Effective date of notice: April 1, 2003

NOTICE OF PRIVACY PRACTICES Scott M. Buckingham, O.D., P.C. John E. Kaminski, O.D., F.A.A.O. 1504 Harcrest Dr. Midland, MI 48640 989-636-7580 fax: 989-636-7583

____________________________________________________________________ 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. _____________________________________________________________________

GENERAL RULE We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give notice of our privacy practices.

Generally, we cannot use your health information in our office or disclose it outside of our office without your permission. Sometimes the written permission will be called a consent form, and sometimes it will be called an authorization form. The type of permission form will depend upon the kinds of used or disclosures that are involved. In some limited situations, the law allows or requires us to disclose your health information without either a written consent or authorization.

USES OR DISCLOSURES WITH CONSENT We may ask you to sign a consent form allowing us to use and disclose your health information for purposes of treatment, payment,. and health care operations of this office. We are not required by law to do this. We are allowed to refuse to treat you if you do not sign the consent form if asked.

We use information for treatment purposes, when, for example, we set up an appointment for you, when our technician or doctor tests your eyes, when the doctor prescribes glasses or contact lenses, when the doctor prescribes medication, when our staff helps you select and order glasses or contact lenses, and when we show you low vision aids. We may disclose your health information outside of our office for treatment purposes if, for example, we refer you to another doctor or clinic for eye care or low vision aids or services, if we send a prescription for glasses or contacts to another to be filled, when we provide a prescription for medication to a pharmacist, or when we phone to let you know that your glasses or contact lenses are ready to be picked up. Sometimes we may ask for copies of your health information from another professional that you may have seen before us.

We use your health information for payment purposes when, for example, our staff asks you about health or vision care plans that you may belong to, or about other sources of payment for our services, when we prepare bills to send to you or your health or vision care plan, when we process payment by credit card, and when we try to collect unpaid amounts due. We may disclose your health information outside of our office for payment purposes when, for example, bills or claims for payment are mailed, faxed, or sent by computer to you or your health or vision plan, or when we occasionally have to ask a collection agency or attorney to help us with unpaid amounts due.

We use and disclose your health information for health care operations in a number of ways. Health care operations means those administrative and managerial functions that we have to do in order to run our office. We may use or disclose your health information, for example, for financial or billing audits, for internal quality assurance, for personnel decisions, to enable our doctors to participate in managed care plans, for the defense of legal matters, to develop busingess plans, and for outside storage of our records.

USES AND DISCLOSURES WITHOUT CONSENT OR AUTHORIZATION In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up at our office at all. Such uses or disclosures are:

specific purpose;

surveillance; and notices to and from the Food and Drug Administration regarding drugs or medical devices;

domestic violence;

for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;

or orders of courts or administrative agencies;

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;

death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;

of the president or high ranking government officicals; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service;

who agree to keep your health information private.

APPOINTMENT REMINDERS We may call to remind you of scheduled appointments. We may also call to notify you of other treatments or services available at you office that might help you.

OTHER DISCLOSURES We will not make any other uses or disclosures of your health information unless you sign a written authorization form. You do not have to sign such a form. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it.

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

treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to Jeri, Compliance Officer, at the address or fax shown at the beginning of this Notice.

rather than at home, by mailing health information to a different address, or by using E-mail to your personal E-mail address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to Jeri, Compliance Officer, at the address or fax shown at the beginning of this Notice.

limited situations in which we can refuse to permit access or copying. For the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us. You may have to pay for photocopies in advance. If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally required. By law, we can have one 30 day extension of the time for us to give you access or photocopies if we send you a written notice of the extension. If you want to review or get photocopies of your health information, send a written request to Jeri, Compliance Officer, at the address or fax shown at the beginning of this Notice.

payment or health care operations and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30 day extensioin of time if we notify you of the extension in writing. If you want a list, send a written request to Jeri, Compliance Officer, at the address or fax shown at the beginning of this Notice.

Jeri, Compliance Officer, at the address or fax shown at the beginning of this Notice.

OUR NOTICE OF PRIVACY PRACTICES By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time in compliance with and as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site.

COMPLAINTS If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to Jeri, Compliance Officer, at the address or fax shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.

FOR MORE INFORMATION If you want more information about our privacy practices, call or visit, Jeri, Compliance Officer at the address or phone number shown at the beginning of this Notice.