Coastal Pain & Spinal Diagnostics Medical Group (CPSD) is required by law to maintain the privacy of your protected health information. This information
consists of all records related to your health, including demographic information, either created by CPSD or received by CPSD from other healthcare
providers. CPSD does not share your personal information with unauthorized third parties. This privacy policy outlines how we collect, use, and protect the
information you provide to us. We collect only the information necessary to provide and improve our services. This may include name, email address,
phone number etc. We do not sell, rent, or share this information with any unauthorized third parties.

We are required to provide you with notice of our legal duties and privacy practices with respect to your protected health information. These legal duties
and privacy practices are described in this Notice. CPSD will abide by the terms of this Notice, or the Notice currently in effect at the time of the use or
disclosure of your protected health information.

CPSD reserves the right to change the terms of this Notice and to make any new provisions effective for all protected health information that we maintain.
Patients will be provided a copy of any revised Notices upon request. An individual may obtain a copy of the current Notice from our office at any time or
by visiting our website, www.coastalpaingroup.com

Uses and Disclosures of Your Protected Health Information Not Requiring Your Consent

CPSD may use and disclose your protected health information, without your written consent or authorization, for certain treatment, payment and
healthcare operations. There are certain restrictions on uses and disclosures of treatment records, which include registration and all other records
concerning individuals who are receiving, or who at any time have received services for mental illness, developmental disabilities, alcoholism, or drug
dependence. There are also restrictions on disclosing HIV test results.

Treatment may include:

• Providing, coordinating, or managing healthcare and related services by one or more healthcare providers;

• ​Consultations between healthcare providers concerning a patient;

• Referrals to other providers for treatment;

• Referrals to nursing homes, foster care homes, or home health agencies.

For example, CPSD may determine that you require the services of a specialist. In referring you to another doctor, CPSD may share or transfer your
healthcare information to that doctor.

Payment activities may include:

• Activities undertaken by CPSD to obtain reimbursement for services provided to you;

• Determining your eligibility for benefits or health insurance coverage;

• Managing claims and contacting your insurance company regarding payment;

• Collections activities to obtain payment for services provided to you;

• Reviewing healthcare services and discussing with your insurance company the medical necessity of certain services or procedures, coverage under your health plan, appropriateness of care, or justification of charges;

• Obtaining pre-certification and pre-authorization of services to be provided to you.

For example, CPSD will submit claims to your insurance company on your behalf. This claim identifies you, your diagnosis, and the services provided
to you.

Healthcare operations may include:

• Contacting healthcare providers and patients with information about treatment alternatives;

• Conducting quality assessment and improvement activities;

• Conducting outcomes evaluation and development of clinical guidelines;

• Protocol development, case management, or care coordination;

• Conducting or arranging for medical review, legal services, and auditing functions.​

​

CPSD will not make any other uses or disclosures of your protected health information without your written authorization. You may revoke such
authorization at any time, except to the extent that CPSD have taken action in reliance thereon. Any revocation must be in writing.

Your Rights Regarding Your Protected Health Information

For example, CPSD may use your diagnosis, treatment, and outcomes information to measure the quality of the services that we provide, or asses the
effectiveness of your treatment when compared to patients in similar situations.

CPSD may contact you, by telephone, text, patient portal, email or mail, to provide appointment reminders. You must notify us if you do not wish to
receive appointment reminders. Text messages will never include your personal or medical information, and we will never ask you for personal or medical
information via text message.

CPSD is committed to safeguarding the privacy of our patients and we will not share your information with any third party other than those listed in this
notice without your consent. We may not disclose your protected health information to family members or friends who may be involved with your
treatment or care without your written permission. Health information may be released without written permission to a parent, guardian, or legal
custodian of a child; the guardian of an incompetent adult; the healthcare agent designated in an incapacitated patient’s health care power of attorney; or
the personal representative or spouse of a deceased patient.

There are additional situations when CPSD is permitted, or required to use or disclose your protected health information without your consent or
authorization. Examples include the following:

• As permitted or required by law. In certain circumstances, we may be required to report individual health to legal authorities, such as law enforcement officials, court officials, or government agencies. For example, we may have to report abuse, neglect, domestic violence or certain physical injuries. We are required to report gunshot wounds or any other wound to law enforcement officials if there is reasonable cause to believe that the wound occurred as a result of a crime. Mental health records may be disclosed to law enforcement authorities for the purpose of reporting an apparent crime on our premises.

