NOTICE OF PRIVACY PRACTICES
OPHTHALMIC PHYSICIANS, INC

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

Ophthalmic Physicians, Inc. (OPI) is required by law to maintain the privacy of patient's personal health
information and to provide patients with OPI privacy practices with respect to your personal health information. OPI is required to abide by the terms of this Notice so long as it remains in effect. OPI reserves the right to change the terms of this Notice of Privacy Practices as necessary and make the new Notice effective for all personal health information maintained by OPI. You may receive a copy of any revised notices at the below listed address or by mailing a request to HIPAA Compliance Officer, Ophthalmic Physicians, mc., Mentor Medical Campus, 9485 Mentor Ave., Suite 110, Mentor, Ohio 44060.

USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION

You will be asked by this practice to sign a consent form. Once you have consented to the use and disclosure of your personal health information it will be used for treatment, payment, health care operations and administrative purposes and to evaluate the quality of care that you receive.

OPI is permitted or required by law to make certain other uses and disclosure of your personal health information without your consent or authorization for the following:

 - For any purpose required by law
 - For public health purposes such as reporting for disease and injury ..
 - For suspected child abuse or neglect; or if there is suspicion that you may be victim of abuse.
 - To your employer when OPI has provided health care to you at the request of your employer to determine
    workplace-related illness or injury .
 - To workers compensation agencies if necessary for worker compensation benefit determination.
 - To government agencies conducting audits, investigations or civil or criminal proceedings.

With your approval, OPI may disclose your personal health information to designated family, friends and other who are involved in your care or in payment of your care. OPI may contact you by phone or mail to provide appointment reminders.

RIGHTS THAT YOU HAVE

In most cases, you have the right to inspect or copy personal health information records that OPI retains. All
requests for access must be made on a "Patients Records Access Request Form". This is available at the office. You must make an appointment with the Supervisor of Medical Records to review this information.

You have the right to receive an accounting of certain disclosures about you for reasons other than for treatment, payment, health care operations and administrative purposes.

You have the right to request a restriction or limitation on personal health information OPI would disclose to
someone who may be involved in your care, like a family member or friend. Your request must be in writing. You must state what information you wish to restrict or limit, whether you want to limit our use, disclosure or both and to whom you want the limits to apply (example: spouse or parent). OPI is not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate.

COMPLAINTS

If you believe your privacy rights have been violated, you can file a complaint with the HIPAA Compliance Officer listed below.

HIPAA COMPLIANCE OFFICER
OPHTHALMIC PHYSICIANS, INC
9485 MENTOR AVE, SUITE 110
MENTOR, OHIO 44060