Our pledge regarding your health information:

We understand that medical Information about you and your health Is personal. We create a record of the care and services you receive from us. We need this record to provide you with quality care, obtain payment for the services we provide and to comply with legal requirements. This notice applies to all of the records of your care generated by us, whether made by your personal doctor, other Practice doctors or Practice staff. We are required by law to (1) make sure that medical information that identifies you is kept private; (2) give you this Notice of our legal duties and privacy practices; and (3) follow the terms of the Notice that Is currently in effect. The professional and non-professional staff at our Practice sites will follow the terms of the Notice. Our *Practice sites may share medical Information with each other for treatment, payment or practice operations purposes described in this Notice.

How we may use and disclose medical Information about you:

The following categories and examples describe the different ways that we use and disclose medical Information. Not every use or disclosure in a category will be listed. However, the ways we are permitted to use and disclose information will fall within one of the categories.

Description and Examples:

We may share medical information about you with another physician, a hospital or other health care provider involved in your care. For example, a hospital may need to see a part of your medical record before you have surgery.

For Payment: We may share medical information with Medicare or other health plans to obtain payment for services provided to you, to verify insurance coverage or to obtain authorization for further treatment. For example, an insurance company may need to see a part of your medical record before they will pay for the services.

For Practice Operations: We may share medical information as necessary to manage the medical, legal and financial affairs of the Practice and to monitor the quality of services provided to our patients. For example, our attorney or accountant may need patient information to provide legal and financial services to the Practice. Any business associate with whom we share medical information will agree in writing to protect your privacy.

Appointment Reminders: We may disclose medical information to remind you of an appointment. We will disclose only the date, time and location of the appointment.

Family Members and Friends: We will share medical information with a friend or family member that is involved in your care or payment of your bill. We will give you an opportunity to agree or object to these disclosures unless it is clear from the circumstances that you do not object.

Worker's Compensation: We may report a work-related injury to a worker's compensation carrier or to advise your employer about a work-related injury.

To Meet Legal Requirements and for Public Health Activities: We may disclose medical information to a government agency that oversees medical practice in the State such as the Florida Agency for Health Care Administration or the Board of Medicine. We are also required to report certain diseases and conditions to the local unit of the Department of Health for its public health activities.

Law Enforcement, Lawsuits, Disputes and Reports of Abuse or Neglect: We may disclose medical information to an attorney or law enforcement official to comply with a court order, subpoena, discovery request or other legal mandate. We may also disclose medical information to assist law enforcement with investigating a crime. For example, we are required to report wounds resulting from violence and incidents of abuse or neglect.

To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or that of the public or another person. Any disclosure, however, would only be to an authority able to respond to the threat.

For Special Government Functions: We may be required to disclose medical information to a government agency for national security purposes to a correctional facility in which you may be incarcerated, or to a military authority if you are in the service or a veteran.

Organ and Tissue Donation: We may disclose medical information to an organization that handles organ, eye or tissue transplantation.

Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner to identify a deceased person or determine the cause of death. We may also release medical information about individuals to funeral directors as necessary to carry out their duties.

Other Uses of Medical Information: Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical Information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

Your Rights Regarding Medical Information:

You May Access Medical Information: To access your medical information, you must submit you request to us at our address listed below. If you request copies, we may charge a fee allowed by law. We may deny your request in certain very limited circumstances.

You May Amend and/or Correct Your Medical Information: You may ask us to amend or correct your medical information. Please make you request in writing and submit it to our office, address listed below. You must provide a reason that supports your request.

You May Request an "Accounting of Disclosures": You may request a list of the disclosures we made of medical information about you, other than for treatment, payment or Practice operations as described above, and without your written authorization.

You May Request Restriction on the Use or Disclosure of Your Medical Information: You may request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or Practice operation. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

You May Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will try to accommodate all reasonable requests.

You have the right to a paper copy of this notice. You may ask us to give you a paper copy of this notice at any time.

Changes to this notice: We reserve the right to change this Notice. We reserve the right to make the changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in prominent locations at our Practice sites. The Notice will contain the effective date.

Exercise of Privacy Rights and Complaints: To exercise your privacy rights or to file a complaint, contact us at our address below. A complaint may also be filed with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.