Notice of Privacy Practices
Long Island Ophthalmology & Eye Surgery, P.C.

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

PLEASE READ IT CAREFULLY

The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives you, the patient, the right to understand and control how your protected health information ("PHI") is used. HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, we prepared this explanation of how we are to maintain the privacy of your health information and how we may disclose your personal information.

We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operation.

•    Treatment means providing, coordinating, or managing health care and related services by one or more healthcare providers. An example of this is a primary care doctor referring you to a specialist doctor.

•    Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review. An example of this would include sending your insurance company a bill for your visit and/or verifying coverage prior to a surgery.

•    Health Care Operations include business aspects of running our practice, such as conducting quality assessments and improving activities, auditing functions, cost management analysis, and customer service. An example of this would be new patient survey cards.

•    The practice may also be required or permitted to disclose your PHI for law enforcement and other legitimate reasons. In all situations, we shall do our best to assure its continued confidentiality to the extent possible.

We may also create and distribute de-identified health information by removing all reference to individually identifiable information. We may contact you, by phone or in writing, to provide appointment reminders or information about treatment alternatives or other health-related benefits and services, in addition to other fundraising communications, that may be of interest to you. You do have the right to "opt out" with respect to receiving fundraising communications from us.
The following use and disclosures of PHI will only be made pursuant to us receiving a written
authorization from you:

•    Uses and disclosure of your PHI for marketing purposes, including subsidized treatment and
health care operations;
•    Disclosures that constitute a sale of PHI under HIPAA; and
•    Other uses and disclosures not described in this notice.

You may revoke such authorization in writing and we are required to honor and abide by that written
request, except to the extent that we have already taken actions relying on your prior authorization.

SPECIAL SITUATIONS:

As Required by Law We will disclose Health Information when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may help prevent the threat.

Business Associates We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Organ and Tissue Donation If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement; banking or transportation of organs, eyes, or tissues to facilitate organ, eye or tissue donation; and transplantation.

Military and Veterans If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.

Workers' Compensation We may release Health Information for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement We may release Health Information if asked by a law enforcement official if the
information is:( (1) in response to a court order, subpoena, warrant, summons or similar process; (2)
limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about
the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the
person's agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal
conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or
the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors We may release Health Information to a
coroner or medical examiner. This may be necessary, for example, to identify a deceased person or
determine the cause of death. We also may release Health Information to funeral directors as necessary
for their duties.

National Security and Intelligence Activities We may release Health Information to authorized
federal officials for intelligence, counter-intelligence, and other national security activities authorized by
law.

Protective Services for the President and Others We may disclose Health Information to authorized
federal officials so they may provide protection to the President, other authorized persons, or foreign
heads of state, or to conduct special investigations.

Inmates or Individuals in Custody If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release Health Information to the correctional institution or
law enforcement official. This release would be if necessary: (1) for the institution to provide you with
health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety
and security of the correctional institution.

You may have the following rights with respect to your PHI.

•    The right to request restrictions on certain uses and disclosures of PHI, including those related to disclosures of family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to honor a request restriction except in limited circumstances which we shall explain if you ask. If we do agree to the restriction, we must abide by it unless you agree in writing to remove it.

•    The right to reasonable requests to receive confidential communications of Protected Health Information by alternative means or at alternative locations.

•    The right to inspect and copy your PHI.

•    The right to amend your PHI.

•    The right to receive an accounting of disclosures of your PHI.

•    The right to obtain a paper copy of this notice from us upon request.

•    The right to be advised of your unprotected PHI is intentionally or unintentionally disclosed.

If you have paid for services "out of pocket," in full and in advance, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.

We are required by law to maintain the privacy of your Protected Health Information and to provide you the notice of our legal duties and our privacy practice with respect to PHI. You may have the following rights with respect to your PHI.

This notice if effective as of September 23, 2013 and it is our intention to abide by the terms of the Notice of Privacy Practices and HIPAA Regulations currently in effect. We reserve the right to change the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI that we maintain. We will post and you may request a written copy of the revised Notice of Privacy Practice from our office.

You have recourse if you feel that your protections have been violated by our office. You have the right to file a formal, written complaint with our office and with the Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you for filing a complaint.

Feel free to contact the Practice Compliance Officer (Mr.Eddie Vaysman @ 718-868-8668) for more information, in person or in writing.