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.

1) Your rights

You have the right to:

• Get a 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. We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

• Ask us to correct your record. If you think information is wrong or incomplete, ask us to correct it. We may say no, but we will tell you why in writing.

• Request confidential communications. You can ask us to contact you in a specific way or to send mail to a different address. We will say yes if it is reasonable.

• Ask us to limit what we use or share. You can ask us not to use or share certain information for treatment, payment, or operations. We may not be able to agree if it would affect your care. If you pay for a service or item in full out of pocket, you can ask us not to share that information with your health plan for payment or operations. We will say yes unless a law requires us to share it.

• Get a list of disclosures. You can ask for a list of the times we have shared your health information for six years before your request, who we shared it with, and why.

• Get a copy of this notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.

• 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.

• File a complaint. If you feel your privacy rights have been violated, you can file a complaint with us using the contact information below. You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

2) Your choices

You can tell us your choices about what we share:

• Family and friends involved in your care. If you have a preference, tell us what we can share. If you are not able to tell us, we may share information if we believe it is in your best interest.

• Disaster relief or directory information. We may share limited information to help in an emergency.

• Marketing and fundraising. We may contact you for appointment reminders or to tell you about treatment options or services related to your care. We will not use or share your information for most marketing purposes without your written permission. You can opt out of any fundraising communications.

3) Our uses and disclosures

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

• Treat you. We use and share information with other professionals who are treating you.

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

• Bill for your services. We use and share information to bill and get payment from health plans or other entities.

We are allowed or required to share your information in other ways, usually to contribute to the public good, meet legal obligations, or for specific safety reasons. We must meet many conditions before we share. Examples include:

• Public health and safety. Preventing disease, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.

• Health oversight and compliance. Audits, inspections, or licensing activities.

• Research. We can use or share information for approved research.

• Organ and tissue donation. When applicable.

• Coroners, medical examiners, and funeral directors. To carry out their duties.

• Workers’ compensation, law enforcement, and other government requests. As allowed by law.

• Lawsuits and legal actions. Responding to a court or administrative order, or a subpoena.

Other uses and disclosures:

• Most sharing of psychotherapy notes, marketing, or sale of your information requires your written authorization.

• You may revoke an authorization at any time in writing, except where we have already relied on it.

4) Our responsibilities

• We are required by law to maintain the privacy of your protected health information, give you this notice, and follow the terms of the notice that is currently in effect.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• 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.

5) Special protections

Some types of records may have additional protections under federal or state law, such as records related to substance use disorder treatment, HIV testing, or certain mental health information. When those laws apply, we follow them.

6) Changes to this notice

We may change the terms of this notice. Changes will apply to all information we have about you. The new notice will be available on our website and in our office with the effective date at the top.

7) Questions and complaints

If you have questions about this notice, or if you want to file a complaint or exercise your rights, contact:

Plantation Medical Clinic
Attn: Privacy Officer
100 NW 82nd Ave., Suite 206, Plantation, FL 33324
Phone: 954-424-7504

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Visit www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.