Privacy Practices

NOTICE OF PRIVACY PRACTICES FOR OPTIMIZED EYE CARE, PC

Optimized Eye Care P.C.

207 E. Ohio Street #233
Chicago, IL 60611

Contact Our Privacy Officer at (773) 309-1281 or privacy@govisibly.com

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

This notice describes how medical information about you may be used and disclosed by Optimized Eye Care, PC (“we”) and how you can get access to this information. Please review it carefully.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your Patient Chart

• You can ask to see or get an electronic or paper copy of your Patient Chart. Ask us how to do this at privacy@govisibly.com.
• We reserve the right to request identification from you to verify your identity before providing a copy of your Patient Chart to you.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your Patient Chart

• You can ask us to correct information about you that you think is incorrect or incomplete. Ask us how to do this at privacy@govisibly.com.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, but will do our best to accommodate you. However, we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. Request an accounting from privacy@govisibly.com.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action on your behalf.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the contact information on page 1
• You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We can not and will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us at privacy@govisibly.com. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information

Our Uses and Disclosures

How do we typically use or share your health information?

• We typically use or share your health information in the following ways.
  • Treat You
    • We can use your health information and share it with professionals, including eye care professionals (ophthalmologist, optometrist, optician, or optical staff) who are treating you.
      • Example: A doctor treating you for an injury asks another doctor about your overall health condition. Send your prescription to eye care product retailers.
      • We can use and share your health information, including your eyewear prescription information, with qualified eye care professionals and eye care product retailers so you can obtain appropriate vision or ocular products for your care.
      • Example: You would like to make a purchase from a retailer of eyewear. You successfully complete Visibly’s vision test and, by agreeing to the to the Service Agreement, you give us permission to send your health information, including vision test status, prescription, and any other pertinent information, to the retailer for the dispensing of your corrective eyewear.
• Run our organization
  • We can use and share your health information to run our practice, improve your care, and contact you when necessary.
    • Example: We use health information about you to manage your treatment and services. Bill for your health services.
    • We can use and share your health information to bill and get payment from health plans or other entities.
    • Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

• Help with public health and safety issues
  • We can share health information about you for certain situations such as:
    • Preventing disease
    • Helping with product recalls
    • Reporting adverse reactions to medications
    • Reporting suspected abuse, neglect, or domestic violence
    • Preventing or reducing a serious threat to anyone’s health or safety
• Do research
  • We may use or share your non-personally identifiable information for health research, such as for academic study, clinical advancements or diagnosis determination research. This research may be sold or made publicly available, but under no circumstances will it include any personally identifiable information. In addition, some research may result in the discoveries or developments of new technologies, medical devices, therapies, or treatments. In the event of any new discoveries or developments, you will have no proprietary or other ownership interest or claim for compensation related to these discoveries or developments.
• Comply with the law
  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
• Respond to organ and tissue donation requests and work with a medical examiner or funeral director
  • We can share health information about you with organ procurement organizations
  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies
• Address workers’ compensation, law enforcement, and other government requests
  • We can use or share health information about you:
    • For workers’ compensation claims
    • For law enforcement purposes or with a law enforcement official
    • With health oversight agencies for activities authorized by law
    • For special government functions such as military, national security, and presidential protective services
• Respond to lawsuits and legal actions
  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Note: we do not create or manage a hospital directory, or maintain psychotherapy notes.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
• For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Certain kinds of medical information may receive enhanced privacy protection under federal or state law. This includes medical information that is:

• Maintained in psychotherapy notes
• About alcohol and drug abuse prevention, treatment and referral
• About HIV/AIDS testing, diagnosis or treatment
• About venereal disease and/or communicable disease(s)
• About genetic testing

We do not expect to maintain this type of sensitive medical information. If we do, we will disclose this type of sensitive medical information only with your prior written authorization or if permitted or authorized by law. The protection given to this type of sensitive medical information may depend upon the State in which you receive services or treatment.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on our web site. You have the right to receive a paper copy of this Notice at any time. If you wish to do so, please contact our Privacy Official at privacy@govisibly.com.