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Proctor Vision Clinic is committed to protecting the confidentiality of your medical information and is required by law to do so. The Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations, and for other purposes that are permitted and required by law. It also describes your rights to access and control your protected health information. We ask for your consent to use and disclose your PHI, as outlined in our Notice of Privacy Practices, by asking you to sign the Consent for Treatment form regarding your care. Generally, unless specifically allowed by state or federal regulations without an authorization, Proctor Vision Clinic will seek a signed authorization from a consumer or personal representative before disclosing PHI to a third party.

USES AND DISCLOSURES Proctor Vision Clinic may use or disclose your protected health information as follows:
Uses and Disclosures with Your Permission: Uses and disclosures of PHI will generally only be made with your written permission, called a “Release of Information”. You have the right to revoke a Release at any time.

For Treatment: Our office will use and disclose your PHI to provide and coordinate your health care and any related services. We may also disclose your PHI to another health care provider working outside of our office for purposes of your treatment.

For Payment: Our office may use and disclose PHI about your for the purpose of determining coverage, billing, claims management, medical data processing, and reimbursement. The information may be released to an insurance company or a third party payer, or its agent. You may request restriction of this if paying for your own services.

For Health Care Operations: Our office may use and disclose PHI about you in order to support quality improvement and other business activities of our organization. These uses and disclosures are necessary for our operations and ensure the quality of care received by our patients.

Other Uses and Disclosures Provided by Law without Authorizations: Our office may use and disclose PHI about you for other purposes and to other individuals and entities without a signed authorization, as provided by state and federal law. This includes but is not limited to court orders, child abuse reporting, adult protective services reporting, etc.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding your protected health information (PHI):

• Right to inspect and have a paper/electronic copy
• Right to request confidential communications
• Right to request an Amendment
• Right to request restrictions
• Right to a paper copy of Notice
• Right to an accounting of certain disclosures
• Right to be notified of breach of unsecured PHI

In 1994, The Vision Care Customer Assistance Act changed the rules governing how contact lenses are prescribed in the State of Washington. This notice is to help clarify these rules.

Shortly, you will see a practitioner who may perform an evaluation for contact lenses. These tests are not part of your routine eye examination. Most insurance companies do not cover the cost of contact lens services, or will cover only a portion of these costs.

To prescribe contact lenses, tests must be completed to evaluate the effects of the contact lenses have on your overall eye health. If you choose to have your contact lenses prescribed elsewhere, you will receive a copy of your glasses prescription stating “OK for Contact lenses” per the Vision Care Consumer Assistance Act. A contact lens prescription does not exist un-l you have seen a practitioner for a followup visit with the prescribed contacts on and the fitting is deemed complete (Washington State Law RCW 181.95). Federal regulations also apply to contact lens prescriptions.

Contact lens fees are not refundable and do not include the cost of contact lens materials.

Evaluation for current lens wearers: $75-$125

Evaluation for new lens wearers: $116-$285

DILATED FUNDUS EXAMINATION

Dilation enables the doctor to examine the eye for cataracts, glaucoma, and other conditions that may result in loss of vision. Early signs of diabetes, arteriosclerosis, and high blood pressure can be detected. In addition, the doctor can examine the retina for any holes, tears, detachments, or tumors.

In order to dilate the eyes, drops are instilled which widen the pupils within 15-20 minutes. Your vision, especially reading vision, may become blurred for about 4-6 hours. Dilation also has a tendency to make your eyes more sensitive to light, so disposable sunglasses are available to ease the glare from the sun.

OPTOMAP + OCT RETINAL EXAMINATION

An Optomap provides your doctor with a view of approximately 82% of your retinal in a single photo capture and helps your doctor to evaluate your vision health The OCT is non-invasive and uses light to capture thickness and details of the optic nerve and layers of the retina. An Optomap + OCT Retinal Exam is fast, painless, and does not require dilating eye drops. Early signs of macular degeneration, diabetes, and hypertension can be detected, in addition to eye birth defects and retinal tears, holes, detachments. A benefit of an annual Optomap + OCT Retinal Exam is a permanent record to compare and track potential eye diseases.