• For public health activities. We may release healthcare records, with the exception of treatment records, to certain government agencies or public health authority authorized by law, upon receipt of written request from that agency. We are required to report positive HIV test results to the state epidemiologist. We may also disclose HIV test results to other providers or persons when there has been or will be risk of exposure. We may report to the state epidemiologist the name of any person known to have been significantly exposed to a patient who tests positive for HIV. We are required by law to report suspected child abuse and neglect and suspected abuse of an unborn child, but cannot disclose HIV test results in connection with the reporting or prosecution of alleged abuse or neglect. We may release healthcare records, including treatment records and HIV test results, for the purpose of reporting elder abuse or neglect, provided the subject of the abuse or neglect agrees, or if necessary to prevent from serious harm. Records may be released for the reporting of domestic violence if necessary to protect the patient or community from imminent and substantial danger.

• For health oversight activities. We may disclose healthcare records, including treatment records, in response to a written request by any federal or state governmental agency to perform legally authorized functions, such as management audits, financial audits, program monitoring and evaluation, and facility or individual licensure or certification. HIV test results may not be released to federal or state governmental agencies, without written permission, except to the state epidemiologist for surveillance, investigation, or to control communicable diseases.

• Judicial and Administrative Proceedings. Patient healthcare records, including treatment records and HIV test results, may be disclosed pursuant to a lawful court order. A subpoena signed by a judge is sufficient to permit disclosure of all healthcare records except for HIV test results.

• For activities related to death. We may disclose patient healthcare records, except for treatment records, to a coroner or medical examiner for the purpose of completing a medical certificate or investigating a death. HIV test results may be disclosed under certain circumstances.

• For research. Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research.

• To avoid a serious threat to health or safety. We may report a patient’s name and other relevant data to the Department of Transportation if it is believed the patient’s vision or physical or mental condition affects the patient’s ability to exercise reasonable or ordinary control over a motor vehicle. Healthcare information, including treatment records and HIV test results, may be disclosed where disclosure is necessary to protect the patient or community from imminent and substantial danger.

• For workers’ compensation. We may disclose your health information to the extent such records are reasonably related to any injury for which workers compensation is claimed.

 

CPSD will not make any other uses or disclosures of your protected health information without your written authorization. You may revoke such
authorization at any time, except to the extent that CPSD have taken action in reliance thereon. Any revocation must be in writing.

 

Your Rights Regarding Your Protected Health Information

You are permitted to request that restrictions be placed on certain uses or disclosures of your protected health information by Coastal Pain & Spinal
Diagnostics Medical Group to carry out treatment, payment, or healthcare operations. You must request such a restriction in writing. We are not required
to agree to your request, but if we do agree, we must adhere to the restriction, except when your protected health information is needed in an emergency
treatment situation. In this event, information may be disclosed only to healthcare providers treating you. Also, a restriction would not apply when we are
required by law to disclose certain healthcare information.

You have the right to review and/or obtain a copy of your healthcare records, with the exception of psychotherapy notes, or information compiled for use
(or in anticipation for use) in a civil, criminal, or administrative action or proceeding. Coastal Pain & Spinal Diagnostics Medical Group may deny access
under other circumstances, in which case you have the right to have such a denial reviewed. We may charge a reasonable fee for copying your records.

 

You may request that Coastal Pain & Spinal Diagnostics Medical Group send protected health information, including billing information, to you by alternate means or to alternative locations. You may also request Coastal Pain & Spinal Diagnostics Medical Group not send information to a particular address or location or contact you at a specific location, perhaps your place of employment. This request must be submitted in writing. We will accommodate reasonable requests by you.

You have the right to request that Coastal Pain & Spinal Diagnostics Medical Group amend portions of your healthcare records, as long as such information is maintained by us. You must submit this request in writing, and under certain circumstances the request may be denied.
You may request to receive an accounting of the disclosures of your protected health information made by Coastal Pain & Spinal Diagnostics Medical
Group for the six years prior to the date of the request, beginning with disclosures made after April 14, 2003. We are not required, however, to record
disclosures we make pursuant to a signed consent or authorization.

 

You may request and receive a paper copy of this Notice, if you had previously received or agreed to receive the Notice electronically.

 

Any person or patient may file a complaint with Coastal Pain & Spinal Diagnostics Medical Group and/or the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complaint with Coastal Pain & Spinal Diagnostics Medical Group, please contact the Privacy Officer at the following:


Privacy Officer
Coastal Pain & Spinal Diagnostics Medical Group
6221 Metropolitan St., Suite 201
Carlsbad, CA 92009
(760) 753-7127

It is the policy of Coastal Pain & Spinal Diagnostics Medical Group that no retaliatory action will be made against any individual who submits or conveys a
complaint of suspected or actual non-compliance or violation of the privacy standards.

This Notice of Privacy Practices is effective April 14, 2003 – Updated December 3, 2024

DOC 7     Coastal Pain & Spinal Diagnostics Medical Group           Notice of Privacy Practices                   Updated December 3, 2024