NOTICE OF PRIVACY PRACTICES

Effective Date: September 16, 2026

BRANDON MEDICAL CENTER

122 S Moon Ave

Brandon, Florida 33511

Phone: 8135026430

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information.

Please review it carefully.

Your health information is personal, and we are committed to protecting it. We are required by law to maintain the privacy of your Protected Health Information (“PHI”), provide you with this Notice explaining our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

YOUR RIGHTS

When it comes to your health information, you have certain rights.

Get a Copy of Your Medical Record

You may request to inspect or obtain a copy of your medical and billing records. We may charge a reasonable, cost-based fee as permitted by law.

Ask Us to Correct Your Medical Record

You may request that we correct information you believe is incorrect or incomplete. We may deny your request in certain circumstances, but we will provide you with a written explanation.

Request Confidential Communications

You may ask us to contact you in a specific way or at a specific location. For example, you may request that we contact you only by telephone or at a particular address.

We will consider reasonable requests.

Ask Us to Limit What We Use or Share

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations.

We are not required to agree to every request.

If you pay for a service or item completely out of pocket and request that information not be disclosed to your health plan for payment or healthcare operations, we will generally honor that request unless disclosure is otherwise required by law.

Get a List of Certain Disclosures

You may request an accounting of certain disclosures of your health information made by us during the applicable period, subject to limitations provided by law.

Get a Copy of This Notice

You may request a paper copy of this Notice at any time. You may also request an electronic copy.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use or share your health information for the following purposes without obtaining your separate authorization, as permitted by law.

Treatment

We may use your health information to provide, coordinate, or manage your healthcare and related services.

For example, we may share information with another healthcare professional involved in your care.

Payment

We may use and disclose health information to obtain payment for services we provide.

For example, we may provide information to an insurance company or other payer to obtain payment for treatment.

Healthcare Operations

We may use and disclose health information for activities necessary to operate our practice, such as quality improvement, staff training, administrative activities, compliance, and business management.

Appointment Reminders

We may use your information to contact you about appointments, appointment reminders, treatmentrelated information, or other communications related to your care.

Treatment Options and Health-Related Benefits

We may contact you about treatment alternatives or health-related products and services that may be of interest to you, as permitted by law.

Individuals Involved in Your Care

We may disclose relevant health information to a family member, close friend, or other person you identify who is involved in your care or payment for your care, when permitted by law.

Required by Law

We may use or disclose your health information when required to do so by federal, state, or local law.

OTHER PERMITTED USES AND DISCLOSURES

We may also use or disclose health information without your authorization when permitted or required by applicable law, including for purposes such as:

  • Public health activities
  • Reporting certain diseases or conditions
  • Reporting suspected abuse, neglect, or domestic violence when legally required or permitted
  • Health oversight activities
  • Judicial and administrative proceedings
  • Law enforcement purposes
  • Coroners and medical examiners
  • Organ and tissue donation
  • Workers’ compensation
  • Certain research activities
  • To prevent or lessen a serious threat to health or safety
  • Specialized government functions
  • Disaster relief activities

We will comply with applicable federal and Florida law when making these disclosures.

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Certain uses and disclosures of your health information generally require your written authorization.

These may include certain uses or disclosures of psychotherapy notes, certain marketing activities, and disclosures involving the sale of PHI, except where otherwise permitted by law.

If you provide an authorization, you may generally revoke it in writing at any time, except to the extent we have already relied upon it.

YOUR CHOICES

For certain health information, you may tell us your preferences regarding what we share.

You may ask us to:

  • Contact you at a particular telephone number or address
  • Share information with certain family members or individuals involved in your care
  • Limit certain communications when permitted by law

Please contact our office if you would like to make a request.

OUR RESPONSIBILITIES

We are required by law to:

  • Protect the privacy and security of your PHI
  • Provide you with this Notice describing our legal duties and privacy practices
  • Notify you if a breach occurs that compromises the privacy or security of your PHI when notification is required by law
  • Follow the terms of the Notice currently in effect

We reserve the right to change our privacy practices and this Notice. Any revised Notice will apply to all PHI we maintain.

A current copy will be available upon request and may be posted on our website.

BREACH NOTIFICATION

If a breach occurs involving your unsecured PHI and notification is required by law, we will notify you as required by applicable federal and state law.

QUESTIONS OR CONCERNS

If you have questions about this Notice or would like additional information about our privacy practices, please contact:

Brandon Medical Center

122 South Moon Ave.

Brandon, FL 33511

Phone:  813-502-6430

Privacy Officer: C. Kilgore

You may also contact the U.S. Department of Health and Human Services, Office for Civil Rights, if you believe your privacy rights have been violated.

You will not be retaliated against for filing a complaint.

ACKNOWLEDGMENT OF RECEIPT

I acknowledge that I have received or been offered a copy of Brandon Medical Center’s Notice of Privacy Practices.

Patient Name: ________

Signature: ___________

Date: ____

If signed by a personal representative:

Representative Name: _______

Relationship to Patient: ______

Signature: ___________

Date: ____