Privacy of Health

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Many of these documents are in pdf format and will require the Adobe Acrobat reader to view them.

Notice of Privacy Practices
Notice describing the company's policies regarding customer's personal health information.

Authorization Acrobat PDF
Form to be completed by customer to request that individually identifiable health information be received or disclosed by a specified person or entity.

Request for Access to Designated Records Acrobat PDF
Form to be completed by customer to request access to the health information contained in the records maintained by the Company.

Request for Restrictions Acrobat PDF
Form to be completed by customer to request restricted uses or disclosures of protected health information.

Request for Confidential Communications Acrobat PDF
Form to be completed by customer to request an alternative means of communicating protected health information.

Request for Amendment to Designated Records Acrobat PDF
Form to be completed by customer to request that the health information contained in the company's records be amended.

Request for an Accounting Acrobat PDF
Form to be completed by customer to request an accounting of the disclosures made by the Company of customer's protected health information.

Complaint under Privacy Rule Acrobat PDF
Form to be completed by anyone wishing to file a complaint against the Company's actions, policies or procedures with respect to the Privacy Rule and/or individually identifiable health information.

The California Transparency in Supply Chains Act of 2010
This act requires that applicable manufacturers and retailers such as National Vision, Inc. ("NVI") disclose their efforts to eradicate slavery and human trafficking from the supply chain.

Contact the Privacy Officer
If you have any questions or concerns, please contact the privacy officer.