This notice describes how medical information about you may be used and disclosed and how to get access to this information.

This notice is solely for your information. Dr. David MacDonald, and Cartier Optical (We) understand that your Personal Health Information (PHI) is confidential. This Notice of our privacy practices describes generally how We may use and disclose PHI to provide services to you and other purposes that are permitted or required by law. This Notice also explains your rights regarding PHI. This Notice becomes effective on April 14, 2003. PHI is protected health information that individually identifies you and relates to past, present, and future health care or payment for such health care services. We are required by the federal privacy regulations to keep PHI about you private; give you this Notice of our legal duties and privacy practices with respect to your PHI; and follow the terms of the Notice that are currently in effect.


In performing our duties, We may use and disclose your PHI in various ways. We have provided you with examples in certain categories, however, not every use or disclosure in a category will be listed. Such uses and disclosures include:


We may use or disclose PHI to your providers, including optical dispensaries or physicians or pharmacies who participate in the provision of your health care. We may provide you with an appointment reminder, general vision care information, including information regarding alternate treatment, services, products or options.


When you use your health care benefits, We may use and disclose PHI about you in several ways, such as, to determine you eligibility in a vision or health care plan, determine your plan benefits, bill and collect payment, coordinate your benefits, or investigate a claim. For example, We may send a claim to your insurance company identifying you and services provided to you so that we may be paid. We may release PHI about your dependents to you. We may provide you with an explanation of benefits for you or your dependents.

Health Care Operations

We may use and disclose PHI about you for certain operational, administrative, research and quality assurance activities. For example, We may perform quality of care reviews. We may assist your health plan in conducting a review of claims submitted by us to ensure you are charged correctly.

Persons involved in Care

We may use our discretion to disclose PHI to notify a family member, your personal representative or another person involved in your care. For example, we may allow another person to pick up medical supplies or a copy of your prescription. We may disclose your PHI to a family member, friend or other person to the extent necessary to help with your care or with payment for your care.

Additional Uses or Disclosures

  • Public Health or Safety to address situations as permitted by law, including reporting problems with products or product recall Notices, threats to public health and safety, disaster relief efforts or national security.
  • Military as required by military command authorities if you are serving in the military.
  • Organ and Tissue Donation to assist in organ or tissue donation and transplantation.
  • Law Enforcement to respond to a law enforcement official, court of administrative order or other lawful purposes.
  • Coroners, Medical Examiners
  • Regulatory or Administrative Oversight to state insurance departments, Office of Civil Rights, Department of Health and Human Services and others that regulate us. Contractors who are our business associates and provide services to us who will be required to protect your PHI.

Disclosure As You Request

We may use and disclose PHI as generally described in this Notice or according to laws that apply to us. Other uses or disclosure of your PHI will be made only with your written permission, identified as an authorization. If you provide us with authorization, you may revoke that permission at any time by sending a written request to us at 90 Main St. Suite 101 Centerbrook, CT 06409. If you revoke your permission, We will no longer use or disclose PHI about you for the reasons stated in your authorization, except to the extent that We have already taken action in reliance in the authorization.


You have the following rights regarding your PHI:

  • Right to Inspect and Copy. You have the right to inspect and copy PHI that We maintain. If you request a copy of the information, We may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
  • Right to Amend. If you feel that PHI We have about you is incorrect or incomplete, You may ask us to amend you PHI. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request, the current information is accurate and complete or if We did not create the information. If We deny your request, you may send us a written notice of disagreement with our denial.
  • Right to an Accounting of Disclosures. You have the right to a list of our disclosures for purposes other than treatment, payment or health care operations or disclosures made to you or your representative, authorized by you, or made to law enforcement personnel. Your request must state a time period and may not include dates before April 14, 2003. If you request more than one list in a year, We may charge you for the costs of providing the list. We will notify you of the cost involved and you may change your request at that time before any costs are incurred.
  • Right to Request Restrictions. You have the right to request that We restrict the way We use or disclose PHI regarding treatment, payment or health care operations. You also have the right to request that We restrict the PHI We disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree with your request.
  • Right to Request Confidential Communications. You have the right to make a reasonable request that We communicate PHI to you in a certain way or at a certain address. Yourrequest must specify how or where you wish to be contacted. We will comply with reasonable requests.
  • Right to a Paper Copy. If you receive this Notice by email or any other method, you are entitled to receive this Notice in written form, and may request from us a paper copy of this Notice at any time.


If you believe your privacy rights have been violated, you may file a complaint. Submit all complaints in writing to 90 Main St. Suite 101 Centerbrook, CT 06409. You must include your name, address, telephone number, and the description of the complaint and we will respond. You may also contact the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.


We may change the terms of this Notice and our privacy policies. If We make such changes, the new terms and policies will apply to all PHI that We currently have or receive in the future. The effective date of this Notice and any revised Notice may be found on the first page of this Notice. If you have any questions about this Notice, please contact us at 90 Main St. Suite 101 Centerbrook, CT 06409. Please include your name, address, and telephone number.