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NOTICE OF PRIVACY PRACTICES
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.
THIS NOTICE IS EFFECTIVE ON JUNE 1, 2026
This Notice describes the privacy policies of Motion Medical Group, LLC and its affiliates and subsidiaries (referred to as “Provider”, “we”, or “us”), and applies to the physicians, health care professionals, employees, staff and other personnel who provide services on behalf of the Provider. This Notice applies to any information in our possession that would allow someone to identify you and learn something about your health (called “Protected Health Information” or “PHI”). The Notice does not apply to information that has been de-identified in such a way that it could not reasonably be used to identify you. We are required by law to maintain the confidentiality of your PHI.
We reserve the right to change our privacy practices, as described in this notice, at any time. We reserve the right to apply these changes to any health information which we already have, as well as to health information we receive in the future. We will post the new notice in our office, and make copies available upon request. The new notice will include an effective date. A copy of the latest version of this notice will also be maintained on our website.
OUR COMMITMENTS
We will maintain the privacy of your PHI. We will provide you with a copy of this Notice. We will abide by the terms of this Notice.
YOUR RIGHTS
Access to and Copies of Health Information. You have the right to get an electronic or paper copy of your medical record. This right does not include psychotherapy notes or health information that is not part of your designated record set. To obtain copies or request inspection of your medical information, you must submit your request in writing to the Greenbrook Medical Privacy Officer, whose contact information is included at the end of this Notice, unless a reasonable accommodation is needed. We may charge a reasonable fee that will be in compliance with applicable law. We may deny your request in limited circumstances. If your request is denied, you may request a review of our denial.
Amend Health Information. You can ask us to correct the medical information we maintain about you if you believe it is incorrect or incomplete. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. Please provide us with a reason for your request and identify the records you would like amended. If we agree to your request, we will notify you and amend your medical information. In certain circumstances, we may deny your request. If your request is denied, we will inform you in writing and explain your rights. Please note that we cannot completely delete information contained in your record and the change requested by you will appear as an addendum to the existing record.
Confidential Communication. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we contact you only at home or only by mail. To request a type of confidential communication, you must make a written request to the Privacy Officer specifying the requested method of contact for billing purposes, or the location where you wish to be contacted. You do not need to give a reason for your request.
Request Restrictions. You have the right to ask us to restrict how we use or disclose your health information. You must make this request in writing. We will consider your request, but we are not required to agree if the request would affect your care. If we do agree, our agreement will be in writing, and we will comply with the restriction unless the information is needed to provide you with emergency treatment or disclosure is required or permitted by law. 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 the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Accounting of Disclosures. You can ask for a list (accounting) of the times we’ve shared your/your child’s health information for six years prior to the date of your request, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months. To request an accounting, submit your request in writing to the Privacy Officer whose information is contained at the end of this Notice.
Paper Copy of this Privacy Notice. You have a right to receive a paper copy of this notice. If you have received this notice electronically, you may receive a paper copy by contacting the Privacy Official.
Personal Representatives. Personal Representatives (including parents and legal guardians) can exercise the rights described in this Notice. If you have given someone the legal authority to exercise your rights and choices covered by this Notice, we will honor such requests once we verify their authority. We may also disclose to your personal representatives who have authority to act on your behalf (for example, to parents of minors or to someone with a power of attorney).
Complaints. You have a right to complain if you think your privacy has been violated. We encourage you to contact our Privacy Official if you have a complaint, or question how your PHI is being used or disclosed. You may also file a complaint with the Secretary of the Department of Health and Human Services, Office for Civil Rights, by sending a letter to, 200 Independence Avenue, S.W., Washington, D.C. 20201, or calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. You alerting us of any concerns you have is a necessary part of a continuous quality process we employ, and we will not retaliate against you for filing a complaint.
YOUR CHOICES
Authorization. We will ask for your written authorization if we plan to use or disclose your health information for reasons not covered in this notice, including but not limited to uses and disclosures relating to psychotherapy notes, marketing activities, and any sale of your PHI. If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time. If you want to revoke an authorization, send a written notice to the Privacy Official listed at the end of this notice. You may not revoke an authorization to the extent that we have already given out your information or taken other action in reliance on the authorization. If the authorization is to permit disclosure of your information to an insurance company, as a condition of obtaining coverage, other laws may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.
Family Members & Friends. We may disclose your health information to individuals who you have chosen to involve in your medical care unless you object to such a disclosure. If you are not able/available to tell us your preference for disclosing your medical information with others involved in your care, we may share the information if we believe in our professional judgment that it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety, subject to the requirements under applicable law.
Disaster Relief. Subject to any additional State Law requirements, in the event of a disaster, we may disclose your medical information to organizations assisting in disaster relief efforts unless you tell us not to, and that decision will not interfere with our ability to respond in emergency circumstances.
Fundraising. We may contact you for fundraising efforts, but you will be given an opportunity to opt-out of further fundraising communications. You may also notify the Privacy Officer at the contact listed below to opt-out at any time. If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.
HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION.
We may use your PHI, or disclose your PHI to others, for a number of different reasons. This Notice describes the categories of reasons for using or disclosing your information. For each category, we have provided a brief explanation, and in many cases have provided examples. The examples given do not include all of the specific ways we may use or disclose your PHI. However, any time we use or disclose your PHI, it will be for one of the categories of listed below.
Treatment. We may use your health information to provide you with medical care and services. This means that our employees and staff and others who work under our direct control may read your health information to learn about your medical condition and use it to make decisions about your care. For instance, a medical assistant may read your medical chart in order to care for you properly. We will also give your information to others who need it in order to provide you with medical treatment or services. For instance, we may send your doctor the results of laboratory tests or x-rays we perform.
