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 staus and business operations of different organizations. The form and content of any Notice of Privacy Practices should be determined only upon informed consultaion with 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 of Notice As a patient you have the right to adequate notice of the uses and disclosures of your protected health information. Under the Health Inurance Portability and Accessility Act (HIPAA), Peninsula Optometry can use your protected health information for treatment, payment and health care operations. a) Treatment- We may use your or disclose your health informationto 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 amy use and disclose your health information in connection with our heaalthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the compency 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 oprations 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 judgement. we will only disclose health information that is directly relevent 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 amy also use or diclose your health information when we are required by 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 victom of abuse, neglect, or domestic violence or the victom of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to you or other people's health or safety.

National Security We may disclose the health information Armed Forces personnel to military authorities under certain circumstances. We may disclose helth informationto authorized federal officials required for lawful intelligence, counterintelligence and otehr national srcurty activities. We may disclose health information of inmates or patients to the appropriate authorites under certain circumstances.

Appointment Reminders We may use or disclose your health information to provide you with appointment reminders via the phone, email 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 recieve confidential communications regarding your protected health information. You have the right to inspect and copy your protected health information. You have the right amend your protected health information. You have the right to recieve an account of disclosures if your protected health information. You have the right to a paper copy of this notice of privacy practices.

Legal Requirements Peninsula Optometry is required by law to maintain the privacy of you protected health information. Weare 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 or office.

Complaints If you have complaints regarding the way your protected health information was handled you may 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 peninsula Optometry's privacies, please contact Dr. Trina Winn at the following address or phone number: Peninsula Optometry 19051 Goldenwest Street Ste 102 Huntington Beach, CA 92648 714-698-2626