Modern Family Vision Mary E. Leazure, O.D. 906 W. McDermott Dr., Suite 120 Allen, TX 75013

Notice Of Privacy Practices This notice describes how medical information about you may be used and disclosed and how you may get access to it. Please review it carefully.

1.) OUR PLEDGE REGARDING MEDICAL INFORMATION: the privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our practice. We need this record to provide you with quality care and comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information.

2.) OUR LEGAL DUTY: Law requires us to: 1.) keep your medical information private. 2.) offer you this notice describing our legal duties, privacy practices, and your rights regarding your medical information. 3.) follow the terms of current notice.

We have the right to: 1.) change our privacy practices and the terms of this notice at any time, provided the changes are permitted by law. 2.) make the changes in our privacy practices and the new terms of our notice effective for all medical information we keep, including information previously created or received before the changes.

Notice of changes to privacy practices: 1.) if we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.

USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION: The following section describes different ways that we use and disclose medical information. Not every use or disclosure will be listed. However, we have listed all of the different ways we are permitted to use and disclose medical information. we will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us at the address listed at the top of this page. FOR TREATMENT: we may use medical information about you to provide you with medical treatment or services. We may this information to doctors, nurses, technicians, medical students, or other people who are taking care of you. We may also share medical information about you to your other health care providers to assist them in treating you.

FOR PAYMENT: we may use and disclose your medical information for payment purposes. A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include your medical information.

FOR HEALTH CARE OPERATIONS: we may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.

ADDITIONAL POSSIBLE USES: facility directory, notification, disaster relief, fundraising, research In limited circumstances, funeral director, coroner, medical examiner, specialized government functions, court orders and judicial and administrative proceedings, public health activities, victims of abuse, Turn page over neglect domestic violence, workers compensation, health oversight activities, law enforcement, appointment reminders and alternative and additional medical services.

YOUR INDIVIDUAL RIGHTS: You have a right to:: 1.) look at or get copies of certain parts of your medical information. You may request this information by writing to us at the address listed on the front page of this notice. If you request copies, we will charge you 25 cents for each page, and postage if you want the copies mailed to you. 2.) receive a list of all the times we or our business associates shared your medical information for purposes other than treatment, payment, and health care operations and other specified exceptions. 3.) request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in case of emergency). 4.) request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means or at different locations must be made in writing. 5.) Request that we change certain parts of your medical information. We may deny your request if we did not create the information you want changed or for other certain reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. if we accept your request to change the information, we will make reasonable efforts to tell other, including people you name, of the change and to include the changes in any future sharing of information. 6.) if you received this notice electronically, and wish to receive a paper copy, you have the right to obtain a paper copy by making a request in writing to the contact person listed at the end of this notice.

If you have any questions about this notice or if you think we may have violated your privacy rights, please contact us. You may also submit a written complaint to the U.S Department of Health and Human Services, we will provide with the address. You may also contact us to submit a complaint or submit requests involving any of your rights in section 4 of this notice by writing to the address on the front of this page.

We will not retaliate in any way if you choose to file a complaint. These privacy practices will remain in effect until further notice.