EMPIRE RECOVERY CENTER NOTICE OF PRIVACY PRACTICES

Effective Date of Notice: May 13, 2013

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.

We respect our legal obligation to keep information private that identifies you. We are obligated by law to give you notice of our privacy Empire Recovery Center s. This notice describes how we protect your information and what rights you have regarding it.

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

The most common reason why we use or disclose your information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing devices; referring you to another provider for care; or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your information for payment purposes are: asking you about your health plans, or other payors; and preparing or sending bills or claims."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 your information for health care operations are: financial or billing audits; internal quality assurance; education of residents and other professionals and related academic programs.

We routinely use your information for these purposes without any special permission.

USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION

In some limited situations, the law allows or requires us to use or disclose your information without your permission. Examples of such uses or disclosures are:

• When a state or federal law mandates that certain information be reported for a specific purpose
• To governmental authorities about victims of suspected abuse, neglect or domestic violence
• For health oversight activities, such as the licensing of professionals; for audits by payors; or for investigation of possible violations of health care laws
• For health related research
• To prevent a serious threat to health or safety
• Of a "limited data set" for research, public health, or health care operations
• Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures
• For legal purposes, such as subpoenas or court orders
• For law enforcement purposes, such as information pertaining to a victim of a crime; or to report a crime
• To a medical examiner; or to funeral directors; or to organizations that handle organ or tissue donations
• For specialized government functions, such as intelligence activities; disaster relief activities; or other national security activities authorized by law
• For public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or devices
• Of de-identified information
• relating to worker's compensation programs
• To "business associates" who provide services for us and who commit to respect the privacy of your information
• For security reasons, visitors to Empire Recovery Center facilities may be asked to wear name badges.
• The requirement of all Empire Recovery Center staff to wear identification badges while on duty.

Unless you object, we will also share relevant information about your care with your family, friends, or caregivers who are helping you with your vision rehabilitation needs.

APPOINTMENT REMINDERS

We may notify, call or write to remind you of scheduled appointments, or that it is time to make a routine appointment. We may also call or write to notify you of other services available at Empire Recovery Center that might help you. Unless you tell us otherwise, we may leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.

OTHER USES AND DISCLOSURES

We will not make any other uses or disclosures of your information unless you sign a written "authorization form". The content of an "authorization form" is mandated by Federal law. In all situations other than those described above, we will ask you for your written authorization before using or disclosing your information.

If you have given us an authorization, you may revoke it at any time, if we have not already acted on it. Revocations must be in writing.

YOUR RIGHTS REGARDING YOUR INFORMATION

1. You have the right to request restrictions on our uses and disclosures of your information for treatment, payment, and health care operations.

2. You have the right to reasonably request to receive communications of your information by alternative means or at alternative locations.

3. Subject to the payment of a reasonable copying charge, you have the right to inspect and receive a copy of the information contained in your records.

* By law, there are a few limited situations in which we can refuse to permit access or copying. For the most part, you will be able to review or receive a copy of your information within thirty days of receipt of your request (or sixty days if the information is stored off-site). If we deny your request, we will send you a written explanation and instructions about how to get an impartial review of our denial, if one is legally available. By law, we can have a thirty day extension of the time for us to give you access or photocopies, if we send you a written notice of the extension.

4. You have the right to request a correction to your information if you think it is incorrect or incomplete.

If we agree to your request, we will amend the information within thirty days of the request. If we do not honor your request, you will receive a written explanation, and you have the right to appeal to the contact person named below. By law, we have one thirty day extension of time to consider a request for amendment, if we notify you in writing of the extension.

5. You have the right to get a list of the disclosures that we have made of your personal information that occurred after April 14, 2003. By law, we need to maintain your information for six years. By law, the list will not include: disclosures for purposes of treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30 day extension of time if we notify you of the extension in writing. If you want a list, send a request to the contact person named at the end of this notice.

6. You have the right to get additional paper copies of this Notice of Privacy Practices upon request. If you want additional paper copies, send a request to the contact person named at the end of this notice.

OUR NOTICE OF PRIVACY PRACTICES

By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy Empire Recovery Center s will apply to your information that we already have, as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will inform you of substantive changes.

PRIVACY COMPLAINTS AND FOR MORE INFORMATION

If you believe that your privacy rights have been violated, you should immediately contact us. We will not take action against you for filing a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.

Empire Recovery Center
ATTN: Administrative Assistant
1237 California Street
Redding, CA. 96001

(530) 243-7470
Fax: (530) 243-7477