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Notice of Terms of Service

Incidental Disclosures

While we take reasonable steps to safeguard the privacy of your health information, certain unavoidable disclosures may occur. For example, during a treatment session, other patients in the area may see or overhear discussion of your health information.

Other Uses of Health Information

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. It also includes disclosure of your health information that would constitute a “sale” of the information, and includes use and disclosure of your health information for marketing purposes when Surgery Consultants is being paid by a third party to make the marketing communication. You may revoke your permission at any time by submitting a written request to our Compliance Officer, except to the extent that we acted in reliance on your permission.

Your Rights Regarding Health Information About You

You have the following rights, subject to certain limitations, regarding health information we maintain about you:

Right to Inspect and Copy
You have the right to inspect and copy health information that may be used to make decisions about your care or payment for your care. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request. Upon request, we will provide you with an electronic copy of the health information that we maintain electronically.

Right to Request Amendments
If you believe that health information we have is incorrect or that important information is missing, you may ask us to correct the records. This request, along with your reason, must be submitted in writing to the Compliance Officer at the address provided at the end of this Notice. You have the right to request an amendment for as long as the information is kept. We may deny your request if we determine that the record is accurate.

Right to an Accounting of Disclosures
You have the right to request a list of other persons or organizations to whom we have disclosed your health information. The list does not include information about certain disclosures, including disclosures made to you or authorized by you, or disclosures for treatment, payment or operations. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list.

Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request, except for certain disclosures to health plans as noted below. If we agree, we will comply with your request unless we terminate our agreement or the information is needed to provide you with emergency treatment.

Right to Restrict Disclosure to Your Health Plan
If you have paid out of pocket in full for any services provided, and you ask us not to disclose that health information to your health plan, we will honor the request, except where we are required by law to make a disclosure.

Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a more confidential way or at a certain location. For example, you can ask that we only contact you by mail or at work. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.

Right to Notification of a Breach of Your Health Information
If there is improper access, use or disclosure of your health information that meets the legal definition of a “Breach” of your health information, we will notify you in writing.

Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time.

How to Exercise Your Rights
To exercise your rights described in this Notice, send your request, in writing, to our Compliance Officer at the address listed at the end of this Notice. Alternatively, to exercise your right to inspect and copy health information, you may contact your physician’s office directly. To obtain a paper copy of our Notice, contact our Compliance Officer by phone or mail.

If you believe your privacy rights have been violated, you may file a complaint with Surgery Consultants. To file a complaint with Surgery Consultants, contact our Compliance Officer at the address listed at the end of this notice. You will not be penalized for filing a complaint.


If you have a question about this Privacy Notice, please contact:

Director of Compliance
Andy Mesa
Surgery Consultants of Florida
4054 Sawyer Road
Sarasota, Fl 34233
Phone: 954-347-1670
email: amesa@pathmedical.com