NOTICE OF PRIVACY PRACTICES
Periman Eye Institute, PLLC
100 W. Harrison Street, North Tower, Suite 360
Seattle, WA 98119
Effective Date: August 12, 2026
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YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN GET ACCESS TO THIS INFORMATION, AND YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice applies to Periman Eye Institute, PLLC ("Periman Eye Institute," "we," "our," or "the Practice") and its physicians, health care professionals, employees, trainees, and other members of its workforce.
For purposes of this Notice, Protected Health Information ("PHI") generally means individually identifiable information about your past, present, or future physical or mental health or condition, the health care provided to you, or payment for your health care.
In addition to federal privacy protections under the Health Insurance Portability and Accountability Act ("HIPAA"), health care information may be protected by Washington State law, including Chapter 70.02 RCW. When another applicable law provides greater privacy protection than HIPAA, we will follow the more protective requirement where required.
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YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities.
Get an Electronic or Paper Copy of Your Medical Record
You may ask to see or obtain an electronic or paper copy of your medical record and other health information we maintain about you.
We will provide access within the time required by applicable law. Under Washington law, upon receipt of a written request, we generally will make the requested information available, provide the requested copy, or otherwise respond to the request within 15 working days. In certain circumstances permitted by law, additional time may be necessary.
We may charge a reasonable fee when permitted by applicable law.
Certain limited information may not be available for inspection or copying when access may lawfully be denied. If we deny access to some or all of your information, we will explain the denial and any rights you may have to review or challenge that decision.
Ask Us to Correct Your Medical Record
You may ask us to correct or amend health information about you that you believe is incorrect or incomplete.
We may deny your request in certain circumstances permitted by law. If we deny your request, we will explain the reason in writing and inform you of any additional rights you have.
Request Confidential Communications
You may ask us to contact you in a specific way or at a specific location.
For example, you may ask us to call you only at a particular telephone number, communicate through a patient portal, or send correspondence to a particular address.
We will accommodate reasonable requests as required by law.
Ask Us to Limit What We Use or Share
You may ask us not to use or disclose certain health information for treatment, payment, or health care operations.
We generally are not required to agree to your request.
However, if you pay in full out of pocket for a particular health care item or service and ask us not to disclose information about that item or service to your health plan for payment or health care operations, we will honor that request unless disclosure is required by law.
Get a List of Certain Disclosures
You may ask for an accounting of certain disclosures of your health information made during the six years before the date of your request.
The accounting generally does not include disclosures made for treatment, payment, or health care operations; disclosures made directly to you; disclosures you authorized; and certain other disclosures excluded by law.
We will provide one accounting during any 12-month period without charge. We may charge a reasonable, cost-based fee for additional requests during the same 12-month period after notifying you of the cost and giving you an opportunity to withdraw or modify your request.
Choose Someone to Act for You
If you have given someone legal authority to act for you, such as through a valid health care power of attorney, or if someone is otherwise legally authorized to act as your personal representative, that person may exercise your privacy rights on your behalf as permitted by law.
We may verify that the person has authority to act for you before taking action.
Receive Notice of a Breach
You have the right to be notified if a breach of your unsecured PHI occurs and notification is required by law.
Get a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.
An electronic version may also be available on our website.
File a Complaint
You may complain if you believe your privacy rights have been violated.
We will not retaliate against you for filing a complaint.
Contact information for our Privacy Officer and the U.S. Department of Health and Human Services Office for Civil Rights appears at the end of this Notice.
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YOUR CHOICES
For certain health information, you may tell us your preferences about what we share.
Family Members, Friends, and Others Involved in Your Care
You may tell us whether you want us to share relevant information with a family member, friend, caregiver, or another person involved in your care or payment for your care.
If you are unable to tell us your preference, such as during an emergency, we may share information when permitted by law if we determine that doing so is in your best interest.
We may also share information when necessary to lessen a serious and imminent threat to health or safety as permitted by law.
Disaster Relief
We may share limited information with organizations assisting in disaster relief efforts when permitted by law so that family members or others responsible for your care may be notified about your location, general condition, or circumstances.
Marketing
Most uses or disclosures of your PHI for marketing purposes that are not otherwise permitted by law require your written authorization.
We will obtain your authorization when required.
Sale of PHI
We will obtain your written authorization before selling your PHI when authorization is required by law.
Fundraising
If Periman Eye Institute contacts you for fundraising purposes, you have the right to tell us not to contact you again for fundraising.
If we maintain substance use disorder patient records protected by 42 CFR Part 2, additional restrictions apply to fundraising communications using those records.
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HOW WE TYPICALLY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use and disclose your health information without your written authorization for the following purposes when permitted by federal and Washington law.
