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HEALTH INFORMATION PRIVACY PRACTICES 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND  DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION, PLEASE REVIEW IT  CAREFULLY. 

Effective Date of This Notice: February 16, 2026

If you have any questions about this notice, please contact the Privacy Official for Clearway Pain  Solutions at 443-693-7246. 

OUR PLEDGE REGARDING YOUR HEALTH INFORMATION 

We will create a record of the care and services you receive from us to provide you with quality care and  to comply with legal or regulatory requirements. 

We are committed to protecting your health information. This Notice applies to all the records generated  or received by us whether we documented the health information, or another doctor forwarded it to us.  This Notice describes how we may use or disclose your health information, your rights to access your  health information, and describes certain obligations we have regarding the use and disclosure of your  health information. 

The federal government has issued a regulation to provide safeguards for privacy and security of health  information that may identify you. This rule was issued under a law called the Health Insurance Portability  and Accountability Act of 1996(HIPAA). This document, called an “Authorization,” describes your rights  and explains how your health information will be used and disclosed. 

The privacy and security provisions of the Health Insurance Portability and Accountability Act(“HIPAA”)  require us to: 

  • Make sure that health information that identifies you is kept private. 
  • Make available this notice of our legal duties and privacy practices with respect to health  information about you; and follow the terms of the notice that is currently in effect. 

Your Information. Your Rights. Our Responsibilities. 

This notice describes how medical information about you may be used and disclosed and how you can  get access to this information. Please review it carefully. 

Your Rights 

You have the right to: 

  • Get a copy of your paper or electronic medical record 
  • Correct your paper or electronic medical record 
  • Request confidential communication 
  • Ask us to limit the information we share 
  • Get a list of those with whom we’ve shared your information 
  • Get a copy of this privacy notice 
  • Choose someone to act for you 
  • File a complaint if you believe your privacy rights have been violated 

Your Choices 

You have some choices in the way that we use and share information as we: 

  • Tell family and friends about your condition 
  • Provide disaster relief 
  • Include you in a hospital directory 
  • Provide mental health care 
  • Market our services and sell your information 
  • Raise funds 

Our Uses and Disclosures 

We may use and share your information as we: 

  • Treat you 
  • Run our organization 
  • Bill for your services 
  • Help with public health and safety issues 
  • Do research 
  • Comply with the law 
  • Respond to organ and tissue donation requests 
  • Work with a medical examiner or funeral director 
  • Address workers’ compensation, law enforcement, and other government requests • Respond to lawsuits and legal actions 

Your Rights 

When it comes to your health information, you have certain rights. This section explains your rights  and some of our responsibilities to help you. 

Get an electronic or paper copy of your medical record 

  • You can ask to see or get an electronic or paper copy of your medical record and other health  information we have about you. Ask us how to do this. 
  • We will provide a copy or a summary of your health information, usually within 30 days of your  request. We may charge a reasonable, cost-based fee. 

Ask us to correct your medical record 

  • You can ask us to correct health information about you that you think is incorrect or incomplete.  Ask us how to do this. 
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications 

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send  mail to a different address. 
  • We will say “yes” to all reasonable requests. 

Ask us to limit what we use or share 

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

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years  prior to the date you ask, who we shared it with, and why. 
  • We will include all the disclosures except for those about treatment, payment, and healthcare  operations, and certain other disclosures (such as any you asked us to make). We’ll provide one  accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one  within 12 months. 

Get a copy of this privacy notice 

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice  electronically. We will provide you with a paper copy promptly. 

Choose someone to act for you 

If you have given someone medical power of attorney or if someone is your legal guardian, that person  can exercise your rights and make choices about your health information. 

We will make sure the person has this authority and can act for you before we take any action.  File a complaint if you feel your rights are violated 

  • You can complain if you feel we have violated your rights by contacting the Privacy Officer for  Clearway Pain Solutions at 443-693-7246. 
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil  Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1- 877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ 

Your Choices 

For certain health information, you can tell us your choices about what we share. If you have a  clear preference for how we share your information in the situations described below, talk to us.  Tell us what you want us to do, and we will follow your instructions. 

In these cases, you have both the right and choice to tell us to: 

  • Share information with your family, close friends, or others involved in your care • Share information in a disaster relief situation 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and  share your information if we believe it is in your best interest. We may also share your information when  needed to lessen a serious and imminent threat to health or safety. 

In these cases, we never share your information unless you give us written permission for: 

  • Marketing purposes 
  • Sale of your information 

In the case of fundraising 

  • We may contact you for fundraising efforts, but you can tell us not to contact you again. 

Our Uses and Disclosures 

How do we typically use or share your health information? 

We typically use or share your health information in the following way to: 

Treat you 

We can use your health information and share it with other professionals who are treating you.* 

Example: A doctor treating you for an injury asks another doctor about your overall health  condition. 

Run our organization 

We can use and share your health information to run our practice, improve your care, and contact  you when necessary. 

Example: We use health information about you to manage your treatment and services.

Bill for your services 

We can use and share your health information to bill and get payment from health plans or other  entities. 

Example: We give information about you to your health insurance plan so it will pay for your  services. 

Substance Use Disorder Treatment Records: Records from a Substance Use Disorder (SUD) treatment  program have heightened protections under federal law. Although we are not a SUD treatment program  under federal law, it is possible, if you are or have been a patient in a SUD treatment program, we may receive information from that program about you as part of the coordination of your care. We may use  these records for treatment, payment, and health care operations. 

How else can we use or share your health information? 

We are allowed or required to share your information in other ways – usually in ways that contribute to the  public good, such as public health and research. We have to meet many conditions in the law before we  can share your information for these purposes. For more information see: 

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html 

Help with public health and safety issues 

We can share health information about you for certain situations such as 

  • Preventing disease 
  • Helping with product recalls 
  • Reporting adverse reactions to medications 
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety 

Do research 

We can use or share your information for health research. 

Comply with the law 

We will share information about you if state or federal laws require it, including with the  Department of Health and Human Service if it wants to see that we’re complying with federal  privacy law. 

Respond to organ and tissue donation requests 

  • We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director 

  • We can share health information with a coroner, medical examiner, or funeral director when an  individual dies. 

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you: 

  • For workers’ compensation claims 
  • For law enforcement purposes or with a law enforcement official 
  • With health oversight agencies for activities authorized by law 
  • For special government functions such as military, national security and presidential protective  services. 

Respond to lawsuits and legal actions 

  • We can share health information about you in response to a court or administrative order, or in  response to a subpoena. 

We will not disclose information received from a SUD program for use in a civil, criminal, administrative,  or legislative proceeding without your written consent or court order. A court order authorizing use or  disclosure of SUD treatment records must be accompanied by a subpoena or other legal requirement  compelling disclosure before the requested records are used or disclosed by us.  

Our Responsibilities 

  • We are required by law to maintain the privacy and security of your protected health information. 
  • We will let you know promptly if a breach occurs that may have compromised the privacy or  security of your information. 
  • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can  in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if  you change your mind. 
  • Please be aware that after we have shared your information in a permitted way, it is possible for  the information to be redisclosed by the recipient, including SUD treatment records. Upon  redisclosure, this information will no longer be protected by the HIPAA Privacy Rule. 

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/comsumers/noticepp.html

Changes to the Terms of this Notice 

We can change the terms of this notice, and the changes will apply to all information we have about you.  The new notice will be available upon request, in our office, and on our website.