Effective Date: September 02, 2025

Your Rights

Get a copy of your medical record

You can ask to see or receive an electronic or paper copy of your medical record and other health information. We will provide it, usually within 15 business days (as required under Texas law), and may charge a reasonable, cost-based fee.

Ask us to correct your record

You can request corrections if you believe the information is inaccurate or incomplete. We may deny the request but will explain the reason in writing within 60 days.

Request confidential communications

You may ask us to contact you in a specific way (e.g., only at work or by mail We will accommodate reasonable requests.

Ask us to limit what we use or share

You can request that we not use or share certain health information. We are not required to agree, except in cases where you pay for a service entirely out-of-pocket and request that it not be shared with your health plan, unless otherwise required by law.

Get a list of those we've shared information with

You can request an accounting of disclosures made in the past six years, excluding disclosures for treatment, payment, and health care operations.

Get a copy of this privacy notice

You can request a paper copy at any time, even if you agreed to receive it electronically.

Choose someone to act for you If you have a medical power of attorney or legal guardian, that person may exercise your rights.

File a Complaint

You may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services if you believe your rights have been violated. We will not retaliate against

Your Choices

We do not use or disclose your health information for marketing or sales purposes without your written consent.

Our Uses and Disclosures

To Treat you - share information with other professionals involved in your care.

To Run our organization - improve care, manage operations, and contact you when needed.

Bill for services - Share information with your health insurer for payment purposes.

Other Permitted Uses and Disclosures

We are permitted or required to share your information in the following situations, with safeguards and limits where required by law: - Public health and safety (disease prevention, recalls, adverse reactions, abuse/neglect, threats to safety) - Research (with IRB approval) - Compliance with the law - Organ and tissue donation - Medical examiners and funeral directors- Health oversight agencies - Special government functions - Lawsuits and legal actions

Texas-Specific Disclosures

Under Texas law, we must obtain your written authorization before disclosing any of the following types of information, unless otherwise permitted by law:

- HIV or AIDS test results - Communicable disease records - Genetic test results - Substance use disorder treatment records

We will never share these without your explicit consent, unless legally required.

Our Responsibilities

We are required by federal and Texas law to maintain the privacy and security of your health information. - We will notify you promptly if a breach occurs that may have compromised your

- We must follow the terms of this Notice and provide you with a copy. - We will not use or disclose your information without your written authorization, except as

- If you give us permission to share your information, you may revoke it at any time in writing.

Changes to This Notice

We reserve the right to change the terms of this Notice at any time. Updates will apply to all information we have about you and will be posted in our office and on our website.

Contact Information

To exercise your rights, file a complaint, or ask questions about this Notice, please contact:

Privacy Officer Austin Eye Studio Emily Simonek, OD info@austineyestudio.com

Or file a complaint with: U.S. Department of Health & Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201

www.hhs.gov/ocr/privacy/hipaa/complaints