THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

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 you health information and what rights you have regarding it.

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples would include: setting up an appointment for you, testing or examining your eyes, prescribing glasses, contact lenses, or medications, referring you to another doctor, getting copies of your health information from another professional, preparing or sending bills or claims, financial or billing audits. For a complete list of examples please contact our office at (740)-773-8055.

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 will] [we usually will not] ask you for special written permission.

USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION

In some 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. Such uses or disclosures are:

1. when state of federal law mandates that certain health information be reported for a specfic purpose, 2. for public health purposes, 3. disclosures to governmental authorities, 4. uses and disclosures for health oversight activites, 5. disclosures for judicial and administrative proceedings, 6. diclosures for law enforcement purposes, 7. disclose to a medical examinier, 8. uses and disclosures for health related research, 9. uses and disclosure to prevent a serious threat to health or safety, 10. uses and disclosure for specialized government functions, 11. disclosure of de-identified information, 12. disclosure relating to worker's compensation programs, 13. disclosure of a "limited data set" for research, public health, or health care operations, 14. incidental disclosure that are an unavoidable by-product of permitted uses or disclosure, 15. disclosure to "business associates" who perform health care operations for us and whom commit to respect the privacy of your health information,

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

APPOINTMENT REMINDERS We may call or write to remind you of schedules appointments, or that it is time to make a routine appointment. 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.

OTHE USES AND DISCLOSURES

We will not make any other uses or disclosures of your health information unless you sign a written "authorzation form." The content of an "authorzation form" is determined by federal law.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION The law gives you many rights regarding your health information. You can: 1. ask us to restrict our uses and disclosures for purpose of treatment (except emergency treatment), payment or health care operations, 2. ask us to communicate with you in a confidental way, 3. ask to see or to get photocopies of your health information, 4. ask us to amend your health information if you think it is incorrect or incomplete, 5. get a list of the disclosures that we have made of your health information within the past six years, 6. get additional paper copies of the Notice of Privacy Practices upon request.

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 furture. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our website.

COMPLAINTS

If you think that we have not properly respected the privacy of your health information, you are free to complain the 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 complaint to the office address listed at the beginning of this notice. If you prefer, you can discuss your complaint in person or by phone.

FOR MORE INFORMATION To receive a complete Notice of Privacy Practices or for more information regarding our privacy practices please contact our office at 77 West Main Street, Chillicothe, Ohio 45601, OR by phone at (740)-773-8055