Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. You have the right to:

  1. Get an electronic or paper copy of your medical records – You can ask to see or get an electronic or paper copy of your medical history and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable cost-based fee.
  2. Ask us to correct your medical record – You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may deny your request, but we will explain why and the next steps in writing within 60 days.
  3. Request confidential communications – You can ask us to contact you in a specific way (for example, by home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
  4. Ask us to limit what we use or share – You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
  5. Get a list of those with whom we have shared information – You can ask for a list (accounting) of the times we have shared your health information for six years before the date you ask, who we shared it with, and why. We will include all the disclosures except those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting per year for free but charge a reasonable, cost-based fee if you request another one within twelve (12) months.
  6. Get a copy of this privacy notice – You can ask for a paper copy at any time, even if you have agreed to receive the information electronically. We will provide you with a paper copy promptly.
  7. Choose someone to act for you – If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will ensure the person has this authority and can act for you before we act.
  8. File a complaint if you feel your rights have been violated – You can complain if you think we have violated your rights by contacting us using the information on page 5. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting We will not retaliate against you for filing a complaint.

Your Choices

You can tell us your choices about what we share for specific health information. Talk to us if you clearly prefer how we share your information in the situations described below. Please tell us what you want to do, and we will follow your instructions.

In these circumstances, you have both the right and choice to tell us to:

  1. Share your information with your family, close friends, or others involved in your care;
  2. Share information in a disaster relief situation;
  3. Include your data in a hospital directory; and
  4. If you cannot tell us your preference, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health and safety.

In these circumstances, we never share your information unless you give us written permission:

  1. Marketing purposes;
  2. Sale of your information; and
  3. Sharing of psychotherapy notes.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways:

  1. Help manage the health care treatment you receive – We can use your health information and share it with other professionals treating you.
  2. Run our organization – We can use and disclose your information to run our organization, improve your care, and contact you when necessary. We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long-term care plans.
  3. Pay for your health services – We can use and disclose your health information as we pay for your health services.
  4. Administer your plan – We may disclose your health information to your health plan sponsor for plan administration.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes.

  1. Help with public health and safety issues – We can share health information about you for certain situations, such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
  2. Do research – We can use or share your information for health research.
  3. Comply with the law – We will share information about you if state or federal laws require, including with the Department of Health and Human Services if it wants to see that we comply with federal privacy law.
  4. Respond to organ and tissue donation requests and work with a medical examiner or funeral director. We can share health information about you with organ procurement organizations and can share health information with a coroner, medical examiner, or funeral director when an individual dies.
  5. Address workers’ compensation, law enforcement, and other government requests – We can use or share health information about you: for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law and for special government functions such as military, national security, and presidential protective services.
  6. Respond to lawsuits and legal actions – We can share your health information in response to a court, administrative order, or subpoena.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information. We will promptly inform you if a breach may have compromised your information’s privacy or security. We must follow the duties and privacy practices described in this notice and give you a copy. Unless we receive your written permission, we will not use or share your information other than as described here. If you tell us we can, you may change your mind anytime. Let us know in writing if you change your mind. For more information, see

Changes to the Terms of this Notice

We can change the terms of this notice, which will apply to all information we have about you. The new notice will be available upon request in our office and on our website:

Contact Information

If you have any questions about this notice, please get in touch with us at:

Griffin Concierge Medical
Att.: Kelly Hood, COO
2420 W. Mississippi Avenue
Tampa, FL 33629
Ph: 813.350.9090
Fax: 813.443.5783