NOTICE OF PRIVACY PRACTICES

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your health information is important to us. If you have any questions about this notice, please contact Dr. Charles R. Nicholson at 208-322-8439 or email dr.nicholson@clearviewboise.com.

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPPA). It describes how we may use or disclose your protected health information, with whom that information may be shared and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside or our system except when the release is required or authorized by law or regulation. This notice takes effect immediately and will remain in effect until we replace it.

Acknowledgement of Receipt on the Notice

You will be asked to provide a signed acknowledgement of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgement. If you decline to provide a signed acknowledgement, we will continue to provide your treatment and will use and disclose your protected health information for treatment, payment and health care operations when necessary.

Our Duties to You Regarding Protected Health Information

“Protected health information” is individually identifiable health information. This information includes demographics, for example, age, address, e-mail address and relates to your past, present or future physical or mental health or condition and related health care services. We are required by law to do the following: • Make sure that your protected health information is kept private. • Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information. • Follow the terms of the notice currently in effect. • Communicate any changes in the notice to you.

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. You may obtain a Notice of Privacy Practices by contacting our office. You may request a copy be mailed to you or ask for a copy at your next appointment.

How We May Use or Disclose Your Protected Health Information

Following are examples of permitted uses and disclosures of your protected health information. These examples are not exhaustive.

Required Uses and Disclosures. By law, we must disclose your health information to you unless a competent medical authority has determined that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.

Treatment. We will use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your health information to doctors, nurses, technicians or other personnel who are involved in taking care of you. We may disclose your protected health information from time-to-time to another treatment facility, physician or health care provider (for example, a specialist, pharmacist or laboratory) who, at the request of your doctor, becomes involved in your care by providing assistance with your health care diagnosis or treatment. This includes pharmacists who may be provided information on other drugs you have been prescribed to identify potential interactions. In emergencies, we will use and disclose your protected health information to provide the treatment you require.

Payment. Your protected health information will be used, as needed, to obtain payment for your health care services. For example, we may give your health information to your insurance company about treatment you receive so they will pay us or reimburse you. We may also tell your insurance company about treatment you are going to receive to obtain prior approval or find out whether they will pay for the treatment.

Health Care Operations. We may use or disclose, as needed, your protected health information to support the daily activities related to health care. These activities include, but are not limited to, quality assessment activities, investigations, oversight or staff performance reviews, licensing, communications about a product or service, and conducting or arranging for other health care related activities. For example, we may call you by name in the waiting room when your doctor is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We will share your protected health information with third party “business associates” who perform various activities (for example, spectacle frame companies and opticianry labs). The business associates will also be required to protect your health information. We may use or disclose your protected health information, as necessary to provide you with information about treatment alternatives or other health related benefits and services that might interest you.

Required by Law. We may use or disclose your protected health information if law or regulation requires the use or disclosure.

Public Health. We may disclose your protected health information to a public health authority that is permitted by law to collect or receive the information. The disclosure may be necessary to do the following: • Prevent or control disease, injury or disability. • Report births and deaths. • Report child abuse and neglect. • Report reactions to medications or problems with products. • Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. • Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.

Communicable Diseases. We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight. We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil right laws.

Food and Drug Administration. We may disclose your protected health information to a person or company required by the Food and Drug Administration to do the following: • Report adverse events, product defects or problems and biologic product deviations. • Track products. • Enable product recalls. • Make repairs or replacements. • Conduct post-marketing surveillance as required.

Legal Proceedings. We may disclose protected health information during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena discovery request, or other lawful process.

Law Enforcement. We may disclose protected health information for law enforcement purposes, including the following: • Responses to legal proceedings. • Information requests for identification and location. • Circumstances pertaining to victims of a crime. • Deaths suspected form criminal conduct. • Crimes occurring at the office (11513 W. Fairview Avenue Suite 103 Boise, Idaho 83713) • Emergencies believe to result from criminal conduct.

Coroners, Funeral Directors and Organ Donations. We may disclose protected health information to coroners or medical examiners for identification to determine the case of death or for the performance of other duties authorized by law. We may also disclose protected health information to funeral directors as authorized by law. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donations.

Research. We may disclose your protected health information to researchers when authorized by law, for example, if their research has been approved by an institutional review board that has reviewed the research proposal and established protocol to ensure the privacy of your protected health information.

Criminal Activity. Under applicable Federal and state laws, we may disclose your protected health information if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security. When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel for activities believed necessary by appropriate military command authorities to ensure the proper execution of the military mission including determination of fitness for duty or to a foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information to authorized Federal officials for conducting national security and intelligence activities including protective services to the President or others.

Workers’ Compensation. We may disclose your protected health information to comply with workers’ compensation laws and other similar legally established programs.

Inmates. We may use or disclose your protected health information if you are an inmate of a correctional facility, and we created or received your protected health information while providing care to you. This disclosure would be necessary (1) for the institution to provide you with health care, (2) for your health and safety or the health and safety to others, or (3) for the safety and security of the correctional institution.

Uses and Disclosures of Protected Health Information Requiring Your Permission

In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required. Unless you object, 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 health care. We may also give information to someone who helps pay for your care. Additionally we may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person who is responsible for your care, of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and coordinate uses and disclosure to family or other individuals involved in your health care.

Your Rights Regarding Your Health Information

You may exercise the following rights by submitting a written request to ClearView Family Eyecare 11513 W. Fairview Avenue Suite 103 Boise, Idaho 83713, or electronic message to Chucknic@excite.com. Please be aware that your request may be denied; however, you may seek a review of the denial.

Right to Inspect and Copy. You may inspect and obtain a copy of your protected health information that is contained in a “designated record set” for as long as we maintain the protected health information. A designated record set contains medical and billing records and any other records that we use for making decisions about you. This right does not include inspection and copying of the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information. You must make a request in writing to obtain access your health information. We will charge you a reasonable cost-based fee for expenses such as copies and stiff time.

Right to Request Restrictions. You may ask us not to use or disclose any part of your protected health information for treatment, payment, or health care operations. Your request must be made in writing where you wish the restriction instituted. In your request, you must tell us (1) what information you want restricted; (2) whether you want to restrict our use, disclosure, or both; (3) to whom you want the restriction to apply, for example, disclosures to your spouse; and (4) an expiration date. If we believe that the restriction is not in the best interest of either party, or we cannot reasonably accommodate the request, we are not required to agree. If the restriction is mutually agreed upon, we will not use or disclose your protected health information in violation of that restriction, unless it is needed to provide emergency treatment. You may revoke a previously agree upon restriction, at any time, in writing.

Right to Request Confidential Communications. You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable requests, when possible.

Right to Request Amendment. If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain the information. While we will accept requests for amendment, we are not required to agree to the amendment.

Right to an Accounting of Disclosures. You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. The disclosure must have been made after July 9, 2007, and no more 6 years from the date of request. This right excludes disclosures made to you, to family members or friends involved in your care, or for notification. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this notice.

Right to Obtain a Copy of this Notice. You may obtain a paper copy of this notice from our office.

Complaints

If you believe these privacy rights have been violated, you may file a written complaint with our office or the Department of Health and Human Services. No retaliation will occur against you for filing a complaint.

Contact Information

You may contact your Privacy Officer for further information about the complaint process, or for further explanation of this document. Your Privacy Officer may be contacted at ClearView Family Eyecare 11513 W. Fairview Avenue Suite 103 Boise, Idaho 83713, by phone at 208-322-8439. You may also e-mail questions to Chucknic@excite.com.

This notice is effective in its entirety as of July 9, 2007.