Effective Date: 8/6/2025

Coastal Vision Medical Group

Website: www.coastalvisionmedical.com

Phone: 888-501-4496

This Notice describes how your medical information may be used and disclosed and how you can access this information. Please review it carefully.

Your Rights

You have the right to:

• Get a copy of your medical record

• Request corrections to your record

• Ask us to limit what we share

• Request confidential communications

• Get a list of those with whom we’ve shared your information

• Get a copy of this privacy notice

• File a complaint if you believe your rights are violated

Your Choices

You can ask us to:

• Share information with your family, close friends, or others involved in your care

• Share information in a disaster relief situation

• Contact you for fundraising efforts

You can tell us your choices about what we share. If you have a clear preference, talk to us and we’ll follow your wishes as much as possible.

Our Uses and Disclosures

We typically use or share your health information to:

• Treat you: Share information with other doctors or specialists involved in your care.

• Run our practice: Improve our services, train staff, manage operations.

• Bill for services: Send information to your health plan or other payers for reimbursement.

We may also use or share your information in other ways:

• Public health and safety (e.g., reporting disease, abuse, or medication issues)

• Research (with special approval and privacy protections)

• Required by law (e.g., subpoenas, court orders)

• Organ and tissue donation requests

• Workers’ compensation, law enforcement, and government functions

• Medical examiners or funeral directors (for decedents)

• To prevent serious threats to health or safety

We never:

• Sell your personal information

• Use your information for marketing without your written permission

• Share psychotherapy notes unless you authorize it

Our Responsibilities

• We are required by law to keep your health information private.

• We will let you know promptly if a breach occurs that may compromise your information.

• We must follow the duties and privacy practices described in this notice.

• We will not use or share your information other than as described here unless you give written permission. You may change your mind at any time.

How to Exercise Your Rights

To request your records, ask for a correction, file a complaint, or exercise other rights, please contact:

Privacy Officer

Coastal Vision Medical Group

Phone: 888-501-4496

Email: arlenegutierrez@coastal-vision.com

You can also file a complaint with the U.S. Department of Health and Human Services at www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

Changes to This Notice

We may update this notice at any time. Updates will be posted on our website and available at all clinic locations. The updated notice will apply to all your information, past and future.