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Effective Date: 09.23.2013Revision Date: 01.29.2016
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.
Other Uses and Disclosures of Your Health InformationExcept as described in this Notice, we will not use or disclose your health information without your written authorization. If you do authorize us to use or disclose your health information, you may revoke your authorization in writing at any time. If you revoke your authorization, this will stop any further use or disclosure of your health information for purposes covered by your written authorization, except if we have already acted on your permission. Please refer to the Notice Addendum to find out about any stricter laws in your State that we must follow when using or disclosing your health information, or any State laws that give you greater rights with respect to your health information.
You Have the Following Rights with Respect to Your Health Information.
Changes to this Notice of Privacy PracticesWe reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our store locations. If we change our Notice, you may obtain a copy of the revised Notice by visiting our website at www.nationalvision.com, or upon request at any of our store locations.
For More Information or to Report a ProblemIf you have questions and would like additional information, you may contact the Privacy Officer at 770-822-3600. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services, Office of Civil Rights, HIPAA, 200 Independence Avenue, S.W., Washington, DC 20201. To file a complaint with us, please contact: Privacy Officer, National Vision, Inc., 2435 Commerce Avenue, Bldg. 2200, Duluth, GA 30096. All complaints must be submitted in writing. Forms also are available on-line at www.nationalvision.com and can be submitted by E-mail to: firstname.lastname@example.org or by fax to 770-822-6206. There will be no retaliation for filing a complaint.
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