HIPAA Privacy Practices Acknowledgment

The Health Insurance Portability and Accountability Act (HIPAA) and applicable Florida laws protect your personal health information. MedLeaf Clinic is required by law to provide you with a Notice of Privacy Practices, which explains how your health information may be used and disclosed, and what rights you have regarding your medical records.

How We Use and Disclose Your PHI

• Treatment – Sharing information with other providers involved in your care
• Payment – Billing for services rendered
• Healthcare operations – Quality assurance, audits, and compliance

Your Rights Under HIPAA

• Inspect and request a copy of your medical records
• Request amendments or corrections to records
• Request restrictions on how your PHI is used or shared
• Request confidential communication methods
• Receive a list of non-routine disclosures
• Receive a copy of this notice in print or electronically

Electronic Communication

We may contact you via phone, email, text, or our secure patient portal. Email and SMS are used for administrative purposes only (e.g., reminders). If you prefer alternative communication, please inform the office in writing.

Breach Notification

You will be notified promptly in the event of any unauthorized access to your PHI as required by HIPAA.

Privacy Questions or Complaints

If you believe your privacy rights have been violated, you may contact MedLeaf Clinic or the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Acknowledgment

I acknowledge that I have received and/or had the opportunity to review MedLeaf Clinic’s Notice of Privacy Practices. I understand my rights regarding my health information and how it may be used and disclosed.