Synergy Medical Group

Notice of Privacy Practices

Effective Date: March 19, 2025

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.

Notice of Organized Health Care Arrangement

An Organized Health Care Arrangement ("OHCA") refers to an organized system of health care in which two or more distinct covered entities participate in certain joint activities. Synergy Medical Group ("Synergy") and Alliance Family Physicians ("Alliance") have established an OHCA. This means Synergy and Alliance are permitted to share your health information among themselves for purposes of treatment, payment, and a broad range of health care operations which include joint utilization review, credentialing, education, risk management, patient safety, quality assessment, and improvement activities.

Synergy and Alliance are separate health care providers and each is individually responsible for its activities, including compliance with privacy laws, and all health care services it provides.

Synergy Medical Group is required by law to maintain the privacy of your medical information and to provide you with notice of its legal duties and privacy practices with respect to this information. We are required to abide by the terms of the notice that is currently in effect at the time your medical information is used or disclosed.

We reserve the right to change the terms of this notice and to make the new notice provisions effective for all medical information that we maintain.

Section A — Uses for Treatment, Payment, and Health Care Operations

For Treatment

Your medical information will be shared among physicians, nurses, and others involved in your care. We may provide medical information about you to health care providers, other Practice personnel, or third parties who are involved in the provision, management, or coordination of your care.

For Payment

We may use or disclose your medical information so that we can collect or make payment for the health care services you receive. If you participate in a health insurance plan, we will disclose necessary information to that plan to obtain preauthorization, if required, or payment for your care.

For Services and Operations

We may use or disclose your medical information for our activities and operations, including quality improvement, credentialing, and other activities necessary to run our Practice and ensure that all of our clients receive quality care.

Appointment Reminders

We may use and disclose medical information to provide appointment reminders or information about treatment alternatives or other health-related benefits.

Section B — Uses and Disclosures Without Your Written Authorization

The following is a description of ways in which we may use and disclose your information for which an authorization or an opportunity to agree or object is not required:

  • As Required By Law: We may use or disclose your medical information to the extent required by law.
  • Public Health Activities: To the extent authorized or required by law, we may disclose your medical information to a public health authority to report a birth, death, disease, or injury.
  • Victim of Abuse, Neglect, or Domestic Violence: If we believe you have been a victim of abuse, neglect, or domestic violence, we may disclose your medical information to a government authority when necessary to prevent serious harm.
  • Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure.
  • Judicial and Administrative Proceedings: We may disclose medical information about you as required by a court or administrative order, or in response to a subpoena, discovery request, or other legal process.
  • Law Enforcement: We may release medical information to law enforcement officials as required by law.
  • Research: If a researcher has obtained the required waiver from the Institutional Review Board or the Privacy Board, we may use and disclose medical information about you for research purposes.
  • To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when we believe in good faith that disclosure is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  • Workers' Compensation: We may release medical information about you as necessary to comply with laws relating to workers' compensation or similar programs.
  • Business Associates: We may disclose your information to a person or organization that performs a function or activity on behalf of the Practice that involves the use or disclosure of protected health information.

Section C — Uses and Disclosures Requiring Your Written Authorization

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. You may revoke this authorization, in writing, at any time. However, this revocation will not apply to the extent we have taken action in reliance on that authorization.

Section D — Your Rights Regarding Medical Information

Right to Request Restrictions

You have the right to request a restriction or limitation on the medical information we disclose about you for treatment, payment, or health care operations. To request a restriction, you must make your request in writing to our Privacy Officer. We are not required to agree to your request.

Right to Receive Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request in writing to our Privacy Officer. We will accommodate all reasonable requests.

Right to Inspect and Copy

You have the right to inspect and obtain a copy of most of your medical information maintained in a paper or electronic record at the Practice. You must submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

Right to Amend

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to our Privacy Officer, and you must provide a reason that supports your request.

Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures we made of medical information about you for a period of time less than six years from the date of your request. To request an accounting, you must submit a written request to our Privacy Officer.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice at any time. To obtain a paper copy, you may print one from our website or ask for a copy by calling our office at (352) 234-3050.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice, you must submit a complaint in writing to our Privacy Officers at:

Synergy Medical Group / Alliance Family Physicians

Privacy Officer: Ashley Connor

817 NW 56th Terrace, Suite B

Gainesville, FL 32605

(352) 234-3050

You will not be retaliated against for filing a complaint.

Effective Date: March 19, 2025

Questions about our privacy practices? Contact us or call 352-234-3050.