Notice of Privacy Practices

About This Notice

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.

Lake Nona Medical Services (“we,” “our,” or “the Practice”) is required by law to maintain the privacy of your Protected Health Information (PHI), to provide you with this Notice of our legal duties and privacy practices regarding your PHI, and to abide by the terms of the Notice currently in effect. PHI is information that may identify you and relates to your past, present, or future physical or mental health condition, the provision of healthcare to you, or payment for that care.

How We May Use and Disclose Your Protected Health Information

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

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This includes consultations between healthcare providers regarding your care, or referral of your care to another provider.

Payment

We may use and disclose your PHI to obtain payment for services we provide to you. This may include activities such as submitting claims to your health insurance plan, determining eligibility or coverage, and other utilization review activities.

Healthcare Operations

We may use and disclose your PHI for our healthcare operations, which include quality assessment, staff training, business management, accreditation, and other activities necessary to run our practice and to serve our patients.

As Required by Law

We will disclose your PHI when required to do so by federal, state, or local law.

Public Health Activities

We may disclose your PHI for public health activities, including preventing or controlling disease, injury, or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or problems with products; notifying people of recalls; and notifying a person who may have been exposed to a disease or who is at risk of contracting or spreading a disease.

Health Oversight Activities

We may disclose your PHI to a health oversight agency for activities including audits, investigations, inspections, and licensure, as authorized by law.

Judicial and Administrative Proceedings

We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal, or in certain conditions in response to a subpoena, discovery request, or other lawful process.

Law Enforcement

We may disclose your PHI to law enforcement officials for purposes such as complying with court orders, identifying or locating a suspect or missing person, or reporting certain types of wounds or injuries.

Coroners, Medical Examiners, and Funeral Directors

We may disclose your PHI to a coroner or medical examiner for identification purposes, to determine cause of death, or as otherwise authorized by law. We may also disclose PHI to funeral directors as necessary to carry out their duties.

Organ and Tissue Donation

We may disclose your PHI to organizations involved in organ procurement, banking, or transplantation, if you are an organ donor.

Research

Under certain circumstances, we may use and disclose your PHI for research purposes, subject to approval by an institutional review board or privacy board.

Threats to Health or Safety

We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person.

Military and Veterans

If you are a member of the armed forces, we may disclose your PHI as required by military command authorities.

Workers' Compensation

We may disclose your PHI to comply with workers' compensation laws or similar programs.

Other Uses and Disclosures

Uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time by submitting a written request to our Privacy Officer. Revocation will not affect any actions we took in reliance on your authorization before we received your revocation.

Your Rights Regarding Your Health Information

You have the following rights with respect to your PHI:

Right to Access

You have the right to inspect and obtain a copy of your PHI contained in a designated record set. You must submit a written request to the Privacy Officer. We may charge a reasonable, cost-based fee for copies.

Right to Request Amendment

You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. Your request must be in writing and must provide a reason for the amendment. We may deny your request under certain circumstances, and we will provide you with a written explanation if we do.

Right to Request Restrictions

You have the right to request a restriction on the PHI we use or disclose about you for treatment, payment, or healthcare operations. We are not required to agree to your request, except that we must agree to restrict disclosures to a health plan for services you paid for entirely out of pocket. Your request must be in writing.

Right to Confidential Communications

You have the right to request that we communicate with you about healthcare matters in a certain way or at a certain location. For example, you may ask that we contact you only by mail or at a specific phone number. Your request must be in writing and must specify how or where you wish to be contacted.

Right to an Accounting of Disclosures

You have the right to request a list (accounting) of certain disclosures we made of your PHI. This accounting will not include disclosures made for treatment, payment, or healthcare operations, or disclosures you authorized in writing. Your request must be in writing and must state a time period (no longer than six years prior to the request).

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time, even if you have previously agreed to receive it electronically. You may request a copy from our front desk or by contacting our Privacy Officer.

Right to Be Notified of a Breach

You have the right to be notified in the event that we discover a breach of your unsecured PHI.

Our Duties

• We are required by law to maintain the privacy and security of your PHI.
• We are required to provide you with this Notice of our legal duties and privacy practices with respect to your PHI.
• We are required to abide by the terms of this Notice currently in effect.
• We will notify you if a breach occurs that may have compromised the privacy or security of your PHI.
• We will not use or disclose your PHI without your written authorization, except as described in this Notice.
• We reserve the right to change the terms of this Notice and to make the new provisions effective for all PHI we maintain. We will make the revised Notice available at our offices and on our website.

Complaints

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

To file a complaint with HHS Office for Civil Rights:

Website Privacy

When you visit our website at lakenonamedicalservices.com, we may collect:

• Information you voluntarily provide through our contact form (name, email, phone number, message)
• Automatically collected technical information (browser type, device type, IP address, pages visited)
• Cookies and similar technologies for website functionality

We do not sell, trade, or otherwise transfer your personal information to outside parties. We may share information with trusted service providers who assist us in operating our website, provided they agree to keep this information confidential. Our website uses SSL encryption for all data transmissions.

Privacy Officer Contact

If you have questions about this Notice or our privacy practices, or if you wish to exercise any of your rights described above, please contact our Privacy Officer: