NOTICE OF PRIVACY PRACTICES Dr. George A. Haas Eye Clinic 3004 E. Kiehl Avenue Sherwood, AR 72120 (501) 835-7800 Fax: (501) 835-5060 32 South Pine, Suite 1 Cabot, AR 72023 (501) 843-6567 Fax: (501) 843-2599 email: gahaas@sbcglobal.net Charlotte Hall, Office Contact Person

THIS NOTICE 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 respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your health information and what rights you have regarding it.

TREATMENT, PAYMENT, AND HEALTHCARE OPERATIONS We may use and disclose your protected health information for purposes of treatment, payment, and health care operations as permitted by Federal law. We may use your health information for treatment by setting up appointments, testing and examining your eyes, prescribing glasses, contact lenses, or eye medications and having them filled, showing you low vision aids, referring you to another doctor or clinic for eye care or low vision aids or services, or getting copies of your health information from another professional you may have seen before us. We may disclose your health information for payment purposes by obtaining information regarding your health or vision care plans, preparing and sending bills or claims, and collecting unpaid amounts (either ourselves or through a collection agency or attorney). We may use your health information for health care operations related to financial or billing audits, participation in managed care plans, or defense of legal matters.

We may use and disclose your protected health information for purposes other than for treatment, payment or health care operations without your consent or authorization, as permitted or required by the Federal law.

USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION In some limited situations, the law allows or requires us to use or disclose your protected health information without your permission. Such uses or disclosures are: · when a state or federal law mandates that certain health information be reported for a specific purpose;

· for public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices;

· disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence.

· uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws.

· disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;

· disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;

· disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;

· uses or disclosures for health related research;

· uses or disclosures to prevent a serious threat to health or safety;

· uses or disclosures for specialized government functions, such as for the protection of the president or high ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health management of the foreign service;

· disclosures of de-identified information;

· disclosures relating to worker's compensation programs;

· disclosures of a "limited data set" for research, public health, or health care operations;

· incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;

· disclosures to "business associates" who perform health care operations for us and who commit to respect the privacy of your health information.

Unless you object, we will also share relevant information with your family or friends who are helping you with your eye care.

APPOINTMENT REMINDERS We may call or write to remind you of scheduled appointments, or that it is time to make a routine appointment. We may also call or write to you to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you an appointment reminder and/or leave you a reminder message on your home answering machine or with someone who answers your phone when you are not home.

OTHER USES AND DISCLOSURES We will not make any other uses or disclosures of your health information unless you sign a written "authorization form." The content of an "authorization form" is determined by Federal law. If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign an authorization form, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to our Office Contact Person.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION The law gives you many rights regarding your protected health information. You can:

· request restriction on certain uses and disclosures of your protected health care information. This organization is not required to agree with the restrictions you have requested.

· access and amend your protected health information that is incorrect or incomplete. This organization is not required to change your information and will provide you with information about our denial.

· inspect and copy your protected health information. Under Federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and private health information that is subject to law that prohibits access to private health information. Please contact our office contact person if you have any questions about access to your medical record.

· receive an accounting of disclosures of your protected health information. This right applies to disclosures for purposes other than treatment, payment, or health care operations. It excludes disclosures we have made to you, to family members or friends involved in your care, directory listings, and certain government functions. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003.

· get additional paper copies of this Notice of Privacy Practices upon request.

COMPLAINTS Complaints about this Notice of Privacy Practices or how this organization handles your protected health information should be directed to Charlotte Hall, Office Contact Person, at the address or email address listed at the beginning of this notice. If you are not satisfied with the way this office handles a complaint, you may submit a formal complaint to the U.S. Department of Health and Human Services, Office for Civil Rights.