Treatment
We may use your health information and share it with health care professionals involved in your treatment.
For example, we may share relevant information with:
* Physicians and other health care providers
* Pharmacies and specialty pharmacies
* Laboratories
* Imaging or diagnostic facilities
* Other specialists involved in your care
* Health care personnel assisting with your treatment
We may also obtain relevant health information from other health care providers when necessary to provide or coordinate your care and as permitted by law.
Health Care Operations
We may use and disclose your health information to operate our Practice, improve the quality of care, and manage our services.
Examples may include:
* Quality assessment and improvement
* Patient safety activities
* Staff training and supervision
* Credentialing
* Compliance activities
* Auditing
* Business planning
* Practice management
* Legal and administrative services
* Evaluating the performance of our health care professionals
* Contacting you when necessary regarding your care
Payment
We may use and disclose health information to bill and obtain payment for services provided to you.
For example, when applicable, we may provide information to a health plan to:
* Verify eligibility or benefits
* Obtain prior authorization
* Submit or support a claim
* Respond to coverage questions
* Assist with reimbursement
* Collect amounts owed for health care services
If you request that certain services not be submitted to your health plan and you have paid for those services in full out of pocket, the restrictions described earlier in this Notice may apply.
Appointment and Care Communications
We may use your contact information to communicate with you about your care, including:
* Appointment reminders
* Scheduling or rescheduling
* Follow-up care
* Prescription information
* Treatment instructions
* Referrals
* Test or laboratory results
* Other health-related services that may be relevant to your care
We will use reasonable safeguards when communicating with you.
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OTHER WAYS WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
Federal and Washington laws allow or require us to use or disclose health information in certain additional circumstances. These disclosures are subject to applicable legal requirements and limitations.
Public Health and Safety
We may disclose health information for certain public health activities, including:
* Preventing or controlling disease
* Reporting certain diseases or conditions
* Reporting adverse reactions to medications or medical products
* Assisting with product recalls
* Reporting information to appropriate public health authorities when required or permitted by law
* Preventing or reducing a serious threat to health or safety
Abuse, Neglect, or Domestic Violence
We may disclose information concerning suspected abuse, neglect, exploitation, or domestic violence when the disclosure is required or permitted by applicable federal or Washington law.
Different reporting requirements may apply depending upon the patient's age, vulnerability, circumstances, and the type of suspected abuse or neglect.
Health Oversight Activities
We may disclose PHI to authorized health oversight agencies for activities permitted by law, including:
* Audits
* Investigations
* Inspections
* Licensure or disciplinary activities
* Government health program oversight
* Compliance activities
Comply With the Law
We will disclose health information when required to do so by federal, state, or local law.
Law Enforcement
We may disclose health information for law enforcement purposes only when permitted or required by applicable law and only to the extent permitted or required.
Washington law imposes specific requirements and limitations on disclosures of patient health care information to law enforcement.
Lawsuits, Court Proceedings, Subpoenas, and Other Legal Actions
We may disclose health information in response to a valid court or administrative order or other lawful process when the requirements of HIPAA, Washington law, and other applicable laws have been satisfied.
Receipt of a subpoena or other request for records does not necessarily mean that we may immediately release your records. We will evaluate requests and disclose information only when the applicable legal requirements for disclosure have been met.
Workers' Compensation
We may disclose health information as authorized by and to the extent necessary to comply with workers' compensation laws and similar programs established by law.
Organ, Eye, and Tissue Donation
We may disclose health information to organ procurement organizations or other entities involved in organ, eye, or tissue donation and transplantation when permitted by law.
Coroners, Medical Examiners, and Funeral Directors
We may disclose health information to coroners, medical examiners, and funeral directors as necessary for them to carry out duties authorized by law.
Specialized Government Functions
We may disclose PHI in certain circumstances involving:
* Members of the armed forces and veterans
* National security and intelligence activities
* Protective services
* Correctional institutions and individuals in lawful custody
* Other specialized governmental activities permitted by law
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RESEARCH
Periman Eye Institute participates in and conducts clinical and scientific research.
We may use or disclose your PHI for research:
* When you provide a valid written authorization;
* When an Institutional Review Board ("IRB") or Privacy Board has approved a waiver or alteration of HIPAA authorization;
* For certain activities preparatory to research when the requirements of law are satisfied;
* For certain research involving deceased individuals; or
* In other circumstances specifically permitted by federal and Washington law.
Whenever an authorization is required, participation is voluntary, and we will obtain your authorization before using or disclosing your PHI for the research covered by that authorization.
Research records may also be subject to additional federal, state, institutional, sponsor, or IRB privacy requirements.
