HIPAA - Patient Privacy Act

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 I understand that I have certain rights to privacy regarding my protected health information. These rights are given to me under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). I understand that by initialing the consent form during my visit, I authorize Eye Physicians of the East Bay to use and disclose my protected health information to carry out: Treatment (including direct or indirect treatment by other healthcare providers involved in my treatment); obtaining payment from third party payers (e.g. my insurance company). I further acknowledge that a copy of the current notice will be made available to me upon request, and I will be offered a copy of any amended notice of Privacy Practices at each appointment.

Consumer information is not shared with third parties for marketing purposes.