This notice describes how medical information about you may be used and
disclosed and how you can access this information. Please review it
carefully.

We respect our legal obligation to keep health information that identifies you private.
We are obligated by law to give you notice of our privacy practices. This notice
describes how we protect your health information and what rights you have
regarding it.

Treatment, Payment and Health Care Operations

The most common reason we use or disclose your health information is for
treatment, payment or health care operations. Examples of how we use or disclose
information for treatment purposes are: scheduling an appointment for you; testing
or examining your eyes; prescribing glasses, contact lenses or eye medications;
showing you low vision devices; referring you to another doctor or clinic for eye care;
getting copies of your health information from another professional that you may
have seen before us. Examples of how we use or disclose your health information
for payment purposes are: asking you about your health or vision care plans or
other sources of payment; preparing and sending bills or claims; collecting unpaid
amounts, either ourselves or through a collection agency or attorney. Health care
operation means those administrative and managerial functions that we have to do
in order to run our office. Examples of how we use or disclose your health
information for health care operations are: financial or billing audits; internal quality
assurance; personnel decisions; participation in managed care plans; defense of
legal matters; business planning; outside storage of our records.

We routinely use your health information inside our office for these purposes without
any special permission. If we need to disclose your health information outside of our
office for these reasons we usually will not ask you for special written permission.

Uses and Disclosures for Other Reasons Without Permission

In certain limited situations, the law allows or requires us to use or disclose your
health information without your permission. Not all of these situations will apply to
us. Some may never come up at our office at all. Examples of such uses or
disclosures are: when a state or federal law mandates that certain health
information be reported for a specific purpose; for public health purposes, such as
contagious disease reporting, investigation or surveillance, and notices to and from
the federal Food and Drug Administration regarding drugs or medical devices;
disclosures to governmental authorities about victims of suspected abuse, neglect or
domestic violence; uses and disclosures for health oversight activities, such as for
the licensing of doctors, for audits by Medicare or Medicaid, or for investigation of
possible health care laws; disclosures for judicial and administrative proceedings,

such as in response to subpoenas or court orders or administrative agencies;
disclosure for law enforcement purposes, such as to provide information about
someone who is or is suspected to be a victim of a crime, to provide information
about a crime at our office, or to report a crime that happened somewhere else;
disclosure to a medical examiner to identify a dead person or to determine the cause
of death, or to funeral directors to aid in burial, or to organizations that handle organ
or tissue donations; uses or disclosures for health related research; uses and
disclosures to prevent a serious threat to health or safety; uses or disclosures to
prevent a serious threat to health or safety; uses or disclosure for specialized
government functions, such as for the protection of the president or high ranking
government officials, for lawful national intelligence activities, for military purposes
or for the evaluation and health of members of the foreign service; disclosures of de-
identified information; disclosures relating to worker’s compensation programs;
disclosures of a “limited data set” for research, public health or health care
operations; incidental disclosures that are an unavoidable by-product of permitted
uses or disclosures; disclosures to “business associates” who perform health care
operations for us and who commit to respect the privacy of your health information;
disclosures relating to public health or child and elderly abuse as required by state
law.

Unless you object, we will also share relevant information about your care with your
family or friends who are helping you with your eye care.

Appointment Reminders

We may call or write to remind you of scheduled appointments or that it is time to
make a routine appointment. We may also call or write to notify you of other
treatments or services available at our office that might help you. Unless you tell us
otherwise, we will mail you an appointment reminder on a post card, and/or leave
you a reminder message on your home answering machine or with someone who
answers your phone if you are not home.

Other Uses and Disclosures

We will not make any other uses or disclosures of your health information unless you
sign a written “authorization form”. The content of an “authorization form” is
determined by federal law. Sometimes we may initiate the authorization process if
the use or disclosure is our idea. Sometimes you may initiate the process if it is your
idea for us to send your information to someone else. Typically in this situation you
will give us a properly completed authorization form, or you can use one of ours.

