement activities, reviewing the competency
or qualifications of healthcare professionals, evaluating provider performance, conducting training programs,
accreditation, certification, licensing or credentialing activities.

Your Authorization
Most uses and disclosures that do not fall under treatment, payment, health care operations will require your written
authorization. Upon signing, you may revoke your authorization (in writing) through our practice at any time.

Emergency Situations
In the event of your incapacity or an emergency situation, we will disclose health information to a family member, or
another person responsible for your care, using our professional judgment. We will only disclose health information
that is directly relevant to the person's involvement in your healthcare.

Marketing
We will not use your health information for marketing communications without your written authorization.

Required by Law
We may also use or disclose your health information when we are required to do so by law.

Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible
victim of abuse, neglect, or domestic violence or the victim of other crimes. We may disclose your health information
to the extent necessary to avert a serious threat to your or other people's health or safety.

National Security
We may disclose the health information of Armed Forces personnel to military authorities under certain
circumstances. We may disclose health information to authorized federal officials required for lawful intelligence,
counterintelligence and other national security activities. We may disclose health information of inmates or patients to
the appropriate authorities under certain circumstances.

Appointment Reminders
We may use or disclose your health information to provide you with appointment reminders via phone, e-mail or letter.

Your Rights as a Patient
You have the right to restrict the disclosure of your protected health information (in writing). The request for restriction
may be denied if the information is required for treatment, payment or health care operations.
-You have the right to receive confidential communications regarding your protected health information.
-You have the right to inspect and copy your protected health information.
-You have the right to amend your protected health information.
-You have the right to receive an account of disclosures of your protected health information.
-You have the right to a paper copy of this notice of privacy practices.

Legal Requirements
Optivision is required by law to maintain the privacy of your protected health information. We are required
to abide by the terms of this notice as it is currently stated, and reserve the right to change this notice. The policies in
any new notice will not be in effect until they are posted to this site, or are available within our office.

Complaints
If you have complaints regarding the way your protected health information was handled, you may submit a complaint
in writing to our office. You will not be retaliated against in any manner for a complaint.

Contact Information
For further information about Optivision's privacy policies, please contact Dr. Henry Rodgin at the
following address or phone number:
Optivision
1623 Hollenbeck Ave
Sunnyvale, CA 94087
(408) 773-0441




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