Your Privacy

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. 



“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:

  • When required by law
  • Public health activities (death, child abuse, neglect, domestic violence, problems with products reactions to medications, product recalls, disease/infection exposure, disease/injury/disability control/prevention)
  • Health oversight activities (audits, investigations, inspections)
  • Judicial and administrative proceedings (court order)
  • Appropriate law enforcement requests (to identify or locate a suspect, fugitive, material witness, or missing person)
  • Deceased person information to coroners, medical examiners, funeral directors
  • Organ and tissue donation
  • Research, provided authorization is IRB-approved or privacy board-approved
  • Emergencies or to avert serious threat to health or safety
  • Specialized government functions (military, inmates)
  • Worker’s compensation
  • Disaster relief

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:

  • Inspect and copy medical information from your chart. You may submit a written request to our office and pay the copy fee and receive a copy of your records. We must respond within 30 days if the record is readily available and within 60 days if it is not readily available.
  • Amend medical information in your chart. You may identify inaccurate or incomplete information in your chart. You can do this with a written request to amend your chart directed to our office. We must respond within 60 days.
  • Receive an accounting of any disclosure made from your record over the last six years, starting April 14, 2003. You can get this with a written request directed to our office. We must respond within 60 days.
  • Request restrictions as the amount of medical information we disclose. This is limited as noted above, and your request may not supersede the typical disclosure noted above. You may revoke or restrict consent.
  • Request confidential communications. All communications in our office are confidential. You may specifically-request that all communications be confidential with a written request directed to our office.
  • Receive a copy of this notice by printing it or with a written request directed to this office, and a copy of this notice will be give with all new patient packets.


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.



Contact Us Today!

30522 US Highway 19 N, Suite # 109

Palm Harbor, FL 34684

Phone: 727-738-0220

Fax:  727-734-7072

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