Make An Appointment Make A Payment Event Registration
Make an appointment

HIPAA Disclosure

updated 4/22/2016


Your Rights

Get an electronic or paper copy of your medical record

Ask us to correct your medical record

Request confidential communications

Ask us to limit what we use or share

Get a list of those with whom we’ve shared information

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time.

Choose someone to act for you

File a complaint if you feel your rights are violated

You can file a complaint with the BG Privacy Officer if you feel we have violated your right.

Borland-Groover Clinic

4800 Belfort Road

Jacksonville, FL 32256

Telephone (904) 398-3262

Email: .(JavaScript must be enabled to view this email address)

U.S. Department of Health

Please contact BG Clinic for address and phone

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest or to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

Fund raising

We can contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures: How do we typically use or share your information?

Treat you

We can use your information and share it with other professionals who are treating you or for electronic health information networks to facilitate the provision of care. 

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We can use health information about you to manage your treatment and services. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services. How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues

We can share health information about you for certain situations such as:

Do research

We can use or share your information for health research.

Comply with the law

We can share health information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with medical examiner, coroner, or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Business Associates

We can share health information with third parties to provide services on our behalf so that they can perform the job we’ve asked them to do. The law requires the business associate to appropriately safeguard your information.

Open Treatment Areas

While special care is taken to maintain patient privacy, others may overhear some patient information while receiving treatment.

Communication with Family/Friends

We can, using our best judgment, disclose to a family member, other relative, close personal friend or any other person, health information relevant to that person’s involvement in your care or payment.  When a family member(s) or a friend(s) accompany you into the exam room, it is considered implied consent that a disclosure of your PHI is acceptable.


We can communicate with you, using any provided number or information, to leave a message on voice mail, speak in person, by encrypted e-mail, patient portal, or text appointment reminders, insurance items, care correspondence, patient satisfaction surveys and patient statements about your health care.

We can record your phone calls in order to monitor the quality of the service we provide you over the phone.

Our Responsibilities

Changes to the Terms of 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 upon request, in our office, and on our web site.