If we initiate the process and ask you to sign an authorization form, you do not have
to sign it. If you do not sign the authorization, we cannot make the use or
disclosure. If you do sign one, you may revoke it at any time unless we have
already acted in reliance upon it. Revocations must be in writing. Send them to the
office contact person named at the beginning of this notice.

Your Rights Regarding Your Health Information

The law gives you many rights regarding your health information. You can:

• Ask us to restrict our uses and disclosures for purposes of treatment,
except

emergency treatment, payment or health care operations. We do not have to agree
to do this, but if we agree, we must honor the restrictions that you want. To ask for

a restriction, send a written request to the office contact person at the address, fax
of e-mail shown at the beginning of this notice.

• Ask us to communicate with you in a confidential way, such as by
phoning

you at work rather than at home, by mailing health information to a different
address, or by using e-mail to your personal e-mail address. We will accommodate
these requests if they are reasonable and if you pay us for any extra cost. If you
want to ask for confidential communications, send a written request to the office
contact person at the address, fax or e-mail shown at the beginning of this notice.

• Ask to see or to get photocopies of your health information. By law,
there are

a few limited situations in which we can refuse to permit access or copying. For the
most part, however, you will be able to review or have a copy of your health
information within 30 days of asking us (or 60 days if the information is stored off-
site). You may have to pay for photocopies in advance. If we deny your request, we
will send you a written explanation and instruction about how to get an impartial
review of our denial if one is legally available. By law, we can have on 30 day
extension of the time for us to give you access or photocopies if we send you a
written notice of the extension. If you want to review or receive photocopies of your
health information, send a written request to the office contact person at the
address, fax or e-mail shown at the beginning of this notice.

• Ask us to amend your health information if you think that it is incorrect
or

incomplete. If we agree, we will amend the information within 60 days of the date
the request was received. We will send the corrected information to persons who we
know received the wrong information and others that you specify. If we do not
agree, you can write a statement of your position and we will include it with your
health information along with any rebuttal statement that we may write. Once your
statement of position and/or our rebuttal is included in your health information, we
will forward it whenever we make a permitted disclosure of your health information.
By law, we can have one 30 day extension of time to consider a request. If you wish
to amend your health information, send a written request to the office contact
person at the address, fax or e-mail shown at the beginning of this notice.

• Get a list of the disclosures that we have made of your health
information

within the past six years (or a shorter period if you want). By law, the list will not
include: disclosures for purposes of treatment, payment or health care operations,
disclosures with your authorization, incidental disclosure, disclosures required by law
and some other limited disclosures. You are entitled to one such list per year
without charge. If you want more frequent lists, you will have to pay for them in
advance. We will usually respond to your request within 60 days of receiving it, but
by law we can have one 30 day extension of time if we notify you of the extension in
writing. If you want a list, send a written request to the office contact person at the
address, fax or mail shown at the beginning of this notice.

• Get additional paper copies of this “Notice of Privacy Practices” upon
request.

It does not matter whether you got one electronically or in paper form already. If
you want additional paper copies, send a written request to the office contact person
at the address, fax or e-mail shown at the beginning of this notice.

Our Notice of Privacy Practices

By law, we must abide by the terms of this “Notice of Privacy Practices” until we
choose to change it. We reserve the right to change this notice at any time as

allowed by law. If we change this Notice, the new privacy practices will apply to your
health information that we already have as well as to such information that we may
generate in the future. If we change our “Notice of Privacy Practices”, we will post
the notice in our office, have copies available in our office, and post it on our web
site.

Complaints

If you think that we have not properly respected the privacy of your health
information, you are free to complain to us or the U.S. Department of Health and
Human Services, Office for Civil Rights. We will not retaliate against you if you make
a complaint. If you want to complain to us, send a written request to the office
contact person at the address, fax or e-mail shown at the beginning of this notice. If
you prefer, you can discuss your complaint in person or by phone.

For More Information

If you want more information about our privacy practices, call or visit the office
contact person at the address of phone number shown at the beginning of this
notice.