Notice of Privacy Practices

Effective date: October 19, 2026

Your information. Your rights. Our responsibilities.

About this notice for our patients and their families. EarWell Centers treats newborns and infants. In this notice, “you” and “your” mean the patient. Because our patients are infants, their parents or legal guardians normally act for them as their personal representatives. A parent or guardian can use the rights and make the choices described in this notice on the child’s behalf (see “Choose someone to act for you”).

Who this notice applies to. This notice applies to EarWell Centers and its doctors, staff and offices:

• Dallas (headquarters): 5445 La Sierra Drive, Suite 105, Dallas, TX 75231
• Southlake: 245 W State Hwy 114, Suite 100, Southlake, TX 76092
• McKinney: 1400 N Coit Rd, Suite 902, McKinney, TX 75071

Privacy questions, requests and complaints: contact the Privacy Officer, EarWell Centers.

• Phone: 214-540-1428
• Email: contact.dallas@earwellcenters.com
• Mail: Privacy Officer, EarWell Centers, 5445 La Sierra Drive, Suite 105, Dallas, TX 75231

Summary

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

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
• Market our services and sell your information
• Raise funds

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

To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

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.
• Texas law: if we keep your record in an electronic health records system that can fulfill the request, we will provide the electronic record within 15 business days of your written request (see “Texas law” below).

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, office, or cell 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

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

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 health care 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 someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• For our infant patients: a parent, a legal guardian, or another person with legal authority to make health care decisions for the child is the child’s personal representative and can use all of the rights in this notice for the child. Other caregivers (for example, a grandparent or babysitter who brings the baby to a visit) can act for the child only with the parent’s or guardian’s permission or other legal authority.
• We will make sure the person has this authority and can act for you before we take any action. We may ask for proof, such as a birth certificate, court order, or guardianship papers.
• In limited situations allowed by law, for example if we reasonably believe a child may be at risk of abuse or neglect by that person, we may decide not to treat someone as the child’s personal representative.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information at the top of this notice.
• 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/hipaa/filing-a-complaint.
• We will not retaliate against you for filing a complaint.

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 or payment for 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:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

We do not use your information to contact you for fundraising.

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 ways.

Treat you. We can use your health information and share it with other professionals who are treating you. Example: Our clinician shares information about your baby’s ear evaluation with your baby’s pediatrician.

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, such as scheduling follow-up visits.

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.

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 the HHS guide to notices of privacy practices.

In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

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 Services 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.

Texas law

Texas law gives you some additional protections:

• Notice of electronic disclosure: Your protected health information may be disclosed electronically. Under Texas law, apart from treatment, payment, health care operations, and disclosures otherwise authorized or required by state or federal law, we will not disclose your protected health information electronically without your separate authorization (or your legally authorized representative’s) for each disclosure. (Tex. Health & Safety Code § 181.154)
• Electronic copies of your record: If we use an electronic health records system that can fulfill the request, we will provide your electronic health record within 15 business days after we receive your written request, unless you agree to another form. (Tex. Health & Safety Code § 181.102)

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 in this notice 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.

For more information see the HHS guide to notices of privacy practices.

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 offices, and on our website at earwellcenters.com/notice-of-privacy-practices/.

You can also see your health information through our patient portal.