FRY EYE ASSOCIATES NOTICE OF PRIVACY PRACTICES

*PLEASE NOTE: FRY EYE ASSOCIATES AND FRY EYE SURGERY CENTER ARE TWO SEPARATE CORPORATIONS THAT SHARE COMMON OWNERSHIP AND CONTROL, AND THEREFORE, ARE KNOWN AS AN ORGANIZED HEALTH CARE ARRANGEMENT FOR PURPOSES OF THE PRIVACY STANDARDS.
FRY EYE ASSOCIATES AND WESTERN KANSAS LOW VISION ASSOCIATES/FOUNDATION ARE TWO SEPARATE CORPORATIONS THAT SHARE COMMON CONTROL AND THEREFORE ARE KNOWN AS AFFILIATED COVERED ENTITIES FOR PURPOSES OF THE PRIVACY STANDARDS.

I. THIS INFORMATION DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

WE ARE REQUIRED BY FEDERAL LAW TO OBTAIN AN ACKNOWLEDGMENT FROM YOU THAT YOU RECEIVED THIS NOTICE. PLEASE SIGN THE ATTACHED ACKNOWLEDGMENT FORM AND RETURN IT TO THE FRONT DESK.

II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)

We are legally required to protect the privacy of your health information. We call this information protected health information, or PHI for short, and it includes information that can be used to identify you that we've created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice.

However, we reserve the right to change the terms of this notice and our privacy policies at any time. When we make an important change to our policies, we will promptly change this notice and post a new notice in the main reception area of "Fry EyeAssociates" and "Fry EyeSurgery Center". You can also request a copy of this notice from the contact person listed in Section VI, below, at any time and can view a copy of the notice on our Web site at www.fryeye.com.

III. HOW WE MAY USE AND DISCLOSE YOUR
PROTECTED HEALTH INFORMATION

We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your specific authorization. Below, we describe the different categories of our uses and disclosures.

A. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations. We may use and disclose your PHI for the following reasons:

1. For treatment. We may disclose your PHI to physicians, nurses, medical students, and other health care personnel who provide you with health care services or are involved in your care.

2. To obtain payment for treatment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you.

3. For health care operations. We may disclose your PHI in order to operate this clinic and/or surgery center. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you.

B. Certain Uses and Disclosures Do Not Require Your Authorization. We may use and disclose your PHI without your authorization for the following reasons:

1. When a disclosure is required by federal, state, or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot or other wounds; or when ordered in a judicial or administrative proceeding.
2. For public health activities. For example, we report information about births, deaths, and various diseases to government officials in charge of collecting that information. We will provide coroners, medical examiners, and funeral directors necessary information relating to an individual's death, if requested to do so.
3. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
4. For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye , or tissue donation and transplants.
5. For research purposes. In certain circumstances, we may provide PHI in order to conduct medical research.
6. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm. If you are an inmate, we may disclose your medical information to correctional institutions or law enforcement personnel having lawful custody of you for administration and maintenance of the safety, security and good order of the correctional institution; of identification necessary to provide health care to you, or to protect you, other inmates, employees and officers of the institution, individuals participating in your transportation, or law enforcement at the institution.
7. For specific government functions. We may disclose PHI of military personnel and veterans in certain situations. And we may disclose PHI for national security purposes, such as protecting the president of the United States or conducting intelligence operations.
8. For workers' compensation purposes. We may provide PHI in order to comply with workers' compensation laws.

9. Appointment reminders and health-related benefits or services. We may use PHI to provide appointment reminders or give you information about treatment alternatives or other health care services or benefits we offer.
10. Disclosures To Our Business Associates: We sometimes work with individuals and businesses that help us operate our business successfully. We may disclose personal information about you to these business associates if they need it to perform the tasks that we hire them to do. To protect your health information, we always include a provision in our contracts with our business associates requiring them to put procedures in place to safeguard the confidentiality of our patients' health information. Examples of our business associates include consultants that we hire to help us ensure our compliance with applicable federal, state, and local laws, our lawyers, and our accountants.

C. Two Uses and Disclosures Require You To Have the Opportunity to Object.

1. Disclosures to family, friends, or others. We will assume that any person present during your examination is privileged to any verbal PHI that is discussed throughout your visit with us. In addition, we may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. With regard to this, we will provide a document for you to list specific persons with whom we may discuss your PHI. The request for medical information has to be initiated by the designated individual listed on the signed consent or yourself. This document may be amended at any time. The opportunity to consent may be obtained retroactively in emergency situations.
2. For disaster relief. We may use or disclose your medical information to an entity that assists in disaster relief efforts.

D. All Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in Sections IIIA, B, and C, above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we haven't taken any action relying on the authorization).

IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

You have the following RIGHTS with respect to your PHI:

A. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.
B. The Right to Choose How We Send PHI to You. You have the right to request in writing that we restrict the way in which we communicate information regarding your health, health care services, or payment. For example, you may ask that we communicate with you only at your home, not at your workplace. We will use reasonable efforts to accommodate your request.
C. The Right to See and Get Copies of Your PHI. In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. If we do not have your PHI but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed.
D. The Right to Get a List of the Disclosures We Have Made. You have the right to request an accounting from us of certain disclosures made by us during the past six years prior to your request, unless you request a shorter time, but no earlier than April 14, 2003.
We will respond within 60 days of receiving your request. The list will include the date of the disclosure, to whom the PHI was disclosed, a description of the PHI disclosed, and the reason for the disclosure. These disclosures do not include those made for purposes of Treatment, Payment, or Operations, or those pursuant to a signed Authorization. We will provide the list to you at no charge.
E. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don't file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.
F. The right to correspond via E-mail. It is our general policy not to initiate correspondence with our patients via e-mail. If you choose to e-mail a member of our staff, we will reply to the same address. If the information discussed is considered PHI, patient identity will be confirmed and a printed copy of the correspondence will be retained in your chart. Please be aware that this is not our preferred method of correspondence.
G. Please direct any requests and/or questions to the contact person listed in Section VI.

V. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you think that we may have violated your privacy RIGHTS, or you disagree with a decision we made about access to your PHI, you may file a written complaint with the person listed in Section VI below. You also may send a written complaint to the Office For Civil RIGHTS Headquarters at the address listed in Section VI. We will take no retaliatory action against you if you file a complaint about our privacy practices.

VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES.

If you have any questions about this notice or any complaints about our privacy practices, or would like to know how to file a complaint, please contact:

Gloria Hopkins, OD
Practice Administrator, Privacy Officer
310 E Walnut St., Ste. 101
Garden City, KS 67846
Phone: 620-275-7248
E-Mail: contactus@fryeye.com

If you prefer, you may contact the national Office for Civil RIGHTS directly at:

OCR HEADQUARTERS
Office For Civil Rights Headquarters
U.S. Dept. of Health and Human Services
200 Independence Ave. SW
Washington, DC 20201

VII. EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on April 14, 2003 (Version No. 1)