EYE SITE SUMMARY OF PRIVACY PRACTICES

This summary of our privacy practices is contains a condensed version of our Notice of Privacy Practices. Our full-length notice is available upon request.

  Date of Last Revision:   4/1/03 

  Effective Date: Immediately

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 understand that your medical information is personal to you, and we are committed to protecting the information about you. As our patient, we create medical records about your health, our care for you, and the services and/or items we provide to you as our patient. By law, we are required to make sure that your protected health information is kept private.

  How will we use or disclose your information? Here are a few examples (for more detail please refer to the Notice of Privacy Practices):

•For medical treatment	•For research
•To obtain payment for our services	•To avert a serious threat to health or safety
•In emergency situations	•For organ and tissue donation
•For appointment and patient recall reminders	•For workersÕ compensation programs
•To run our Practice more efficiently and ensure all our patients receive quality care	•In response to certain requests arising out of lawsuits or other disputes

  If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice, contact our practice administrator. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

  You have certain rights regarding the information we maintain about you. These rights include:

•.The right to inspect and copy	•.The right to request restrictions
•.The right to amend	•.The right to a paper copy of this notice
•.The right to an accounting of disclosures	•.The right to request confidential communications

  If you would like more detailed information about this privacy practice, please request the information at eyesite@eye-lasers.com.