**NOTICE OF PRIVACY PRACTICES**

This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

**OUR COMMITMENT TO YOUR PRIVACY**

At Summerhill Eye Care, we are committed to maintaining the privacy and confidentiality of your medical information. We understand that your medical information is personal, and we are dedicated to protecting it. This Notice of Privacy Practices explains how we may use and disclose your medical information and your rights regarding your medical information.

**HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION**

We may use and disclose your medical information for the following purposes:

1. Treatment: We may use and disclose your medical information to provide you with optometric treatment and services. This includes sharing your information with other healthcare professionals involved in your care.

2. Payment: We may use and disclose your medical information to bill and collect payment for the services provided to you. This may include sharing your information with your insurance company, Medicare, or Medicaid.

3. Healthcare Operations: We may use and disclose your medical information for our healthcare operations, such as quality improvement activities, staff training, and business management.

4. Appointment Reminders: We may use and disclose your medical information to remind you of appointments or to provide information about treatment alternatives or other health-related benefits and services.

5. Required by Law: We may use and disclose your medical information when required by law, such as reporting certain diseases or injuries, or responding to a court order.

6. Health Oversight Activities: We may disclose your medical information to health oversight agencies for activities authorized by law, such as audits, investigations, and inspections.

7. Research: We may use or disclose your medical information for research purposes, provided that your privacy is protected.

8. Other Uses and Disclosures: We may use or disclose your medical information for other purposes not listed above, but only with your written authorization. You have the right to revoke this authorization at any time, except to the extent that we have already taken action in reliance on your authorization.

**YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION**

You have the following rights regarding your medical information:

1. Right to Access: You have the right to access and obtain a copy of your medical information, with some limited exceptions.

2. Right to Request Amendments: If you believe that your medical information is incorrect or incomplete, you have the right to request that we amend it.

3. Right to Request Restrictions: You have the right to request restrictions on how we use and disclose your medical information.

4. Right to Request Confidential Communications: You have the right to request that we communicate with you about your medical information in a certain way or at a certain location.

5. Right to Receive a Notice of Breach: You have the right to be notified in the event of a breach of your unsecured medical information.

6. Right to File a Complaint: If you believe your privacy rights have been violated, you have the right to file a complaint with us or with the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.

**OUR RESPONSIBILITIES**

We are required by law to maintain the privacy of your medical information and to provide you with this Notice of Privacy Practices. We reserve the right to change the terms of this Notice at any time and to make the revised Notice effective for medical information we already have about you, as well as any information we receive in the future. We will provide you with a copy of the revised Notice upon request.

**CONTACT INFORMATION**

If you have any questions or concerns about this Notice of Privacy Practices or our privacy practices, please contact:

Summerhill Eye Care
572 Hank Aaron Dr. SE, Suite 1130, Atlanta, GA 30312
404-205-5669

Effective Date: 04/03/2024