Patient Info

Privacy Policy

This Policy describes how medical information about you may be used and disclosed, and how you can get access to this information.

Uses & Disclosure of Health Information:

We are committed to protecting the privacy of the information you provide to us regarding your health. Information regarding your health will be recorded and maintained in a record kept on-site or off-site in a 24 hour secure facility. Information contained in that record may be used in your treatment (for example, copies of your medical information may be sent to the physician who referred you to your surgeon), obtaining payment for that treatment (for example, submitting a claim for payment to your insurance company), and for administrative purposes (for example, quality assurance and business planning purposes).

We may, under certain circumstances, use or disclose you medical information without your authorization. Subject to certain requirements, we may use or disclose your medical information for: public health purposes; health oversight activities; the reporting of suspected abuse or neglect; workers’ compensation purposes; and for judicial and administrative proceedings. We may disclose your medical information when otherwise required by law, such as for law enforcement purposes under certain circumstances. Other uses of your medical information will be made only with your written authorization, such as uses and disclosures of your medical information for marketing purposes, and disclosures that constitute a sale of your medical information. You may revoke a written authorization for the use or disclosure of your medical information at any time.

We reserve the right to change the terms of this notice at any time and to make the new notice provisions effective for all medical information that we maintain. We will post a copy of the current notice in our waiting room, which will include the effective date of the notice. You may also request a copy of the notice at any time by contacting the Business Office Director or Administrator. Other uses and disclosures not described in this notice will be made only with an authorization from the individual.

Your rights regarding your medical information:

In most cases, you have the right to inspect and receive a copy of the medical information used to make decisions about your care. We may charge you a fee for copies of your medical information. You have the right to amend the medical information we have regarding you, if you believe that information is incorrect or incomplete. You also have the right to receive a list of the instances in which your medical information was disclosed for reasons other than treatment, payment, or our health care operations.

You have the right to request that we communicate with you regarding your medical information in a certain confidential manner, for example by mail sent to you directly. You have the right to opt out of any fundraising communications. You have the right to restrict certain disclosures of your medical information to a health plan if you pay for a service in full and out of pocket. You have the right to request in writing that we not use or disclose your medical information for treatment, payment, or our health care operations purposes, or other persons involved in your care except when specifically authorized by you, except when required by law or in an emergency. We will consider your written request, but are not required to accept such a request. You have the right to be notified of a breach of unsecured medical information in the event you are affected. To exercise any of your rights regarding your medical information, please contact the Business Office Director or Administrator.

Our duties regarding your medical information:

We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices with respect to your medical information. We are required to abide by the terms of the notice of our privacy policy currently in effect.


If you believe your rights have been violated, you may contact any of the below listed entities.

Administrator Atlantic Surgery Center 541 Health Blvd. Daytona Beach, FL 32114 Phone: 386-239-0021

AAAHC 5250 Old Orchard Road #200 Skokie, IL 60077 Phone: 847-853-6060

State of Florida HHS 1-888-633-4227 or Elder Abuse Hotline: 800-963-5337

Advance Directive