Dr. Ananda Som and our team respect your privacy. It is our responsibility to use practices that keep your information confidential. Please review our HIPAA Privacy Act Statement.
NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
“This notice describes how medical information about you may be used and disclosed and how you may get access to this information.” Please review it carefully!
We safeguard information about your health and person:
We collect information from you and store it in a medical record as well as on a computer. Charts are stored in a secure area and available only to designated staff and only for designated reasons. Housekeeping, maintenance, and other non-office personnel have no access to the chart area. Services technicians may have access to the computer, but only for services of computer operations.
Typical Uses and Disclosures of Medical Information:
We collect medical information from you. Within our office, we restrict the disclosure of this information to doctors, nurses, technicians, and insurance and billing personnel. We may use your medical information for treatment and care, payment to insurances and for healthcare options. Outside our office, we restrict the disclosure to those people, entities and agencies for which you authorize disclosure such as other healthcare providers (doctors, nurses, and extended care facilities), insurance companies, billing agencies, hospitals and surgery sites, or those agencies and entities for whom legal and administrative requirements demand disclosure such as:
We will not use of disclose your medical information for any purpose not listed without your specific written authorization. Any specific written authorizations you provide may be revoked at any time by writing to us.
Patient Privacy Rights:
You have the right to:
NOTICE OF PRIVACY PRACTICES:
I acknowledge that I have reviewed a copy of the Notice of Privacy Practices. The Notice of Privacy Practices describes types of uses and disclosures of my protected health information that might occur in my treatment, payment of my bills, or in the performance of the Medical Center on the Gulf health care operations. This also describes my rights and the duties of Medical Center on the Gulf with respect in protected health information. Medical Center on the Gulf reserves the right to change the privacy practices that are described in the Notice of Privacy Practices. I may obtain a copy of the revised Notice of Privacy Practices by calling the office at 727-738-0220 and requesting a copy to be sent to me via mail or electronically providing I have an email consent on file.
MEDICAL CENTER ON THE GULF LLC.
30522 US Highway 19 N, Suite # 109
Palm Harbor, FL 34684
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