Notice of Privacy Practices

Your Information.
Your Rights.
Our Responsibilities.

Click here to download a printable PDF of this document.

 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.

Get an electronic or paper copy of your medical record.
  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Contact Release of Information at 863-904-2652.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record.
  • You can ask us to correct health information about you that you think is incorrect or incomplete. Contact Release of Information at 863-904-2652.
  • We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request confidential communications.
  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say "yes" to all reasonable requests.

Ask us to limit what we use or share.
  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
  • We are not required to agree to your request, and we may say "no" if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.

Get a list of those with whom we've shared information.
  • You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice.
  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

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 health information. A copy of this document must be provided to the Privacy Office.
  • We will make sure the person has this authority and can act for you before we take any action.
  • Information will be shared after death as permitted by HIPAA.

File a complaint if you feel your rights are violated.
  • You can complain if you feel we have violated your rights by contacting us by calling the Compliance and Privacy Hotline at 1-800-569-9720.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or click here.
  • 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 have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:
  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Contact you for fundraising efforts

  • If you are not able to tell us your preference, for example if you are unconscious or not present, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed 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:
  • Marketing purposes
  • Sale of your information
  • Certain information regarding alcohol or drug abuse treatment
  • Most sharing of psychotherapy notes

In the case of fundraising:
  • We may contact you for fundraising efforts, but you can tell us not to contact you again by writing the Privacy Officer.

 Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Treat you.
  • We can use your health information and share it with other professionals who are treating you.
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. We can share your information with our business associates as described on this form.
Example: We use health information about you to manage your treatment and services. We may use it to create de-identified health information to use for all lawful purposes.

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.

Health Information Exchange.
  • Health information exchange allows doctors, hospitals, and other health care providers to share health information about patients electronically. This is done for several purposes, including, but not limited to, treatment, quality assurance, state law reporting requirements, health care operations, and payment. Watson Clinic physicians and staff, hospitals, and other health care providers may share and receive your health care information electronically through various health information exchange connections with other health care providers.
Example: We may exchange your information electronically with providers including, but not limited to, Lakeland Regional Health or Lakeland Surgical and Diagnostic Center, as needed for treatment or health care operations purposes.
This HIE is the electronic sharing of health information across other EPIC Health System organizations and the Tampa Bay RHIO. Exchanging information electronically is a faster way to share your health information with health care providers treating you. For example, if you go to a hospital emergency room that participates in these networks, the emergency room physicians would be able to access your Watson Clinic Health information to help make treatment decisions for you. These organizations like Watson Clinic are required to meet the rules that protect the privacy and security of your health and personal information. You must sign an authorization to allow the electronic sharing of your health information with these networks.
  • OPTING OUT of this HIE of Care Everywhere©  and the RHIO: You have the ability to change your mind and OPT OUT of this HIE by using the OPT OUT form located on the Clinic's website and mailing it to the Privacy Office address on this notice, or requesting the form at a reception desk at any Clinic location. 

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. For more information click here.

Help with public health and safety issues.
We can share health information about you for certain situations such as:
  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone's health or safety

Do research.
  • We can use or share your information for health research.

Comply with the law.
  • We will share 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 a medical examiner 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:
  • For workers' compensation claims
  • For law enforcement purposes or with a law enforcement official, or certain information relating to inmates
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

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.

Other uses and disclosures

  • Business Associates - There are some health-related services provided through contracts with third parties, called "business associates," that may need the information to perform certain services on our behalf. Examples include software or technology vendors we may utilize to provide technical support, attorneys providing legal services to us, accountants, consultants, and others. When such a service is contracted, we may share your protected health information with such business associates and may allow our business associates to create, receive, maintain or transmit your information on our behalf in order for the business associate to provide services to us, or for the proper management and administration of the business associate. Business associates must protect any health information they receive from, or create and maintain on behalf of, the Provider. In addition, business associates may re-disclose your health information to subcontractors in order for the subcontractors to provide services to the business associate. Whenever such an arrangement involves the use or disclosure of your information, we will have a written contract that contains terms designed to protect the privacy of your information.

     Our Responsibilities

    • We are required by law to maintain the privacy and security of your protected health information.
    • We will let you know promptly if a breach occurs that may have compromised the privacy or security of you information.
    • We must follow the duties and privacy practices described in this notice and give you a copy of it.
    • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
    • If more stringent laws apply, they will be included in an addendum to this Notice.
    • We will comply with State Law. We will obtain your written consent for certain disclosures if your consent is required under State law. For example, Florida requires us to obtain your written consent to disclose for payment purposes.

    For more information, click here.

    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.

    The effective date of this Notice is March 7, 2019. Prior to converting to the federal government's model form, Watson Clinic LLP implemented a prior Notice that was compliant with and effective as of the date of the HITECH Act compliance date (September 23, 2013).


    This Notice of Privacy Practices applies to the following organizations:

    Watson Clinic LLP
    P.O. Box 95000
    Lakeland, FL 33804-5000
    Compliance & Privacy Hotline: 1-800-569-9720
    Compliance & Privacy Office: 863-680-7402


Watson Clinic LLP (Clinic) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Clinic does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

The Clinic provides free aids and services to people with disabilities to communicate effectively with us, such as:

  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages.

  • If you need the above services, please call 863-904-3080.


    If you believe that the Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by contacting:
    Patient Advocate  
    1600 Lakeland Hills Boulevard
    Lakeland, FL 33805  
    Phone: 863-680-7269
    Fax: 863-616-2460

    You can file a grievance in person, by phone, fax, mail or email.

    You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available by clicking here, or by mail or phone at:
    U.S. Department of Health and Human Services  200 Independence Avenue, SW
    Room 509F, HHH Building
    Washington, D.C. 20201
    1-800-368-1019, 800-537-7697 (TDD)

    Complaint forms are available by clicking here.