phone 407-480-4445

fax 407-480-4446



The following is a brief summary of your rights and our responsibilities as detailed in the Notice of Privacy Practices (the "Notice"). This summary is for your convenience and is not a substitute for reading the entire Notice ( read notice ). This summary does not modify the terms of the Notice.


1. How this Medical Practice May Use or Disclose Your Health Information

For treatment purposes by our Practice or other health care providers included in your treatment

 For payment purposes for our services to you, such as to your insurance carrier

 For Practice operations purposes, such as quality improvement, planning, staff development

 For our business associates, such as billing service and medical transcriptionists

 For a variety of other purposes, including appointment reminders, public health requirements, judicial proceedings, workers' compensation


2. When This Medical Practice May Not Use or Disclose Your Health Information

Except as stated above, our Practice will not use or disclose your health information without your written consent.


3. Your Health Information Rights

 You have the right to request restrictions on certain uses and disclosures of your health information

 You have the right to request that you receive your health information in a specific way.

 You have the right to inspect and copy your health information

 You have the right to request an amendment or supplement to your health information if you believe it is incorrect or incomplete

 You have the right to an accounting of disclosures of your health information

 You have a right to receive a paper copy of this Notice.


4. Special Rules Regarding Disclosure of Psychiatric, Substance Abuse and HIV-Related Information

Additional restrictions apply to disclosures of health information that relates to care for the above-listed conditions.


5. Changes to this Notice of Privacy Practices

Our Practice has the right to amend this Notice in the future and will provide you with a copy upon request. The current Notice will also be posted on our website:


6. Complaints

Complaints about how our Practice handles your health information should be directed to our Privacy Officers; you may also submit a complaint to the Department of Health and Human Services. You will not be penalized for filing a complaint.


Office Hours: Monday - Friday 8 am - 5 pm