Notice of Patient Privacy

Effective Date: April 1, 2026

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

OUR LEGAL DUTY

Kresloff Eye Associates is required by federal and New Jersey law to:

• Maintain the privacy of your protected health information (“PHI”)
• Provide you with this Notice of Privacy Practices
• Abide by the terms of the Notice currently in effect
• Notify you following a breach of unsecured PHI as required by law We are required to follow the privacy practices described in this Notice.

We reserve the right to change this Notice at any time. Any revised Notice will apply to all PHI we maintain and will be posted in our office and on our website. A copy will be available upon request.

HOW WE MAY USE AND DISCLOSE YOUR INFORMATION

We may use and disclose your PHI without your written authorization for the following purposes:

1. Treatment

We may use and disclose your medical information to provide, coordinate, or manage your health care.

Examples include:

• Sharing information with referring physicians
• Sending reports to specialists
• Coordinating care with surgical centers or anesthesia providers
• Discussing your condition with technicians or clinical staff involved in your care

2. Payment

We may use and disclose your information to bill and collect payment for services provided. Examples include:

• Submitting claims to insurance companies
• Obtaining prior authorization
• Responding to insurance inquiries
• Billing you for deductibles, copayments, coinsurance, or non-covered services

3. Health Care Operations

We may use your information for business and operational activities necessary to run our practice.

Examples include:

• Quality assessment and improvement
• Staff training and education
• Licensing and accreditation
• Compliance reviews and audits
• Business management and administrative activities

4. Appointment Reminders & Treatment Alternatives

We may contact you regarding:

• Appointment reminders
• Follow-up care
• Treatment options
• Health-related benefits and services

5. Individuals Involved in Your Care or Payment

Unless you object, we may disclose relevant information to family members, friends, or caregivers involved in your care or payment for your care.

6. As Required by Law

We may disclose your information when required by federal or New Jersey law, including:

• Public health reporting
• Communicable disease reporting
• Abuse or neglect reporting
• Law enforcement requests
• Court orders or subpoenas
• Workers’ compensation programs

7. Public Health & Safety

We may disclose information to:

• Prevent serious threats to health or safety
• Report adverse events
• Assist with public health investigations

USES REQUIRING YOUR WRITTEN AUTHORIZATION

We will not use or disclose your PHI for:

• Marketing purposes
• Sale of PHI
• Most uses involving psychotherapy notes Unless you provide written authorization.

You may revoke your authorization at any time in writing, except to the extent action has already been taken in reliance upon it.

YOUR RIGHTS

You have the following rights regarding your PHI:

• Right to Inspect and Obtain a Copy

You may request access to your medical record in paper or electronic format. Reasonable, cost-based fees may apply as permitted by law.

• Right to Request an Amendment

If you believe information in your record is incorrect or incomplete, you may request an amendment. We may deny your request under certain circumstances, but you will receive a written explanation.

• Right to an Accounting of Disclosures

You may request a list of certain disclosures made outside of treatment, payment, and health care operations.

• Right to Request Restrictions

You may request restrictions on how we use or disclose your PHI.

We are not required to agree to requested restrictions, except as described below.

If you pay out-of-pocket in full for a specific service and request that we not disclose information about that service to your health plan, we will honor that request unless disclosure is required by law.

• Right to Request Confidential Communications

You may request that we contact you in a specific way (for example, at a different address or phone number). We will accommodate reasonable requests.

• Right to Receive a Paper Copy

You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

HOW TO EXERCISE YOUR RIGHTS

To exercise any of these rights, contact:

Privacy Officer Kresloff Eye Associates 1055 Haddon Avenue

Collingswood, NJ 08108

Phone: (856) 854-4242

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with: Privacy Officer

Kresloff Eye Associates OR

U.S. Department of Health & Human Services Office for Civil Rights

www.hhs.gov/ocr 1-800-368-1019

You will not be retaliated against for filing a complaint.