xxxx-xxxx-xxxxx

xxxxxxx-xxxxx

Phone Number

(xxx) xxx-xxxx

Make Appointment
  • Follow Us :
Effective Date: June 2026

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.

At Okeechobee Wound and Wellness Clinic, we are committed to maintaining the privacy and
confidentiality of your health information. As required by the Health Insurance Portability and
Accountability Act of 1996 (“HIPAA”), we are providing this Notice of Privacy Practices
(“Notice”) to inform you of our privacy practices regarding your protected health information
(“PHI”).

1. Our Legal Duty


We are required by law to:
• Maintain the privacy of your PHI.
• Provide you with this Notice of our legal duties and privacy practices with respect to your
PHI.
• Abide by the terms of this Notice, as may be amended from time to time.
• Notify you if we are unable to comply with privacy requirements that affect you.

2. Uses and Disclosures of Your Health Information

We may use or disclose your PHI for the following purposes:

A. Treatment

We may use your health information to provide you with medical treatment or services. For
example, we may share your health information with specialists, labs, or pharmacies involved in
your care.

B. Payment

We may use and disclose your health information to obtain payment for services rendered. For
example, we may send information about your medical treatment to your health insurance
company to obtain reimbursement for medical services provided.

C. Healthcare Operations

We may use and disclose your PHI for healthcare operations, such as quality assessments,
employee training, and audits. These uses are necessary to operate our medical office efficiently
and ensure that we provide high-quality care.

D. Appointment Reminders

We may contact you to remind you about an upcoming appointment or to inform you of other
treatment options or health-related benefits and services.

E. Legal Requirements
We may disclose your PHI as required by federal, state, or local law. This includes disclosures to
public health authorities, law enforcement, or as required by a court order.

F. Public Health Activities

We may disclose your PHI to public health authorities for activities such as preventing or
controlling disease, injury, or disability.

G. Health Oversight Activities

We may disclose your PHI to government agencies involved in monitoring the health care
system, such as health department investigations or audits.

H. Research
We may disclose your PHI to researchers conducting studies, but only after we have taken steps
to protect your privacy and obtain the necessary approval from a research oversight board.

I. Organ and Tissue Donation
If you are an organ donor, we may disclose your PHI to organ procurement organizations.

J. Workers’ Compensation
We may disclose your PHI to comply with laws regarding workers’ compensation or similar
programs.

3. Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization before using or disclosing your PHI in the following
situations:
• Marketing purposes.
• Most uses and disclosures of psychotherapy notes.
• Any other uses or disclosures not described in this Notice.
You may revoke your authorization in writing at any time, except to the extent that we have
already taken action in reliance on it.

4. Your Rights Regarding Your Health Information

You have the following rights regarding your health information: 

A. Right to Inspect and Copy

You have the right to inspect and copy your PHI that we maintain in designated record sets. This
includes medical and billing records. To request access, you must submit a written request to our
office

B. Right to Amend

 If you believe that your PHI is incorrect or incomplete, you have the right to request an
amendment. We may deny your request under certain circumstances, such as when the
information is accurate or complete.

C. Right to an Accounting of Disclosures

You have the right to request an accounting of disclosures of your PHI made by us during the
past six years, excluding disclosures for treatment, payment, and healthcare operations.

D. Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your PHI. However,
we are not required to agree to your request, except when the disclosure is to a health plan for
purposes of carrying out payment or healthcare operations, and the PHI pertains solely to an item
or service for which you have paid out-of-pocket in full.

E. Right to Request Confidential Communications

You have the right to request that we communicate with you in a certain way or at a certain
location (e.g., by email or at a specific phone number). We will accommodate reasonable
requests.

F. Right to a Copy of this Notice 

You have the right to receive a paper copy of this Notice at any time, even if you have agreed to
receive it electronically. To obtain a copy, please contact our office.

5. Our Responsibilities

We are required to:
• Maintain the privacy and security of your PHI.
• Provide you with a copy of this Notice of Privacy Practices.
• Notify you if we are unable to comply with privacy requirements.
• Comply with the terms of this Notice.

6. Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or
with the U.S. Department of Health and Human Services. To file a complaint with us, please
contact:
Okeechobee Wound and Wellness Clinic
Privacy Officer: Dianna Dashner
Phone Number: TBD
Address: TBD

You will not be penalized or retaliated against for filing a complaint.

7. Changes to this Notice

We reserve the right to change the terms of this Notice at any time. Any changes will apply to all
health information we maintain. We will post a revised Notice in our office and on our website,
if applicable. You may request a copy of the most current Notice by contacting our office.

Effective Date: This Notice is effective as of June 2026.