Privacy InView Vision Respects your Privacy
InView Vision Notice of Privacy Practices.

This notice described how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

InView Vision respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information without your authorization or unless the law authorizes or requires us.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information for other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment, health care operations and to disclose this information for payment purposes.

Examples of Use and Disclosures of Protected Health Information for Treatment, Payment and Health Operations.

• Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you.
• We may also provide information to others providing you care. This will help them stay informed about your care.

For payment:

• If we request payment from your health insurance plan, health plans need information from us about your medical care. Information provided to health plans may include your diagnosis, procedures performed, or recommended care.

For health care operations:

• We use your medical records to assess quality and improve services.
• We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff.
• We may contact you to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services.
• We may contact you to raise funds.
• We may use and disclose your information to conduct or arrange for services, including:
  • Medical quality review by your health plan;
  • Accounting, legal, risk management, and insurance services;
  • Audit functions, including fraud and abuse detection and compliance programs.

Your Health Information Rights

The health and billing records we create and store are the property of InView Vision. The protected health information in it, however, generally belongs to you. You have a right to:

• Receive, read, and ask questions about this Notice;
• Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request;
• Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information ("Notice");
• Request that you receive a copy of your protected health information. You must make this request in writing. InView Vision has a form available for this type of request. You may request this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months;
• Have us review a denial of access to your health information;
• Ask us to amend your health information. You must give us this request in writing. Review of such requests may take up to 60 days to implement. We are not required to grant the request. You may write a statement of disagreement if your request is denied. It will be stored in your medical record and included with any release of your records.
• Request that you receive a list of disclosures of your health information. The list will not include disclosures to third-party payers. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months.
• Ask that your health information be given to you by another means or at another location. You must make this request in writing.
• Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Authorization requests cannot be cancelled if its purpose was to obtain insurance.

Our Responsibilities

We are required to:

• Keep your protected information private;
• Give you this Notice;
• Follow the terms of this Notice.

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by visiting our InView Office to pick one up or by visiting our website at www.inviewvision.com.

To Ask for Help or Complain

If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact:

Matthew Marsich, O.D.
Clinical Director
InView Vision

If you believe your privacy rights have been violated, you may discuss your concerns or deliver a written complaint to Matthew Marsich, OD, Privacy Officer at the address and phone number above.

You may also file a complaint with the U.S. Secretary of Health and Human Services. We respect your right to file a complaint with us or with the US Secretary of Health and Human Services. If you file a complaint, we will not retaliate against you in any way.

Other Disclosures and Uses of Protected Health Information

Notification of Family and Others

• Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose health information about you to assist in disaster relief efforts.

You have the right to object to these uses or disclosure of your information. If you object, we will not use or disclose it.

We may use and disclose your protected health information without your authorization as follows:

• With Medical Researchers - if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
• To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.
• To Comply with Workers' Compensation Laws - if you make a workers' compensation claim.
• For Public Health and Safety Purposes as Allowed or Required by Law:
  • To prevent or reduce a serious, immediate threat to the health or safety of a person
  • Or the public.
  • To public health or legal authorities
    • To protect public health and safety
    • To prevent or control disease, injury, or disability
    • To report vital statistics such as births or deaths.
• To Report Suspected Abuse or Neglect to public authorities.
• To Correctional Institutions if you are in jail or prison, as necessary for your health and the health and safety of others.
• For Law Enforcement Purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
• For Health and Safety Oversight Activities. For example, we may share health information with the Department of Health.
• For Disaster Relief Purposes. For example, we share health information with disaster relief agencies to assist in notification of your condition to family or others.
• For Work-Related Conditions That Could Affect Employee Health. For example, an employer may ask us to assess health risks on a job site.
• To the Military Authorities of US and Foreign Military Personnel. For example, the law may require us to provide information necessary to a military mission.
• In the Course of Judicial/Administrative Proceedings at your request, or as directed by a subpoena or court order.
• For Specialized Government Functions. For example, we may share information for national security purposes.

Other Uses and Disclosures of Protected Health Information

Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.

Web Site

We have a Web site that provides information about us. For your benefit, this Notice is on the Web site at this address: www.inviewvision.com.

Effective Date:

The effective date of this Notice is June 2, 2005.