THE FOLLOWING CONTRACT TERMS ARE INTENDED TO SPECIFY THE CHURCHILL VISION AND LASER CENTER'S OBLIGATION TO YOU AS A PATIENT UNDER THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA). UNDER HIPAA, HEALTH CARE PROVIDERS HAVE CERTAIN OBLIGATIONS TO PROTECT INFORMATION ABOUT OUR PATIENTS. THIS KIND OF INFORMATION IS CALLED "PROTECTED HEALTH INSURANCE" (PHI). THE CHURCHILL VISION AND LASER CENTER (CVLC) AGREES TO PROTECT ANY PROTECTED HEALTH INFORMATION WE OBTAIN FROM YOU OR ON YOUR BEHALF AS FOLLOWS: 1. CVLC WILL ONLY USE OR DISCLOSE PHI IT OBTAINS FROM YOU OR ON YOUR BEHALF (a) FOR PURPOSES OF PROVIDING SERVICES TO YOU, (b) IF NEEDED BY CVLC FOR INTERNAL MANAGEMENT AND ADMINISTRATIVE NEEDS OR (c) IF NEEDED TO FULFILL CVLC'S LEGAL OBLIGATIONS. 2. CVLC WILL NOT USE OR DISCLOSE PHI IT OBTAINS FROM YOU OR ON YOUR BEHALF FOR ANY OTHER ACTIVITY OR PURPOSE, UNLESS YOU HAVE AUTHORIZED CVLC TO DO SO IN WRITING AND SUCH USE OR DISCLOSURE IS OTHERWISE PERMITTED BY LAW. 3. CVLC WILL ESTABLISH AND MAINTAIN POLICIES, PROCEDURES AND TECHNICAL SOLUTIONS WHICH IT DETERMINES ARE REASONABLY NECESSARY TO PROTECT ANY PHI IT OBTAINS FROM YOU OR ON YOUR BEHALF. 4. IF A PATIENT OF THE CVLC REQUESTS TO REVIEW OR COPY THEIR PHI, UPON THAT PATIENTS WRITTEN REQUEST VIA OUR PATIENT RECORDS ACCESS FORM, THE CVLC WILL PROMPTLY PROVIDE REASONABLE ACCESS TO OR COPIES OF SUCH INFORMATION. 5. DR. SZOKO WILL ADDRESS ANY QUESTIONS REGARDING HIPAA.