NOTICE OF PRIVACY PRACTICE

Dr. Robert K. Browder, Optometrist
415 N. Greenwood, Suite F
Pueblo, CO 81003
Office:(719)561-4365

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.

THIS NOTICE IS EFFECTIVE 04/01/03 UNTIL FURTHER NOTICE.

Right to Notice
As a patient, you have the right to adequate notice of the uses and disclosures of your
protected health information. Under the Health Insurance Portability and Accessibility Act
(HIPAA), Dr. Robert K. Browder can use your protected health information for
treatment, payment and health care operations.
a) Treatment - We may use or disclose your health information to a physician or other
healthcare provider providing treatment to you.
b) Payment - We may use and disclose your health information to obtain payment for
services we provide you.
c) Health care operations - We may use and disclose your health information in connection
with our healthcare operations. Healthcare operations include quality assessment and
improvement activities, reviewing the competency or qualifications of healthcare
professionals, evaluating provider performance, conducting training programs,
accreditation, certification, licensing or credentialing activities.

Your Authorization
Most uses and disclosures that do not fall under treatment, payment, health care
operations will require your written authorization. Upon signing, you may revoke your
authorization (in writing) through our practice at any time.

Emergency Situations
In the event of your incapacity or an emergency situation, we will disclose health
information to a family member, or another person responsible for your care, using our
professional judgment. We will only disclose health information that is directly relevant to
the person's involvement in your healthcare.

Marketing
We will not use your health information for marketing communications without your
written authorization.

Required by Law
We may also use or disclose your health information when we are required to do so by
law.

Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably
believe that you are a possible victim of abuse, neglect, or domestic violence or the victim
of other crimes. We may disclose your health information to the extent necessary to avert
a serious threat to your or other people's health or safety.

National Security
We may disclose the health information of Armed Forces personnel to military authorities
under certain circumstances. We may disclose health information to authorized federal
officials required for lawful intelligence, counterintelligence and other national security
activities. We may disclose health information of inmates or patients to the appropriate
authorities under certain circumstances.

Appointment Reminders
We may use or disclose your health information to provide you with appointment
reminders via phone or postcard.

Your Rights as a Patient
You have the right to restrict the disclosure of your protected health information (in
writing). The request for restriction may be denied if the information is required for
treatment, payment or health care operations.
-You have the right to receive confidential communications regarding your protected
health information.
-You have the right to inspect and copy your protected health information.
-You have the right to amend your protected health information.
-You have the right to receive an account of disclosures of your protected health
information.
-You have the right to a paper copy of this notice of privacy practices.

Legal Requirements
Dr. Robert K. Browder, Optometrist, is required by law to maintain the privacy of your
protected health information. We are required to abide by the terms of this notice as it is
currently stated, and reserve the right to change this notice. The policies in any new notice
will not be in effect until they are posted to this site, or are available within our office.

Complaints
If you have complaints regarding the way your protected health information was handled,
you may submit a complaint in writing to our office. You will not be retaliated against in
any manner for a complaint.

Contact Information
For further information about Dr. Browder's privacy policies, please contact Dr. Browder
at the following address or phone number:
Dr. Robert K. Browder, Optometrist
415 N. Greenwood, Suite F
Pueblo, CO 81003
(719)561-4365