Eyeworks of San Mateo complies with the Federal Health Insurance
Portability and Accessibility Act (HIPAA).  We take your privacy very
seriously and take every mean possible to ensure that privacy.
Note: This Notice of Privacy Practices is provided for educational and informational purposes only. This Notice is not intended as legal
advice, and is not provided for adoption or publication by any party. The publication of any such notice may create legal obligations or
liabilities which may vary depending upon the legal status and business operations of different organizations. The form and content of
any Notice of Privacy Practices should be determined only upon informed consultation with qualified legal counsel.

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), Eyeworks of San Mateo, 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
EYEWORKS OF SAN MATEO, AN OPTOMETRIC CENTER  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 EYEWORKS OF SAN MATEO's privacy policies, please contact
Dr. Gary Lai at the following address or phone number:

EYEWORKS OF SAN MATEO, AN OPTOMETRIC CENTER
214 SOUTH B STREET
SAN MATEO, CA 94401
650.343.2080
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