Pestana Comprehensive Wellness
Tatiana A. Pestana, MD, MPH, CCMS, IFMCP

Address:
3100 Coral Hills Drive, Suite 201
Coral Springs, FL 33065

Phone: (954) 755-8844

This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

You have the right to:

• Get a copy of your paper or electronic medical record
   
• Request correction of your paper or electronic medical record
   
• Request confidential communications
   
• Ask us to limit the information we use or share
   
• Receive a list of disclosures of your health information
   
• Get a copy of this Notice of Privacy Practices
   
• Choose someone to act for you (medical power of attorney or legal guardian)
   
• File a complaint if you believe your privacy rights have been violated
   

Additional details about these rights and how to exercise them are provided below.

You have choices regarding how we use and share information when we:

• Share information with family members or others involved in your care
   
• Communicate during disaster relief situations
   
• Include information in directories where applicable
   
• Provide mental health care
   
• Conduct marketing or fundraising activities
   

You may tell us your preferences, and we will follow your instructions unless required otherwise by law.

We may use and share your health information to:

• Provide medical treatment
   
• Operate and manage our practice
   
• Bill and receive payment for services
   
• Comply with legal and regulatory requirements
   
• Support public health and safety activities
   
• Conduct research where permitted by law
   
• Respond to legal actions and government requests
   

You may request to inspect or receive a copy of your medical records in paper or electronic form. We will provide access within 30 days and may charge a reasonable, cost-based fee.

You may request corrections to information you believe is incorrect or incomplete. We may deny the request but will provide a written explanation within 60 days.

You may request that we contact you in a specific way or at a specific location. We will accommodate reasonable requests.

You may request limits on how we use or share your health information. We are not required to agree to all requests. However, if you pay for a service out-of-pocket in full, you may request that we not share information related to that service with your health insurer.

You may request a list of disclosures of your health information for up to six years prior to your request, excluding certain routine disclosures. One request per year is provided at no charge.

You may request a paper copy of this Notice at any time.

If you have a medical power of attorney or legal guardian, that individual may exercise your rights. We will verify authority before acting.

If you believe your privacy rights have been violated, you may file a complaint with:

Pestana Comprehensive Wellness
3100 Coral Hills Drive, Suite 201
Coral Springs, FL 33065
Phone: (954) 755-8844

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at:
https://www.hhs.gov/ocr/privacy/hipaa/complaints

We will not retaliate against you for filing a complaint.

Pestana Comprehensive Wellness will never disclose the following without your explicit written authorization, except as required by law:

• Psychotherapy notes
   
• Mental health records
   
• HIV/AIDS-related information
   
• Drug and alcohol abuse treatment records
   

You may authorize disclosure to specific family members or trusted individuals by completing a written consent form.

If you have a healthcare Power of Attorney, please provide a copy for our records. Any revocation or modification of authorizations must be submitted in writing.

Written requests may be mailed to our office address above or sent via secure email to:
assistance@pestanawellness.com

We are required by law to:

• Maintain the privacy and security of your protected health information
   
• Provide you with this Notice
   
• Follow the terms of this Notice
   

This Notice applies to:
Pestana Comprehensive Wellness
3100 Coral Hills Drive, Suite 201
Coral Springs, FL 33065

HIPAA Privacy & Security Officer:
Dr. Tatiana A. Pestana
Phone: (954) 755-8844