American Vision Center, p.c.
Dr. Jay S. Greenstein and Associates
Clinic Notice of Privacy Practices

This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully.
\tAt AVC Clinic, we have always kept your health information secure and confidential. A new law requires us to continue maintaining your privacy, to give you this notice and to follow the terms of this notice.
\tThe law permits us to use or disclose your health information to those involved in your treatment. For example, a review of your file by a specialist doctor whom we may involve in your care.
\tWe may use or disclose your health information for payment of your services. For example we may send a report of your progress to your insurance company.
\tWe may use or disclose your health information for our normal healthcare operations. For example, one of our staff will enter your information into our computer.
\tWe may share your medical information with our business associates, such as a billing service. We have a written contract with each business associate that requires them to protect your privacy.
\tWe may use your information to contact you. For example, we may send newsletters or other information. We may also want to call and remind you about your appointments. If you are not at home, we may leave this information on your machine or with the person who answers the telephone.
\tIn an emergency, we may disclose your health information to a family member or another person responsible for your care.
\tWe may release some or all of your health information when required by law.
\tIf this practice is sold, your information will become the property of the new owner.
\tExcept as described above, this practice will not use or disclose your health information without your prior written authorization.
\tYou may request in writing that we not use or disclose your health information as described above. We will let you know if we can fulfill your request.
\tYou have the right to know any uses or disclosures we make with your health information beyond the above normal uses.
\tAs we will need to contact you from time to time, we will use whatever address or telephone number you prefer.
\tYou have the right to transfer copies of your health information to another practice. We will mail your files for you.
\tYou have the right to see and receive a copy of your health information, with a few exceptions. Give us a written request regarding the information you want to see. If you also want a copy of your records, we may charge you a reasonable fee for the copies.
\tYou have the right to request an amendment or change to your heath information. Give us your request to make changes in writing. If you wish to include a statement in your file, please give it to us in writing. We may or may not make the changes you request, but will be happy to include your statement in your file. If we agree to an amendment or change, we will not remove nor alter earlier documents, but will add new information.
\tYou have the right to receive a copy of this notice.
\tYou may file a complaint with the Department on Health and Human Services, 200 Independence Avenue, S.W., Room 509 F, Washington, DC 20201. You will not be retaliated against for filing a complaint. However, before filing a complaint, or for more information or assistance regarding your health information privacy, please contact our Privacy Officer, in writing, by phone, or by email
\tThis notice goes into effect as of April 14, 2003.

Denver: 26 South Broadway, 80209 tel.303-777-7990
Littleton: 8500 W Bowles Suite 300, Wells Fargo Bank Building, 80123 tel.303-972-0717
E-mail drjay519@hotmail.com
Privacy Officer: Kathe Greenstein