Payment. We may use your health information, and disclose it to others, as necessary to obtain payment for the services we provide to you. For instance, an employee in our business office may use your health information to prepare a bill. And we may send that bill, and any health information it contains, to your insurance company. We may also disclose some of your health information to companies with whom we contract for payment-related services. We may give information about you to a health plan that pays for your benefits. We will not use or disclose more information for payment purposes than is necessary.
Health Care Operations. We may use your health information for activities that are necessary to operate this organization. This includes reading your health information to review the performance of our Staff. We may also use your information and the information of other patients to plan what services we need to provide, expand, or reduce. For example, we may disclose your health information to a company that assists us with quality assurance. We may disclose your health information as necessary to others who we contract with to provide administrative services. This includes our lawyers, auditors, accreditation services, and consultants, for instance.
Health Information Exchanges and Affiliations. We may participate in one or more Health Information Exchanges (“HIE”). HIEs allow health care entities participating in the same HIE to quickly share health information as necessary to support timely care coordination and quality health care. For example, your health information related to a recent hospital visit may be shared via a HIE with us so that we can promptly coordinate necessary follow-up treatment with you. If we participate in a HIE, we will follow applicable State Law related to consent and/or opt-out requirements.
Public Health Oversight. Subject to applicable law, we may disclose your health information to a public health oversight agency for oversight activities. This includes uses or disclosures in civil, administrative or criminal investigations; licensure or disciplinary actions (for example, to investigate complaints against health care providers); inspections; and other activities necessary for appropriate oversight of government programs (for example, to investigate Medicaid fraud).
To Report Abuse. We may disclose your health information when the information relates to a victim of abuse, neglect or domestic violence. We will make this report only in accordance with laws that require or allow such reporting, or with your permission.
Legal Requirement to Disclose Information. We will disclose your information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. For instance, we may be required to disclose your health information, and the information of others, if we are audited by Medicare or Medicaid.
Law Enforcement. We may disclose your health information for law enforcement purposes. This includes providing information to help locate a suspect, fugitive, material witness or missing person, or in connection with suspected criminal activity. We must also disclose your health information to a federal agency investigating our compliance with federal privacy regulations.
For Lawsuits and Disputes. We may disclose PHI in response to an order of a court or administrative agency, but only to the extent expressly authorized in the order. We may also disclose PHI in response to a subpoena, a lawsuit discovery request, or other lawful process, but only if we have received adequate assurances that the information to be disclosed will be protected. We will comply with applicable state laws when certain information is afforded additional protections.
Specialized Purposes. We may disclose your health information for a number of other specialized purposes. We will only disclose as much information as is necessary for the purpose. For instance, we may disclose your information to coroners, medical examiners and funeral directors; to organ procurement organizations (for organ, eye, or tissue donation); or for national security and intelligence purposes. We may disclose the health information of members of the armed forces as authorized by military command authorities. We also may disclose health information about an inmate to a correctional institution or to law enforcement officials to provide the inmate with health care, to protect the health and safety of the inmate and others, and for the safety, administration, and maintenance of the correctional institution. We may also disclose your health information to your employer for purposes of workers’ compensation and work site safety laws (OSHA, for instance). We may disclose PHI to organizations engaged in emergency and disaster relief efforts.
To Avert a Serious Threat. We may disclose your health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.
Research. We may disclose your health information in connection with medical research projects if allowed under federal and state laws and rules. The Provider may disclose PHI for use in a limited data set for purposes of research, public health or health care operations, but only if a data use agreement has been signed.
Substance Use Disorder Records. To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
OUR RESPONSIBILITIES
Right to Notification of Breach of Unsecured PHI. We will comply with the requirements of HIPAA and its implementing regulations to provide notification to affected individuals, HHS, and the media (when required) if we or a business associate discover a breach of unsecured PHI.
State Rights More Stringent Than HIPAA. In certain instances, protections afforded under applicable state law may be more stringent than those provided by HIPAA and are therefore not preempted. For instance, certain records pertaining to substance abuse records are subject to more stringent protections pursuant to Section 397.501(7) F.S., and certain mental health records are protected under Section 394.4615(2) F.S. Disclosures of such records (i.e., if subpoenaed) typically require consent of the patient or a court order.
Communicating with You. We may use your health information to provide you with additional information. This may include sending you appointment reminders. This may also include giving you information about treatment options or other health-related services that we provide. We provide mechanisms that can be used by you to communicate with us via secure electronic messaging platforms.
We do not advise that you communicate with us via unsecured email or text message. We recognize, however, that there may be times when you choose to communicate with us using unsecure email or standard text messaging for convenience purposes. If you provide us with an email address or mobile phone number, we may communicate with you using unsecured text or email related to general information or reminders. Using any unsecure electronic communication methods (such as regular email) to communicate with us can present risks to the security of information. These risks include possible interception of information by unauthorized parties, misdirected emails, shared accounts, message forwarding, or storage of the information on unsecured platforms and/or devices. You will be provided with an opportunity to opt-out of communications and can opt out at any time by notifying the Privacy Official in writing.
By choosing to correspond with us via unsecure electronic communication platforms, you are acknowledging and accepting the risks involved and understand that you are responsible for any charges applied by your telecommunications carrier. The use of any form of electronic messaging is not appropriate for medical emergencies.
CONTACT THE PRIVACY OFFICER FOR MORE INFORMATION
If you have any questions regarding this Notice or if you wish to exercise any of your rights described in this Notice, you may contact the Privacy Official at:
Sam Brochot
Motion Medical Group,
LLCPO Box 13169
Tampa, FL 33681
917-825-5988