Draft for review. This page is a working scaffold prepared by
DV8 Web as part of a website concept. It has not been reviewed by an attorney. Before this site goes
live, every legal page must be reviewed and approved by counsel familiar with Florida Chapter 491,
HIPAA and the No Surprises Act.
Last updated: August 2026
This is the summary scaffold, not a completed notice.
A HIPAA Notice of Privacy Practices has specific required content and specific required wording. This
draft outlines the structure so it can be completed and approved with counsel.
Your rights and our duties
This notice describes how medical information about you may be used and disclosed, and how you can
get access to this information. Please review it carefully.
How your health information may be used and disclosed
- For treatment. To provide, coordinate and manage your care.
- For payment. To bill and obtain payment from you or your health plan.
- For health care operations. Necessary administrative and quality activities.
- As required by law. Including mandatory reporting of suspected abuse or neglect, and
circumstances involving a serious and imminent threat to health or safety.
Most other uses and disclosures require your written authorisation, which you may revoke at any time.
Psychotherapy notes receive additional protection and generally require your specific authorisation.
Your rights regarding your health information
- Inspect and obtain a copy of your record
- Request an amendment to your record
- Request an accounting of certain disclosures
- Request restrictions on certain uses and disclosures
- Request confidential communications by a particular means or at a particular location
- Receive a paper copy of this notice
- Be notified in the event of a breach of unsecured protected health information
Complaints
If you believe your privacy rights have been violated you may complain to the practice, and you may
also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will
not be penalised for filing a complaint.
Website and technology
Information you submit through this website is used to arrange contact. Website forms and the
automated assistant are not protected channels and should not be used to share health information.