We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This notice describes how we protect your health information and what rights you have regarding it. The most common reason why we use or disclose your health information is for treatment, payment, or health care options. Examples of how we us or disclose information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses, or eye medications and faxing them to be filled; showing you low vision aids; referring you to another doctor or clinic for eye care or low vision aids or services; or getting copies of you're health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or vision care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). "Health care operations" mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our record. Unless you object, we will also share relevant information to remind you of scheduled appointments, or that it is time to make a routine appointment. We may also you tell us otherwise, we will mail you an appontment reminder on a post card, and/or leave you a reminder message on you home answering machine or with someone who answers your phone if you are not home. I consent to the use and disclosure by EyeX Optometry any information concerning my vision examination and products, to any third party and/or agent including, but not limited to my employer, health plan or plan sponsor, as needed for my treatment, the payment of my vision benefit claims, and related customer communication regarding health care services provided by EyeX Optometry. If I desire to seek third party reimbursement for the services received, I authorize EyeX Optometry to submit a vision benefit claim for payment to any third party as identified. I understand that I am responsible for all charges incurred, including any portion not paid by any third party. I understand that the consent for release if voluntary and I may revoke my consent at any time by notifying EyeX Optometry in writing, except for any disclosure alerady taken in reliance of my consent to release of information. I understand that I may request EyeX Optometry to restrict the use and disclosure of my information, as provided for by law. If desire to seek third party reimbursement for the services received,I authorize EyeX Optometry to submit a vision benefit claim for payment to any third party as identified.