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REQUEST OF CONFIDENTIAL COMMUNICATION OF MEDICAL INFORMATION

"Protected individuals", as defined in Civil Code section 56.05 subdivision (l), receiving care will receive receipt of sensitive services directly.

EYEXAM will not disclose medical information relating to sensitive health services provided to a protected individual to the primary subscriber or any other plan enrollees other than the protected individual receiving care, absent an express written authorization of the protected individual receiving care.

Are you a Protected individual, EYEXAM of California has established a system to ensure confidentiality of Medical Information. You can submit a Request of Confidential Communication of Medical Information through this website by clicking below.

Authorization for Request of Confidential Communication of Medical Information below: