Notice of Privacy Practices

Jacksonville Concierge Medicine, LLC

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Dr. Kyle Mikals
5011 Gate Parkway Bldg 100
Ste 100 PMB 1064
Jacksonville, FL 32256
https://myjaxconcierge.com
PRIVACY OFFICIAL/OTHER PRIVACY CONTACT: Dr. Kyle Mikals
PRIVACY CONTACT PHONE: 904-925-1951
PRIVACY CONTACT EMAIL ADDRESS: membership@myjaxconcierge.com

Effective date: 29JUL2025

SUMMARY

This is a summary of how we may use and disclose your protected health information and your rights and choices when it comes to your information. We will explain these in more detail on the following pages.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic protected health information.
  • Correct your protected health information.
  • Ask us to limit the information we share, in some cases.
  • Get a list of those with whom we’ve shared your information.
  • Request confidential communication.
  • Get a copy of this privacy notice.
  • Choose someone to act for you.
  • File a complaint if you believe we have violated your privacy rights.

Your Choices

You have some choices about how we use and share information as we:

  • Communicate with you.
  • Tell family and friends about your condition.
  • Provide disaster relief.
  • Market our services.

Our Uses and Disclosures

We may use and disclose your information as we:

  • Treat you.
  • Bill for services.
  • Run our organization.
  • Do research.
  • Comply with the law.
  • Respond to organ and tissue donation requests.
  • Work with a medical examiner or funeral director.
  • Address workers’ compensation, law enforcement, and other government requests.
  • Respond to lawsuits and legal actions.

Purpose

Jacksonville Concierge Medicine, LLC (We) respect your privacy. We are also legally required to maintain the privacy of your protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). We follow state privacy laws, including when they are stricter or more protective of your PHI than federal law.

As part of our commitment and legal compliance, we are providing you with this Notice of Privacy Practices (Notice). This Notice describes:

  • Our legal duties and privacy practices regarding your PHI, including our duty to notify you following a data breach of your unsecured PHI.
  • Our permitted uses and disclosures of your PHI.
  • Your rights regarding your PHI.

Contact

If you have any questions about this Notice, please contact [PRIVACY CONTACT].

PHI Defined

Your PHI:

  • Is health information about you:
    • which someone may use to identify you; and
    • which we keep or transmit in electronic, oral, or written form.
  • Includes information such as your:
    • name;
    • contact information;
    • past, present, or future physical or mental health or medical conditions;
    • payment for health care products or services; or
    • prescriptions.

Scope

We create a record of the care and health services you receive, to provide your care, and to comply with certain legal requirements. This Notice applies to all the PHI that we generate and to substance use treatment-related records (substance use treatment records) under 42 U.S.C. ยง290dd-2 and 42 C.F.R. Part 2 (Part 2) that we receive or maintain. We also follow the confidentiality protections of Part 2 for such records.

We and our employees and other workforce members follow the duties and privacy practices that this Notice describes and any changes once they take effect.

Changes to this Notice

We can change the terms of this Notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office, and on our website.

Data Breach Notification

We will promptly notify you if a data breach occurs that may have compromised the privacy or security of your PHI. We will notify you within the legally required time frame.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You have the right to:

  • Get a copy of your PHI. You can ask to see or obtain an electronic or paper copy of the PHI that we maintain about you (right to request access).
  • Ask us to correct your medical record. You may ask us to correct or amend PHI that we maintain about you that you think is incorrect or inaccurate.
  • Ask us to limit what we use or share. You have the right to ask us to limit what we use or share about your PHI (right to request restrictions). You can contact us and request us not to use or share certain PHI for treatment, payment, or operations or with certain persons involved in your care.
  • Get a list of those with whom we’ve shared your PHI. You have the right to request an accounting of certain PHI disclosures that we have made.
  • Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your PHI
  • Request confidential communications. 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 can ask that we only contact you at work or at a specific address
  • Make a complaint. You have the right to complain if you feel we have violated your rights. We will not retaliate against you for filing a complaint. You may either file a complaint:
    • directly with us by contacting [PRIVACY CONTACT]. All complaints must be submitted in writing; or
    • with the Office for Civil Rights at the US Department of Health and Human Services. visit www.hhs.gov/ocr/privacy/hipaa/complaints/.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, please contact us and we will make reasonable efforts to follow your instructions.

In these cases, you have both the right and choice to tell us whether to:

  • Share information with your family, close friends, or others involved in your care.
  • Share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest, according to our best judgment. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

You may revoke your authorization at any time, but it will not affect information that we already used and disclosed.

Uses and Disclosures of Your PHI

The law permits or requires us to use or disclose your PHI for various reasons, which we explain in this Notice. We have included some examples, but we have not listed every permissible use or disclosure. When using or disclosing PHI or requesting your PHI from another source, we will make reasonable efforts to limit our use, disclosure, or request about your PHI to the minimum we need to accomplish our intended purpose.

Uses and Disclosures for Treatment, Payment, or Health Care Operations

  • Treatment. We may use or disclose your PHI and share it with other professionals who are treating you, including doctors, nurses, technicians, medical students, or hospital personnel involved in your care. For example, we might disclose information about your overall health condition to physicians who are treating you for a specific injury or condition.
  • Billing and payment. We may use and disclose your PHI to bill and get payment from health plans or others. For example, we share your PHI with your health insurance plan so it will pay for the services you receive.
  • Running our organization. We may use and disclose your PHI to run our practice, improve your care, and contact you when necessary. For example, we may use your PHI to manage the services and treatment you receive or to monitor the quality of our health care services.

Other Uses and Disclosures

We may share your information in other ways, usually for public health or research purposes or to contribute to the public good. For more information on permitted uses and disclosures, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

The privacy laws of a particular state or other federal laws might impose a more stringent privacy standard. If these more stringent laws apply and are not superseded by federal preemption rules, we will comply with the more stringent law.