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Christa Kim, O.D. and Associates, PC Custom Eyes Optique and Eyecare

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS IT. PLEASE REVIEW IT CAREFULLY.

We are obligated to maintain the privacy of your protected health information and to provide you with this Notice of Privacy Practices and to abide by its terms. We reserve the right to change our privacy practices and apply revised privacy practices to protected health information. You may request a copy of our notice at any time, or print a copy from our website. For more information about our privacy policies, please contact us at 2840 Legacy Drive Suite #430 Frisco, TX 75034.

USES AND DISCLOSURES OF MEDICAL INFORMATION

We use and disclose medical information about you for treatment, payments and referrals to specialists (if necessary). This office may use and disclose medical and financial information related to your care that may be necessary now or in the future to facilitate payment by third parties for services rendered by us, to assist with, aid in, or facilitate the collection for data for purposes of utilization review, quality assurance or medical outcomes evaluation purposes. Such

INDIVIDUAL RIGHTS

This office will not use or disclose any of your medical and financial information for any purpose not state bout without your specific authorization. You may revoke your authorization at any time. You may request restrictions on certain uses and disclosures. This office is not required to agree to a requested restriction. You have the right to receive confidential communications of your protected health information. You have the right to inspect, copy, and amend your protected health information. You may also request and accounting of disclosures of your protected health information from this office. We may charge a cost based fee for copying records and for postage.

QUESTIONS AND COMPLAINTS

You may register a complaint with this office if you suspect that your privacy rights have been violated. We will investigate the complaint and inform you of the findings. No retaliation will be made against you by this office because you registered a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.