HIPAA Privacy Notice

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HIPPA Privacy Notice LaserCare Eye Center notice of Privacy Practices Effective August 1, 2005 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. WHO WILL FOLLOW THIS NOTICE? This notice describes the practices of LaserCare Eye Center and the practices that will be followed by all of LaserCare Eye Center workforce members who handle your medical information. OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION LaserCare Eye Center understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We maintain our records and conduct our treatment environment with a goal of providing the highest level of protection for your medical information, while still providing you with the highest level of medical care. This notice applies to all of the records of your medical care which are received or created by LaserCare Eye Center. Your other medical treatment providers (e.g. doctors, hospitals, home health agencies, etc.) may have different policies or notices regarding the use and disclosure of your medical information. This notice will tell you about the ways in which LaserCare Eye Center may use and disclose medical information about you. Your medical information, also referred to as “protected health information” is that information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health information and related health care services. In this notice, we also describe your rights and certain obligations LaserCare Eye Center has regarding the use and disclosure of your protected health information. We are required by name to:

Make sure that medical and other information that identifies you (protected health information) is kept private. Give you this notice of our legal duties and privacy practices with respect to protected health information about you. Follow the terms of the notice that is currently in effect.

USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS By becoming a patient at LaserCare Eye Center, you are giving consent for LaserCare Eye Center to use your protected health information for certain activities, including treatment, payment and other health care operations. Sometimes, you may hear these three activities referred to as “TPO”. First of all, we may use and disclose protected health information about you so that LaserCare Eye Center and its medical professionals can treat you. For example, we may use your past medical information in order to diagnose your present condition or we may provide information regarding your medical condition to another doctor to whom we refer you for additional care. We may also use and disclose protected health information about you so that we may be paid for the medical treatment we provide you. For example, we will submit protected health information about you to your insurance company in order to receive payment for services we have provided to you. We may also use and disclose protected health information about you for LaserCare Eye Center’s health care operations, in other words, those other tasks that we need to perform to make sure that you are provided the highest quality of medical care. For example, we may use your protected health information to evaluate how we can better meet your needs or we may provide protected health information about you to an auditor who reviews our books so that we can keep our license to provide medical services in 440 W. Interstate 635, #300, Irving, TX, 75063. Other uses and disclosures of your protected health information The following uses of your protected health information may be made without any additional authorization from you. (Not every use or disclosure is listed, but be assured that all uses and disclosures made by LaserCare Eye Center are only those which are permitted under the law). Licensure proceedings by the American Board of Plastic Surgery. Uses and disclosures for appointment reminders We may use and disclose your medical information to contact you as a reminder that you have an appointment at the office. If you request that such communications be made confidentially, please contact our office in writing at 440 W. Interstate 635, #300, Irving, TX, 75063 . We will accommodate all reasonable requests. Uses and disclosures to others involved in your healthcare We may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your medical care. If you are unable to agree or object to this disclosure, we may disclose such information as necessary if we determine that it is in your best interests based on our professional judgment. We may also use or disclose protected health info

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