Notice of Privacy Practices

This Notice explains how Modern Optical NY may use and share your health information, and your rights regarding that information. We are required by federal and New York State law to protect the privacy of your health information.

1. Effective Date and Covered Entity

Effective date: May 27, 2026

Covered entity: Modern Optical NY
453 Kings Hwy, Brooklyn, NY 11223
Phone: (718) 336-1060 · Email: info@modernopticalny.com

2. Our Legal Duty

We are required by law to:

• Maintain the privacy and security of your protected health information (PHI);
• Provide you with this Notice describing our legal duties and privacy practices;
• Follow the terms of the Notice currently in effect;
• Notify you promptly if a breach of your unsecured PHI occurs.

We reserve the right to change our privacy practices and to make the new terms effective for all PHI we maintain, including PHI we created or received before the change. If we make a material change, we will post the revised Notice in our office and on our website, and provide a copy on request.

3. How We May Use and Disclose Your PHI Without Your Written Authorization

We may use and disclose your PHI for the following purposes without your written authorization, when permitted or required by law:

• Treatment. To provide, coordinate, or manage your eye care and related services. Example: sharing your prescription with a lab that fabricates your eyeglass lenses, or consulting with an ophthalmologist we refer you to.
• Payment. To bill and collect payment for the services you receive. Example: submitting a claim to your vision or health insurer with the procedure codes for your exam.
• Health care operations. To run our practice. Examples: quality assessment, staff training, accreditation and licensing reviews, business planning, and care-coordination activities.
• Appointment reminders and health-related communications. To contact you about appointments, test results, recall reminders (for example, an annual exam), treatment alternatives, and health-related products and services we provide.

We may also use or disclose PHI without your authorization in the following situations permitted or required by 45 CFR § 164.512:

• When required by law;
• For public health activities (for example, reporting disease, injury, or vital events);
• For health oversight activities (audits, investigations, inspections);
• In connection with judicial or administrative proceedings, in response to a court order, subpoena, or discovery request as permitted by law;
• For law-enforcement purposes as permitted by law;
• To coroners, medical examiners, and funeral directors;
• For organ, eye, or tissue donation purposes;
• For research, under conditions that protect your privacy;
• To avert a serious and imminent threat to health or safety;
• For specialized government functions (for example, military, national security);
• For workers' compensation as authorized by law;
• To business associates who perform services for us under a written agreement requiring them to safeguard your PHI.

4. Uses and Disclosures That Require Your Written Authorization

The following uses and disclosures will be made only with your specific written authorization:

• Psychotherapy notes (in the rare event we maintain any);
• Marketing communications (other than face-to-face communications or promotional gifts of nominal value);
• Sale of PHI (we do not sell PHI, and we will not do so without your specific written authorization);
• Any other use or disclosure not described in this Notice.

You may revoke your authorization in writing at any time, except to the extent that we have already acted in reliance on it.

5. Substance Use Disorder (SUD) Records and 42 CFR Part 2

Some health information we may receive from another provider (for example, when a treating physician sends us a referral or chart summary) may include records of substance-use-disorder treatment that are protected under federal law, 42 CFR Part 2. Effective February 16, 2026, federal law requires us to tell you the following about SUD Records:

• How we may use and disclose SUD Records. If we receive SUD Records that are subject to 42 CFR Part 2, we will use and disclose them only in ways permitted by HIPAA and by Part 2, including for treatment, payment, and health-care operations, in accordance with any patient consent that accompanied the records.
• Prohibition on use in legal proceedings. SUD Records protected by 42 CFR Part 2 may not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you without your specific written consent or a court order issued under 42 CFR § 2.64 or § 2.65. This includes use in investigations and prosecutions.
• Fundraising opt-out for SUD Records. Before we could ever use or disclose SUD Records subject to Part 2 for fundraising communications, we would have to obtain your prior written consent, and you would have the right to opt out of receiving any such communications. See Section 6 below regarding our fundraising practices generally.
• We are not a Part 2 program. Modern Optical NY does not provide substance-use-disorder treatment and is not a "Part 2 program" under 42 CFR § 2.11. The protections above apply when we hold records that came to us already covered by Part 2 from another provider.

