Your Authorization

Your protected health information (PHI) such as your name, date of birth, phone/fax numbers, email address, home address, and social security number shall only be used when it pertains to your diagnosis and treatment and may only be used by administrative personnel and the doctors at Capitol Eye Care Center. After signing our Privacy Notice, you may revoke your authorization in writing 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 judgement. We will only disclose health information that is directly relevant to the person’ s involvement in your healthcare.


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 also use or 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 you 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.

Your Rights as a Patient

You have the right to restrict the disclosure or 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 heath information. You have the right to a paper copy of this Notice of Privacy Practices.

Legal Requirements

Capitol Eye Care Center is required by law to maintain the privacy of your protected health information. We are required by law to abide by the terms of this notice as it is currently stated, and reserve the right to change this notice.


If you have complaints regarding the way your protected health information was handled, you may submit a complaint (in writing) to Enjoli Perkins, Privacy Officer, at the address shown at the beginning of this notice. You will not be retaliated against in any manner for a complaint.

Examples of how we may use information for treatment purposes

  1. When we set up an appointment for you.
  2. When our technician or doctor tests your eyes.
  3. When the doctor prescribe medication.
  4. When our staff helps you select and order glasses or contacts.
  5. Appointment reminders via phone, postcard, etc.
  6. If we refer you to another doctor or clinic for eye care.
  7. When we provide a prescription for medication to a pharmacist.
  8. When we phone to let you know that your glasses or contacts are ready for dispensing.
  9. When we ask you about health or vision care insurance plans.
  10. When we prepare claims, billings or payments to you.