Welcome to Lexington Eye Associates

NOTICE OF LEXINGTON EYE ASSOCIATES PRIVACY PRACTICES

Federal and state law require Lexington Eye Associates and your other health care providers to protect the privacy of medical and health information about you. We are also required to make available to patients this notice which describes our policies concerning how medical and health information about patients (known as protected health information or PHI) can be used, and how you can gain access to your own protected information.

Uses and Disclosures That Are Permitted Without Your Written Authorization

We may use and disclose, by mail, fax, phone call, etc., protected health information without your written authorization, but only to support these purposes listed below:

To diagnose and treat your injury or illness or provide other medically necessary services that you need. In addition, we may call and/or send a post card to remind you of upcoming appointments. We also may inform you about treatment alternatives, or disclose protected information to other providers involved in your treatment. Other providers contracted by Lexington Eye include Katrinka Heher, MD from New England Eye Center (an oculoplastics consultant) and Delia Sang, MD, a vitreo-retinal consultant from Ophthalmic Consultants of Boston.

To obtain payment for services provided to you; for example, disclosures to obtain payment from your health insurer, HMO, or other company that arranges or pays most of the cost of your health care — or to verify that your health insurer will pay for a service.

To improve Lexington Eye Associates' health care operations. These include administration, planning, and activities to improve the quality and cost-effectiveness of the care you receive from our physicians, technicians and other health care workers. We may disclose protected information to our staff members in order to resolve any complaints or concerns you may have.

To support public health activities. We may disclose protected information to public health authorities for the purpose of preventing or controlling disease, injury or disability; to report suspected child abuse or neglect to public health or other government authorities; to report to the U.S. Food and Drug Administration information about products and services under FDA jurisdiction; to 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; and to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.

To support health oversight activities by agencies that oversee the health care system, including compliance with the rules of government health programs such as Medicare or Medicaid.

To comply with legal requirements resulting from: judicial proceedings by the police or the courts; administrative subpoena; investigations by a coroner or medical examiner; organ, eye, or tissue procurement, banking or transplantation; research, if an Institutional Review or Privacy Board has approved a waiver of authorization for disclosure; action to stop a serious and imminent threat to a person's or the public's health or safety; special functions of units of the government such as the U.S. military or the U.S. Department of State, workers' compensation or other similar programs; or any other law not already referred to above.

We may also disclose protected information to a family member, other relative, close personal friend, or any other person identified by you prior to the disclosure. In an emergency, we may use our professional judgment to determine whether a disclosure is in your best interest. If we disclose information to such a person, we will include only information that is directly relevant to that person's involvement with your health status, condition, or related payment.

All of the above disclosures may include the release of highly confidential information. If you object to such uses or disclosures, please notify our staff in writing.

Uses and Disclosures Requiring Your Written Authorization

We must obtain your written separate authorization to use or release the highly confidential types of your protected information, unless the information is for Treatment, Payment or Health Care Operations. Highly confidential information may include mental health and developmental disabilities; alcohol and drug abuse prevention, treatment and referral; HIV/AIDS testing, diagnosis or treatment; venereal disease(s); genetic testing; documented child abuse or neglect; domestic abuse of an adult with a disability; sexual assault; or any amendment to your medical file. Any reporting of highly confidential information to a state agency will NOT requires your written authorization; however if this confidential information is to be used or disclosed to another party, written authorization is required. You will also need to give written permission before we can send protected information to your life insurance company, to your child's camp or school, or to the attorney representing the other party in a lawsuit in which you are involved. We also need your written permission before we can use protected information to identify marketing materials to send to you. We can, however, give you marketing materials in a face-to-face encounter. You can obtain an authorization form from any staff member at Lexington Eye Associates.

Your Individual Rights

If you want more information about your privacy rights, are concerned that we may have violated your privacy, or disagree with a decision that we made about access to protected information, you may contact a member of the Lexington Eye Associates staff. You may also file a written complaint with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Our staff can help you contact the Director.

You may request additional restrictions on our use and disclosure of protected information for treatment, payment, and health care operations, and to specific individuals. All requests for such restrictions must be made in writing. While we will consider all requests for additional restrictions carefully, we are not required to agree to them. If you wish to request additional restrictions, please speak to a staff member. A form will be sent to you, and a written response will forwarded in a timely fashion.

We will agree to any reasonable written request for you to receive a copy of your medical or billing records. You also have the right to make a written request that we amend protected information maintained in your medical record file or billing records. A form may be requested for such an amendment. We can amend your record by adding your written amendment to your file, but we cannot delete or change the original record entries. Upon written request, we will prepare for you a list of disclosures of your protected information made during a specified period of time. We may change the terms of this notice at any time and will post the revised notice in waiting areas of Lexington Eye Associates and on our Internet site at www.lexeye.com.

EFFECTIVE DATE OF THIS NOTICE: APRIL 14, 2003