OPTICS PLUS OPTICIANS, INC., gathers and uses patient information in order to provide health related services to its patients. The .Protected Health Information. or .PHI. for each patient will always be treated with respect for the possible personal or confidential nature of this information.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU (PHI) MAY BE USED AND DISCLOSED IN ORDER FOR OPTICS PLUS TO CONDUCT ITS NORMAL COURSE OF TREATMENT, SERVICE, OR OPERATIONS, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Your PHI may be used and disclosed in order to perform our .health care operations. as detailed below:

Care & Treatment: Prescription information or information determined during Optometric examinations are necessary to provide complete eye care services. We may contact other health providers involved in your treatment to share PHI. And we may contact you to provide information about other health related services, benefits, products, or alternative treatments. We may also contact you to provide appointment reminders.

Payment: It may be necessary for us to disclose certain PHI to obtain payment for services that we provide to you. .Your Payer,. your health insurer, HMO, or other agent that arranges for the payment of your health costs will require certain information either prior to, or in order to approve payment.

Internal Operations: Your PHI may be used for administration and planning purposes within our organization for the purpose of improving the way we perform our activities. For example, your PHI may be useful in the evaluation of the performance of staff members or office procedures or situations.

PHI may be shared with family members, close friends, or other caregivers in your presence. If disclosures are objectionable please inform the office manager, optometrist, or optician. If you are not present, or incapacitated, or an emergency situation arises we may exercise our professional judgment to determine whether disclosure of PHI to a relative, friend, or other involved party would be in your best interest. We may also divulge PHI in order to notify or assist in notifying such persons of your location and general health status.

PHI may be disclosed for various public health activities such as:

Reports to public health authorities for the purpose of controlling or preventing disease, injury, or disability.

Reporting of child abuse or neglect to public health authorities or other government agencies authorized by law to receive such reports when we reasonably believe the situation warrants the report.

Reporting of abuse, neglect, or domestic violence to a governmental agency, including a social service, or protective service agency legally authorized to receive such reports when we reasonably believe the situation warrants the report.

Report information about products and services under the jurisdiction of the U.S. Food and Drug Administration,

Alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.

Report information to your employer AS REQUIRED UNDER LAWS governing work-related illnesses and injuries or workplace medical surveillance.

Upon the receipt of properly documented requests, we may also disclose specific items of your PHI to, or for, the following:

A health oversight agency charged with ensuring compliance with the rules of government health programs such as Medicare or Medicaid.

Judicial or administrative proceedings in response to a legal order or other lawful request.

An authorized law enforcement agency as permitted or required in compliance with a court order or a grand jury or administrative subpoena.

A medical examiner or coroner with legal authorization.

Workers Compensation or other similar programs to the extent that compliance is necessary.

Other authorized state or federal government agencies when specifically directed by law.

For any purpose other that those specified above we may only disclose your PHI after we receive your written authorization form (.PHI Authorization Form.), available from our office manager. Common examples of disclosures requiring signed authorizations may include:

Memos for schools or camps regarding specific health status of your child.

Information requested by Life Insurance Companies.

Information requested by an attorney representing other parties in litigation in which you are involved.

We would also be required to obtain your signed authorization (.PHI Marketing Authorization.) prior to releasing your PHI to outside marketing concerns. While WE may contact you about specific services or products that we feel may be of special interest or offer specific benefits to you, this information will not be made available to other parties without your express written permission.

YOUR INDIVIDUAL RIGHTS:

If you desire additional information about your privacy rights, or if you are concerned that we have violated your privacy rights, or if you disagree with a decision that was made about your access to your PHI, you may contact our Office Manager. (Contact information may be found at the end of this notice.) You may also file a written complaint with the Director of the Office for Civil Rights of the U.S. Department of Health and Human Services.

You may request additional restrictions on the use and disclosure of PHI. These requests should be made in writing (to the attention of the Office Manager). The management of Optics Plus will carefully consider all requests for additional restrictions. You will be informed of final decisions in a timely fashion. We are NOT obligated to agree to additional restrictions, and will only consider exceptions that do not hinder patient care, operations, or legal obligations.

You may make a written request, and we will try to accommodate any reasonable request, for you to receive PHI by alternative means of communication or at alternative locations.

You may request access to your medical record file and billing records maintained by Optics Plus. Requests for copies of the medical or billing records may also be made. All requests for access or copies shall be made in writing. Your request may be denied under certain circumstances, which would be explained, in writing, by the management of Optics Plus. Copies of records may be provided at a cost of $0.50 for each page.

Upon reviewing your medical records you may make a written request to make amendments to your medical records if you feel there has been an error. We will try to comply with your request unless we feel the amendment would be inaccurate, incomplete, or in conflict with other special circumstances for which you would be notified in writing. Your request for an amendment would then be added to your medical records.

You have the right to revoke an authorization by writing a Revocation request and submitting to our office manager.

You may make a written request for an accounting of disclosure of PHI made by Optics Plus within a 6-year period. This applies to any disclosures made after April 14, 2003 . If you request an accounting more than once within a 12 month period we will charge a reasonable, cost based fee for preparing the statement.

TERMS OF THIS NOTICE ARE SUBJECT TO CHANGE AT ANY TIME.

A copy of the latest version of our privacy policy will be available in our office, and on our web site, www.optics-plus.com. Also, printed or electronically transmitted copies will be made available to any patient upon request.

FOR ANY INFORMATION OR COMMUNICATION ABOUT THIS NOTICE PLEASE CONTACT:

OFFICE MANAGER

OPTICS PLUS OPTICIANS, Inc.

8285 Jericho Tpke.

Woodbury , N.Y. 11797

516 367-2020

Fax: 516 367-3379

Email: admin@optics-plus.com