Cooperative Optical Services, Inc. (Co/op Optical) is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at Co/op Optical, please contact:

Privacy Officer
Co/op Optical
2424 E. 8 Mile Rd.
Detroit, MI 48234

Effective Date of This Notice: April 15, 2003

I. How Co/op Optical May Use or Disclose Your Health Information

Co/op Optical collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of Co/op Optical, but the information in the medical record belongs to you. Co/op Optical protects the privacy of your health information. The law permits Co/op Optical to use or disclose your health information for the following purposes:

1. Treatment. We may use your health information to facilitate your eye examination and/or to order and manufacture eyeglasses or contact lenses, i.e., your prescription could be sent to an eyeglass laboratory.

2. Payment. We may use your health information to receive payment from an insurance company or through a collection agency.

3. Regular Healthcare Operation. We may use your health information in the performance of our normal healthcare operations, including quality reviews, customer service, training, business planning, etc.

4. Required by law. As required by law, we may use and disclose your health information.

5. Health oversight activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.

6. Judicial and administrative proceedings. We may disclose your health information in the course of any administrative or judicial proceeding.

7. Law enforcement. We may disclose your health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.

8. Worker's compensation. We may disclose your health information as necessary to comply with worker's compensation laws.

9 Marketing. We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you.

10. Health plan. We may disclose your health information to the sponsor of your health plan.

11. Change of ownership. In the event that Co/op Optical is sold or merged with another organization, your health information/record will become the property of the new owner.

II. When Co/op Optical May Not Use or Disclose Your Health Information

Except as described in this Notice of Privacy Practices, Co/op Optical will not use or disclose your health information without your written authorization. If you do authorize Co/op Optical to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

III. Your Health Information Rights

1. You have the right to request restrictions on certain uses and disclosures of your health information. Co/op Optical is not required to agree to the restriction that you requested.

2. You have the right to receive your health information through a reasonable alternative means or at an alternative location. Written request should be sent to:

Privacy Officer
Co/op Optical
2424 E. 8 Mile Rd.
Detroit, MI 48234.

3. You have the right to inspect and copy your health information.

4. You have a right to request that Co/op Optical amend your health information that is incorrect or incomplete. Co/op Optical is not required to change your health information and will provide you with information about Co/op Optical's denial and how you can disagree with the denial.

5. You have a right to receive an accounting of disclosures of your health information made by Co/op Optical, except that Co/op Optical does not have to account for the disclosures for treatment, payment, health care operations, or information provided to you or certain government functions as listed in Section I of this Notice of Privacy Practices.

6. You have a right to a paper copy of this Notice of Privacy Practices.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact:

Privacy Officer
Co/op Optical
2424 E. 8 Mile Rd.
Detroit, MI 48234

IV. Changes to this Notice of Privacy Practices

Co/op Optical reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until such amendment is made, Co/op Optical is required by law to comply with this Notice.

V. Complaints

Complaints about this Notice of Privacy Practices or how Co/op Optical handles your health information should be directed to:

Privacy Officer
Co/op Optical
2424 E. 8 Mile Rd.
Detroit, MI 48234


If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201

You may also address your compliant to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.