Effective date of notice: April 14, 2003

NOTICE OF PRIVACY PRACTICES

JOHN D. MILLER, O.D., P.C. FAMILY PRACTICE OF OPTOMETRY 4343 SHALLOWFORD ROAD SHALLOWFORD OFFICE PARK MARIETTA, GEORGIA 30062 TELEPHONE (770) 640-7800 FAX (770) 640-7779 John D. Miller, O.D., P.C. - 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 READ 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 HEALTH CARE OPERATIONS The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses, or eye medications and sending them to be filled; showing you low vision aids; referring you to another doctor or clinic for eye care or low vision aids or services; getting copies of your health information from another professional that you may have seen before us or providing medical information to those healthcare professions, whether on this office's staff or not, directly involved in your care so that they may understand your medical condition and needs; sending a prescription for glasses or contact lenses to another professional to be filled; and providing a prescription for medication to a pharmacist. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or vision care plans, or other sources of payment; preparing and sending bills or claims; processing payment by credit card and collecting unpaid amounts (either ourselves or through a collection agency or attorney); providing your medical information, directly or through a billing service, to appropriate third party payers, pursuant to their billing and payment requirements; and when bills or claims for payment are mailed, faxed, or sent by computer to you or your health or vision plan. This office may also need to tell your insurance plan about a treatment you are going to receive so that it can be determined whether or not your plan will cover the treatment. Health care operations mean those administrative and managerial functions that we have to do in order to run our office and this medical information may be collected, compiled and disseminated. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records. We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.

USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION 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:

· 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 DEA 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, inspections and 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 and 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 of members 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; · Disclosures to personal representatives, under applicable Georgia law that have the authority to represent you in making decisions related to your healthcare; · Disclosures for emergency situations for the purpose of obtaining or rendering emergency treatment to you, if the office attempts to obtain consent but is unable to do so; and to a public or private entity authorized by law or its charter to assist in disaster relief efforts; · Disclosures for communication barriers creating the inability to communicate where this office has been unable to obtain consent and this office determines, in the exercise of professional judgment, that your consent to receive treatment is clearly inferred from the circumstances; · Disclosures in order to notify or assist in the notification of a family member, a personal representative or another person responsible for your care or your location or general condition; · Disclosures to the military and veterans as required by military command authorities; · Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your care.

APPOINTMENT REMINDERS We may call or write to remind you of scheduled appointments, to notify you that your glasses or contact lenses are ready, or that it is time to make an appointment. We may also call or write to notify you of other treatments or services available at our office that might help you or to send out newsletters. We may mail you an appointment reminder, and/or leave you a reminder message on your answering machine at home or at work or with someone who answers your phone. We may also send you a note or call you to thank you for referring others to our practice.

OTHER USES AND DISCLOSURES We will not make any other uses or disclosures of your health information unless you sign a written "authorization form." Federal law determines the content of an "authorization form". Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes you may initiate the process if it's your idea for us to send your information to someone else. Typically, in this situation you will give us a properly completed authorization form, or you can use one of ours. 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 one, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of this Notice.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION The law gives you many rights regarding your health information. You can: · Ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions you want. To ask for a restriction, send a written request to the office contact person named at the beginning of this Notice. · Ask us to communicate with you in a confidential way. 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 the office contact person named at the beginning of this Notice. · Inspect and copy your health information as provided by law. This right includes access to medical and billing records. To inspect and copy your health information, send a written request to the office contact person named at the beginning of this Notice. This office can charge you a fee for the costs of copying, mailing or other supplies associated with your request. This office may deny you access to medical information but you have the right to have this denial reviewed as will be set forth more fully in the written denial notice. · Amend incorrect or incomplete health information as provided by law. To request an amendment, send a written request to the office contact person named at the beginning of this Notice. You must provide a reason that supports your request for the amendment(s). This office may deny your request if it is not in writing, if you do not provide a reason in support of your request, if the information to be amended was not created by this office (unless the individual or entity that created the information is no longer available), if the information is not part of the medical information maintained by the office, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. · Receive an accounting of disclosures (but not the uses) of health information as provided by law. To request an accounting, send a written request to the office contact person named at the beginning of this Notice. The request must state a time period that may not be longer than 6 years and may not include dates before April 14, 2003. The request should indicate in what form you want the list (such as a paper or electronic copy). The first list you request within a 12-month period will be free but this office may charge you for the costs of providing additional lists. This office will notify you of the costs involved and you can decide to withdraw or modify your request before any costs are incurred. · Get additional paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already. If you want additional paper copies, send a written request to the office contact person named 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 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 and have copies available in our office.

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 the office contact person 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 the office contact person shown at the beginning of this Notice.