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USES AND DISCLOSURES THAT GENERALLY REQUIRE YOUR WRITTEN AUTHORIZATION
We will obtain your written authorization before using or disclosing PHI when authorization is required by law.
Examples include:
* Most uses and disclosures for marketing
* Sale of PHI when authorization is required
* Most uses and disclosures of psychotherapy notes, if we maintain such notes
* Research uses and disclosures when a HIPAA authorization or another legally permitted basis for use or disclosure is required
* Other uses or disclosures not described in this Notice and not otherwise permitted or required by law
You may revoke an authorization in writing at any time.
Your revocation will not affect actions we already took in reliance on your authorization before receiving the revocation.
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SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS
Certain substance use disorder ("SUD") patient records are protected by a federal confidentiality law known as 42 CFR Part 2.
Periman Eye Institute is not representing through this Notice that it operates a federally assisted substance use disorder treatment program. However, we may receive or maintain records from another provider that are protected by Part 2.
To the extent we create or maintain records protected by 42 CFR Part 2, additional federal confidentiality protections apply.
In particular, we will not use or disclose Part 2-protected SUD patient records in a civil, criminal, administrative, or legislative investigation or proceeding against you unless:
1. You provide the specific written consent required by law; or
2. The use or disclosure is authorized by an appropriate court order and subpoena or other legal mandate that satisfies Part 2.
Additional restrictions may apply to the use, disclosure, and redisclosure of Part 2 records.
Where Part 2 provides greater privacy protection than HIPAA, we will follow the Part 2 requirements.
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ADDITIONAL WASHINGTON STATE PRIVACY PROTECTIONS
Periman Eye Institute is located in Washington State and is subject to applicable Washington health-information privacy laws, including Chapter 70.02 RCW, the Uniform Health Care Information Act.
Washington law may provide privacy protections or restrictions that are different from or more protective than federal HIPAA requirements.
Disclosure of Health Care Information
Except where authorized or required by law, Washington health care providers generally may not disclose a patient's health care information without the patient's authorization.
When disclosure without authorization is permitted, we will disclose information only as permitted by applicable law and, where required, only to the extent the recipient needs to know the information.
Sensitive Health Information
Certain categories of health information may receive additional protection under Washington or federal law, including, where applicable:
* Mental health treatment information
* Substance use disorder records
* Sexually transmitted disease information
* HIV-related information
* Reproductive health information
* Genetic information
* Information concerning minors who may independently consent to certain health care services
We will follow applicable special confidentiality requirements when they apply to information we maintain.
Legal Requests for Medical Records
Washington law establishes specific procedures governing certain discovery requests, subpoenas, and compulsory legal processes seeking patient health care information.
We will not release health care information merely because someone requests it. We will determine whether the request satisfies applicable federal and Washington legal requirements before disclosing protected information.
Access to Records
Washington law generally requires health care providers to respond to a patient's written request to examine or copy recorded health care information within 15 working days.
When unusual circumstances or other legally recognized conditions apply, Washington law may permit additional time or may permit or require us to limit access to certain information.
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OUR RESPONSIBILITIES
We are required by law to:
* Maintain the privacy and security of your PHI;
* Provide you with this Notice explaining our legal duties and privacy practices;
* Follow the duties and privacy practices described in the Notice currently in effect;
* Notify you if a breach occurs that may have compromised the privacy or security of your information and notification is required by law; and
* Comply with applicable federal and Washington State privacy laws.
We will not use or disclose your health information other than as described in this Notice unless you authorize us to do so in writing or another use or disclosure is permitted or required by law.
If you give us written authorization, you may revoke it in writing as described above.
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CHANGES TO THIS NOTICE
We may change the terms of this Notice and our privacy practices.
Changes may apply to all PHI we maintain, including information created or received before the revised Notice became effective.
If we materially revise this Notice, the current version will be:
* Available upon request;
* Available at our office;
* Posted prominently where required; and
* Available on our website at perimaneyeinstitute.com
You may request a paper copy at any time.
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QUESTIONS OR COMPLAINTS
If you have questions about this Notice, would like to exercise one of your privacy rights, or believe your privacy rights have been violated, please contact:
Privacy Officer
AnaLucia Clarkson
Periman Eye Institute, PLLC
100 W. Harrison Street, North Tower, Suite 360
Seattle, WA 98119
Phone: 206-347-0821
Fax: 206-580-4003
Email: analucia@perimaneyeinstitute.com
You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Phone:1-877-696-6775
Complaints may also be submitted through the HHS Office for Civil Rights complaint process.
Periman Eye Institute will not retaliate against you for filing a complaint or exercising your privacy rights.
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Effective Date: August 12, 2026
Periman Eye Institute, PLLC
100 W. Harrison Street, North Tower, Suite 360
Seattle, WA 98119
206-347-0821