HIPAA Notice of Privacy Practices

Effective Date: May 14, 2026

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.

This Notice of Privacy Practices is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). It describes your rights regarding your Protected Health Information (PHI) and our duties to safeguard it.

Table of Contents

1. 1. 1. 1. Who We Are
         2. What is Protected Health Information?
         3. How We May Use and Disclose Your PHI
         4. Uses and Disclosures That Do Not Require Your Authorization
         5. Uses and Disclosures That Require Your Authorization
         6. Your Rights Regarding Your PHI
         7. Our Duties
         8. How to File a Complaint
         9. Contact Us

1. Who We Are

Pacific Coast Multi-Specialty Surgery, LLC (“PCMSS,” “we,” “us,” “our”) is an AAAHC-accredited ambulatory surgery center located at 10900 Warner Ave., Suite 101A, Fountain Valley, California 92708. As a healthcare provider, we are required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this Notice of our legal duties and privacy practices.

This Notice applies to all records of your care generated by PCMSS and all PCMSS workforce members, including employees, contractors, physicians, and volunteers.

2. What is Protected Health Information?

Protected Health Information (PHI) is any information that we create or receive about your past, present, or future physical or mental health condition, the provision of healthcare to you, or payment for that healthcare — if it can be used to identify you. This includes information in your medical records, billing records, conversations between you and your care team, and any other health-related information we maintain.

3. How We May Use and Disclose Your PHI

We use and disclose your PHI primarily for Treatment, Payment, and Health Care Operations (TPO), and in limited other circumstances described below. We will obtain your written Authorization for uses or disclosures beyond those described in this Notice.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. For example, we may share your information with surgeons, anesthesiologists, nurses, or other providers involved in your care, including providers outside our facility who participate in your treatment.

Payment

We may use and disclose your PHI to obtain payment for the treatment and services we provide. For example, we may submit claims to Medicare, Medicaid, your health insurance company, or other payors, and may need to provide them with information about your diagnosis, procedures, and treatment.

Health Care Operations

We may use and disclose your PHI for our internal operations, such as quality assessment and improvement, reviewing the competence of healthcare professionals, employee training, accreditation and licensing, conducting audits, and business planning activities.

4. Uses and Disclosures That Do Not Require Your Authorization

In certain situations, we are permitted or required by law to use or disclose your PHI without your written authorization, including:

• • • As Required by Law. When required by federal, state, or local law.
    • Public Health Activities. To public health authorities for disease prevention, injury or disability reporting, or for FDA oversight of products and services.
    • Health Oversight Activities. To government agencies for audits, investigations, inspections, and licensing relating to the healthcare system.
    • Judicial and Administrative Proceedings. In response to a court order, subpoena, discovery request, or other lawful process.
    • Law Enforcement. To law enforcement officials in limited circumstances, such as to identify a suspect or victim, or in response to a court order.
    • Decedents. To coroners, medical examiners, and funeral directors as necessary.
    • Organ and Tissue Donation. To organizations involved in organ, eye, or tissue procurement, banking, or transplantation.
    • Research. Under certain conditions, to researchers when an institutional review board or privacy board has approved the research.
    • Serious Threats to Health or Safety. To prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
    • Workers’ Compensation. To comply with workers’ compensation laws and programs.
    • Facility Directory. Unless you object, we may include your name, general condition, and location in our facility directory for visitors and clergy who ask for you by name.
    • Individuals Involved in Your Care. To family members, close friends, or others you identify who are involved in your care or payment for your care, unless you object.
    • Appointment Reminders and Health Information. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits.

5. Uses and Disclosures That Require Your Authorization

All other uses and disclosures of your PHI not described in this Notice will be made only with your written Authorization. You have the right to revoke any Authorization you have given us at any time by submitting a written revocation, except where we have already taken action in reliance on the Authorization.

Specific situations requiring Authorization include:

• • • Most uses and disclosures of psychotherapy notes;
    • Uses and disclosures of PHI for marketing purposes;
    • Disclosures that constitute a sale of PHI; and
    • Other uses and disclosures not otherwise permitted by law.

6. Your Rights Regarding Your PHI

You have the following rights with respect to your PHI. To exercise any of these rights, please contact us in writing at the address or email below.

Right to Access and Receive a Copy

You have the right to inspect and receive a copy of your PHI that we maintain in a designated record set, except for certain records such as psychotherapy notes and information compiled for legal proceedings. We may charge a reasonable, cost-based fee for copies. We will respond to your request within 30 days.

Right to Amend

You have the right to request that we amend PHI that you believe is incorrect or incomplete. We may deny your request under certain circumstances. If we deny your request, you may submit a written disagreement. We will respond within 60 days.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your PHI during the six years prior to your request (not including disclosures for Treatment, Payment, or Health Care Operations, or disclosures made with your Authorization). We will respond within 60 days.

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your PHI for Treatment, Payment, or Health Care Operations, or to persons involved in your care. We are not required to agree to most requested restrictions. However, if you pay for a service entirely out of pocket and request that we not disclose that PHI to your health plan solely for payment or operations purposes, we are required to agree.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your PHI in a specific way or at a specific location (e.g., only by phone at your work number, or only by mail to a P.O. box). We will accommodate reasonable requests.

Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically. Contact us at the address below to request a paper copy.

Right to Notification of a Breach

You have the right to receive notification in the event of a breach of unsecured PHI that may compromise the privacy or security of your information, in accordance with HIPAA’s Breach Notification Rule.

7. Our Duties

We are required by law to:

• • • Maintain the privacy of your PHI;
    • Provide you with this Notice of our legal duties and privacy practices;
    • Abide by the terms of the Notice currently in effect; and
    • Notify you in the event of a breach of your unsecured PHI.

We reserve the right to change our privacy practices and the terms of this Notice at any time, and to make new provisions effective for all PHI we maintain. We will post a revised Notice on our website and make paper copies available at our facility. You may request a copy of the current Notice at any time.

8. How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with PCMSS or with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR). You will not be retaliated against for filing a complaint.

• • • File a complaint with PCMSS: Contact us in writing at the address or email below.
    • File a complaint with HHS OCR: Visit hhs.gov/ocr/privacy/hipaa/complaints, call 1-800-368-1019, or write to: U.S. Department of Health & Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201.

9. Contact Us

For questions about this Notice, to exercise your rights, or to request a paper copy, please contact our Privacy Officer:

Pacific Coast Multi-Specialty Surgery, LLC
Privacy Officer
10900 Warner Ave., Suite 101A
Fountain Valley, California 92708
Phone: 800-340-6311
Email: admin@pcsurg.com

This Notice is effective as of May 14, 2026.