Notice of Privacy Practices

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.

Green Eye Institute is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this notice of our legal duties and privacy practices with respect to protected health information. We are required by law to abide by the terms of the Notice, making any revisions applicable to all of the protected health information we maintain. If we revise the terms of this Notice, we will post a revised notice and make available paper copies of this Notice of Privacy Practices.

How Your Medical Information Will be Used and Disclosed

We will use your protected health information as part of rendering patient care. For example, your protected health information may be used by the health care professional treating you, by the business office to process your payment for the services rendered and by our staff reviewing the quality and appropriateness of the care received. We may also use and/or disclose your information in accordance with federal/state laws for the following.

Unless you object: *We may disclose to family members, other relatives, or close personal friends, the medical information directly relevant to such person's involvement with your care; *We may use or disclose your medical information to notify a family member, or other person responsible for your care of our location and your general condition, or death; *We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits that may be of interest to you.

We may use or disclose your medical information: *When required by the U.S. Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws; for public health activities, including the reporting of disease, injury, and the conduct of public health surveillance; *Concerning abuse, neglect, or violence in accordance with federal and state law; *In the course of certain judicial or administrative proceedings; to a coroner, medical examiner, or funeral director; *To prevent or lessen a serious threat to health and safety of another or the public; *As authorized by laws relating to Workers Compensation or other programs.

We will not use or disclose your medical information for any other purposes without your written authorization. Once given, you can revoke your authorization at any time.

If you need an explanation of any of this information, please contact us.

Your Rights Regarding Your Medical Information

You have the following rights with respect to your medical information: *The right to request restrictions on certain uses and disclosures of your protected health information. We are not required to agree to your requested restriction, but if we do, we will honor the request. *The right to receive communications from us in a confidential manner. *The right to inspect and copy your medical information. This right is subject to certain specific exceptions and you may be charged a reasonable fee for any copies of your records. *The right to request an amendment of your medical information. We may deny your request for certain specific reasons, and if denied, we will provide you with a written explanation for the denial and information regarding further rights you will have at that point. *The right to receive an accounting of the disclosures of your medical information in the six years prior to your request (following April 14, 2003), except for disclosures for treatment, payment, or practice operational purposes, disclosures pursuant to an authorization and certain other specific disclosure types. *The right to request a paper copy of this Notice of Privacy Practices. *The right to complain to us and/or the U.S. Department of Health and Human Services, if you believe we have violated your privacy rights. To complain to Green Eye Institute, please contact:

Privacy Officer 102 East Hospital Drive Hattiesburg, MS 39402 601-268-5144

If you choose to file a complaint, you will not be retaliated against in any way.

This notice is effective as of April 14, 2003.