NOTICE OF PRIVACY PRACTICES

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 March 1, 2003 until further notice.

The Health Insurance Portability & Accountability Act of 1996 (?HIPAA?) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. As required by ?HIPAA?, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

We may use and disclose your medical records for each of the following purposes: treatment, payment and health care operations. Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would be if we referred you to another doctor for cataract surgery. Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities. An example of this would be sending a bill for your exam to your insurance company for payment. Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review.

We may contact you to provide appointment reminders or information about treatment alternatives.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Douglas Hollabaugh, O.D. or Betty Kinoshita, O.D.:

* 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. * The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations. * The right to inspect and copy your protected health information. * The right to amend your protected health information. * The right to receive an account of dislcosures of your protected health information. * The right to obtain a paper copy of this notice from us upon request.

In emergency situations and in the event of your incapacity, we will dislcose your health information to a family member, or another person responsible for your care, using our professional judgement. We will only dislcose health information that is directly relevant to the person?s involvement in your healthcare.

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

El Dorado Hills Eyecare Optometry 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 in our office.

If you have a complaint regarding the way your protected health information has been handled, you may submit a complaint in writing to us or the the U.S. Department of Health and Human Services. You will not be retaliated against in any manner for a complaint.

Contact information: Douglas Hollabaugh, O.D. Betty Kinoshita, O.D. 899 Embarcadero Dr., Ste 3 El Dorado Hills CA 95762 (916) 939-6631