NOTICE OF PRIVACY PRACTICES

This Notice is provided to you as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the HITECH Act, applicable Florida law, and federal regulations at 45 CFR Parts 160 and 164. It describes your rights regarding your Protected Health Information (PHI) and our legal obligations and privacy practices at all Family Medical Group clinic locations throughout Florida.

1. Our Legal Duty

The Family Medical Group is required by law to:

• Maintain the privacy and security of your Protected Health Information (PHI)
• Provide you with this Notice of our legal duties and privacy practices regarding your PHI
• Follow the terms of the Notice currently in effect
• Notify you following a breach of unsecured PHI
• Comply with Florida Statute § 456.057 governing access to medical records
• Comply with Florida Statute § 395.3025 for hospital and facility records

2. How We May Use and Disclose Your Health Information

A. Uses and Disclosures for Treatment, Payment, and Healthcare Operations

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

• Treatment: To provide, coordinate, and manage your medical care. For example, a physician may share your records with a specialist or laboratory providing services to you.
• Payment: To bill and collect payment for your healthcare services, including submission of claims to your insurance company or Medicare/Medicaid.
• Healthcare Operations: For quality assessment, staff training, compliance activities, accreditation, business planning, and other administrative purposes necessary to operate our clinics.

B. Other Permitted Uses and Disclosures Without Authorization

As permitted or required by law, we may use or disclose your PHI without authorization for:

• Public Health Activities: Reporting to public health authorities to prevent or control disease, injury, or disability as required by Florida and federal law.
• Health Oversight Activities: For audits, inspections, and investigations by the Florida Agency for Health Care Administration (AHCA), the U.S. Department of Health and Human Services (HHS), and other authorized agencies.
• Judicial and Administrative Proceedings: In response to a court order, subpoena, or other lawful process.
• Law Enforcement: To comply with applicable law enforcement requests, including reporting certain types of injuries or crimes.
• Coroners, Medical Examiners, and Funeral Directors: As necessary to identify deceased persons or determine cause of death.
• Organ and Tissue Donation: To organ procurement organizations.
• Research: Under limited circumstances with appropriate protections in place as required by law.
• Serious Threats to Health or Safety: To prevent or lessen a serious and imminent threat.
• Workers’ Compensation: As authorized by Florida workers’ compensation laws.
• Reporting Abuse, Neglect, or Domestic Violence: As required by Florida Statute § 39.201 and other applicable Florida law.
• Communicable Disease Reporting: As required by Florida Department of Health regulations.
• Appointment Reminders and Treatment Alternatives: We may contact you regarding appointment reminders or information about treatment alternatives.

C. Uses and Disclosures Requiring Your Written Authorization

The following uses and disclosures of your PHI require your prior written authorization:

• Most disclosures of psychotherapy notes
• Marketing communications (except certain treatment-related communications)
• Sale of your PHI
• Disclosures of PHI related to substance use disorder treatment records (protected under 42 CFR Part 2)
• Any other disclosures not described in this Notice

You may revoke any authorization you have given us in writing at any time, except to the extent we have already acted on it.

3. Your Rights Regarding Your Health Information

A. Right to Access and Download Your Records

You have the right to inspect and receive a copy of your medical records and other PHI used to make decisions about your care. Because The Family Medical Group does not currently offer an online patient portal, you may request your records through the following methods:

• By Phone: Call 1-877-804-4FMG (1-877-804-4364) to speak with our Medical Records department
• By Email: Send your written request to records@thefamilymedgroup.com
• In Person: Visit any FMG clinic location during regular business hours
• By Mail: The Family Medical Group, Attn: Medical Records, [Clinic Address], Miami, FL

We will provide records in your preferred format — paper or electronic (including downloadable PDF or other electronic format) — within 30 days of receiving a valid written request with proper identification. A reasonable cost-based fee may apply per Florida Statute § 456.057. We may deny access in limited circumstances, and you have the right to request a review of any denial.

B. Right to Request Amendment

If you believe that health information we have about you is incorrect or incomplete, you may request an amendment. We may deny your request under certain circumstances. Submit amendment requests in writing to our Privacy Officer.

C. Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures of your PHI that we have made for purposes other than treatment, payment, or healthcare operations. This right applies to disclosures made up to six years prior to your request. The first accounting in any 12-month period is free; subsequent requests may incur a reasonable fee.

D. Right to Request Restrictions

You have the right to request that we restrict our use or disclosure of your PHI for treatment, payment, or healthcare operations. We are not required to agree to all restrictions, except in one case: if you paid out of pocket in full for a service and ask us not to share information about that service with your health plan, we must comply.

E. Right to Confidential Communications

You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may ask that we only contact you at a specific phone number or address. We will accommodate reasonable requests.

F. Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice at any time. You may request a copy by contacting any FMG clinic or our Privacy Officer.

G. Right to Notification of Breach

You have the right to be notified following a breach of your unsecured PHI. We will provide notification as required by the HIPAA Breach Notification Rule and Florida law within 60 days of discovery, and within 30 days for breaches affecting Florida residents under Florida Statute § 501.171.

4. How to Submit Requests and Forms

FMG provides the following HIPAA forms to help you exercise your rights. These forms are available at any of our clinic locations or by contacting our Privacy Officer:

• Authorization to Disclose Protected Health Information – To authorize release of your records to a third party
• Request to Access / Download Protected Health Information – To request a copy of your records in paper or electronic format
• Request to Restrict Use or Disclosure of PHI – To limit how we use or share your information
• Request to Amend Protected Health Information – To request corrections to your records
• Confidential Communication Request Form – To request alternative contact methods
• Accounting of Disclosures Request Form – To request a list of certain disclosures
• Privacy and Security Complaint Form – To file a complaint about our privacy practices

5. Our Obligations and Changes to This Notice

We are required to abide by the terms of this Notice as currently in effect. We reserve the right to change the terms of this Notice and to make the new provisions effective for all PHI we maintain. If we make a material change, we will post the revised Notice at all FMG clinic locations and on our Website. You may request a current copy at any time.

6. How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with FMG or with the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

To file a complaint with FMG:

Privacy Officer, The Family Medical Group

Phone: 1-877-804-4FMG (1-877-804-4364)

Email: privacy@thefamilymedgroup.com

To file a complaint with HHS Office for Civil Rights:

Website: www.hhs.gov/ocr/privacy/hipaa/complaints

Phone: 1-800-368-1019 / TDD: 1-800-537-7697

7. Contact Our Privacy Officer

For questions about this Notice, to exercise your rights, or to obtain HIPAA forms, contact:

Privacy Officer – The Family Medical Group

Phone: 1-877-804-4FMG (1-877-804-4364)

Email: privacy@thefamilymedgroup.com

Website: www.thefamilymedgroup.com

Mailing Address: The Family Medical Group, Attn: Privacy Officer, Miami, FL

8. Language Assistance

The Family Medical Group provides language assistance services at no cost to patients who need them. To request interpreter services or a translated copy of this Notice, please call 1-877-804-4FMG.

ESPAÑOL: Si usted necesita asistencia en español para entender este aviso, llame al 1-877-804-4FMG.