6. Fundraising

Modern Optical NY does not currently conduct fundraising activities. If we begin to use PHI to send fundraising communications in the future, the Notice will be updated and you will have the right to opt out of receiving any further fundraising communications. As described in Section 5, fundraising involving SUD Records subject to 42 CFR Part 2 requires your prior written consent.

7. Your Rights Regarding Your Health Information

You have the following rights regarding the PHI we maintain about you:

• Right to inspect and copy. You may inspect and request a copy of your health record, including an electronic copy where we maintain the record electronically, subject to limited exceptions. We may charge a reasonable cost-based fee for copies as permitted by law.
• Right to amend. You may request an amendment to your record if you believe information is incorrect or incomplete. We may deny a request in limited circumstances, in which case you may submit a written statement of disagreement.
• Right to an accounting of disclosures. You may request a list of certain disclosures of your PHI we made during the six (6) years before the date of your request, subject to exceptions under 45 CFR § 164.528 (for example, disclosures for treatment, payment, and operations are excluded).
• Right to request restrictions. You may ask us to restrict uses or disclosures of PHI for treatment, payment, or operations, or to family members involved in your care. We are not required to agree, except: where you paid out-of-pocket in full for a service and ask us not to share that information with your health plan for payment or operations purposes, we must agree.
• Right to request confidential communications. You may ask us to contact you at a specific address, phone number, or by a specific method (for example, only at home or only by email). We will accommodate reasonable requests.
• Right to a paper copy of this Notice. You may request a paper copy of this Notice at any time, even if you originally received it electronically.
• Right to choose someone to act for you. If you have given someone a medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information, with appropriate documentation.
• Right to breach notification. We will notify you in writing if a breach of your unsecured PHI occurs, as required by 45 CFR §§ 164.400-414.
• Right to file a complaint. You may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights (see Section 11). We will not retaliate against you for filing a complaint.

8. More-Protective State Laws

Where a state or federal law is more protective of your health information than HIPAA, we follow the more-protective law. This includes, where applicable, the New York Mental Hygiene Law, the New York Public Health Law (including Article 27-F protections for HIV-related information), and the New York SHIELD Act for the security of private information. As an optical practice, we generally do not maintain mental-health or HIV-program records, but we will apply the appropriate stricter standard if we ever receive such records.

9. Our Duties

In addition to the duties described in Section 2 above:

• We will protect your PHI using reasonable administrative, technical, and physical safeguards consistent with HIPAA, HITECH, and the New York SHIELD Act;
• We will limit our uses and disclosures to the minimum necessary to accomplish the intended purpose, except for treatment-related disclosures and certain other permitted uses;
• We will train our workforce on these privacy practices and the protections for SUD Records described in Section 5;
• We will require our business associates to safeguard your PHI under written agreements;
• We will follow the terms of the Notice currently in effect.

10. Availability of This Notice

We make this Notice available in the following ways:

• At your first service. New patients receive a paper copy of this Notice no later than the date of first service delivery, including telehealth visits, and we ask you to sign an Acknowledgment of Receipt. If you decline to sign, we will document that and still provide services.
• Posted in our office. A copy is posted in a visible location at 453 Kings Hwy, Brooklyn, NY 11223.
• Posted online. The current Notice is always available on our website at modernopticalny.com/notice-of-privacy-practices/.
• On request. A paper copy is available at any time on request - to current patients, former patients, or any other person who asks - even if you originally received the Notice electronically.
• Alternative formats. On request, we will provide this Notice in alternative formats reasonably available to us, including large print, audio, or a translated copy where translation is available. Contact our Privacy Officer to request an alternative format.

11. How to File a Complaint

If you believe your privacy rights have been violated, you may file a written complaint with us or directly with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Modern Optical NY - Privacy Officer
453 Kings Hwy, Brooklyn, NY 11223
Phone: (718) 336-1060
Email: info@modernopticalny.com

U.S. Department of Health and Human Services - Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll-free: 1-877-696-6775
Online complaint portal: https://www.hhs.gov/ocr/privacy/hipaa/complaints/

12. Contact

For questions about this Notice, to exercise any of your rights, or to request a copy in an alternative format, contact our Privacy Officer using the information in Section 11 above.