Matilsky & Morris Medical Associates – Merna Matilsky, M.D. & Steven Morris, M.D.

2900 N. Military Trail, Suite 245, Boca Raton, Florida  33431  |  Phone: 561-994-2007   Fax: 561-994-2003



This notice takes effect on January 1, 2014 and remains in effect until we replace it.


The privacy of your medical information is important to us.  We understand that your medical information is personal and we are committed to protecting it.  We create a record of the care and services you receive with our organization. We need this record to provide you with quality care and to comply with certain legal requirements.  This notice will tell you about the ways we may use and share medical information about you.  We also describe your rights and certain duties we have regarding the use and disclosure of medical information.


Law requires us to:

  1. Keep your medical information private.
  2. Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
  3. Follow the terms of the notice that is now in effect.

We have the right to change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.  Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.


The following section describes different ways that we use and disclose medical information.  For each kind of use or disclosure, we will explain what we mean and give an example.  Not every use or disclosure will be listed.  However, we have listed all of the different ways we are permitted to use and disclose medical information.  We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization.  Any specific written authorization you provide may be revoked at any time by writing us.

FOR TREATMENT/SERVICES:  We may disclose medical information about you to doctors, nurses, home health agencies, laboratories, or other people who are taking care of you.

Example:  You are consulted by our physicians for cellulitis of the leg and the physician orders lab work and infusion of antibiotics.  A number of health care and support staff need to know about you condition:

  • The laboratory running your lab tests.
  • The home health agency handling the nursing care for the infusion of the antibiotics.
  • The pharmacy providing you with the antibiotics for the infusion.

We may also share medical information about you to the other health care providers to assist them in treating you.

FOR PAYMENT:  We may use and disclose your medical information for payment purposes.

Example:  You are treated by our physicians for cellulitis of the leg and the physician orders lab work and infusion of antibiotics.  We may need to give your health insurance plan information about the infusion of antibiotics so that your health plan will provide coverage.


This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.


We may use and disclose medical information for the following purposes….

Notification:  Medical information to notify or help notify

  • A family member
  • Your personal representative
  • Another person responsible for your care

We will share information about your location, general condition, etc.  If possible, we will get your permission before we share, or give you the opportunity to refuse permission.  We will share only the health information that is directly necessary for your care.  We will make decisions in your best interest about allowing someone to pick up medicine, medical supplies or medical information for you.

Disaster relief:  Medical information with a public or private organization or person who can legally assist in disaster relief efforts.

Research in Limited Circumstances:  Medical information for research purposes, in limited circumstances, where the research has been approved by a review board that has reviewed the research proposal and established protocols to ensure the privacy of medical information.

Court Orders and Judicial and Administrative Proceedings:  We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process under certain circumstances.  Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with the law enforcement officials.  We may share limited information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person.  We may share the medical information of an inmate or other person in lawful custody with a law enforcement official or correctional institution under certain circumstances.

Public Health Activities:  As a required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect.  We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting adverse events associated with product defects or problems, to enable product recalls, repairs or replacements, to track products, or to conduct activities required by the Food and Drug Administration. We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.

Victims of Abuse, Neglect or Domestic Violence:  We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other

crimes.  We may share medical information when necessary to help law enforcement officials capture a person who has admitted to being part of a crime or has escaped from legal custody.

Workers Compensation:  We may disclose health information when authorized and necessary to comply with the laws

relating to workers compensation or other similar programs.

Health Oversight Activities:  We may disclose medical information to an agency providing health oversight for activities authorized by law, including:  audits, civil/administrative/criminal investigations or proceedings, inspections, licensure, disciplinary actions, or other authorized activities.

Law Enforcement:  Under certain circumstances, we may disclose health information to law enforcement officials.  These circumstances include reporting required by certain laws (such as reporting certain types of wounds) pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.


Look at or get copies of your medical information.  You may request that we provide copies in a format other than photocopies.  We will use the format you request unless it is not practical for us to do so.  You must make your request in writing.  You may get the form to request access by using the contact information listed at the end of this notice.  You may also request access by sending a letter to the contact person listed at the end of this notice.  Under section 59R-10.003, Florida Administrative Code entitled the “Cost of Reproducing Medical Records,” a licensed physician may condition the release of patient records upon payment of reasonable costs for written or typed records.  That cost is set at no more than $1.00 per page for the first twenty-five pages and $0.25 for any other pages.

Receive a list of all of the times we or our business associates shared your medical information for the purposes other than treatment, payment, and health care operations and other specified exceptions.

Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to those additional restrictions, but if we do, we will abide by our agreement.

Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means or at different locations must be made in writing to the contact person listed at the end of this notice.

Request that we change your medical information. We may deny your request if we did not create the information you want changed or for certain other reasons.  If we deny your request, we will provide you a written explanation.  You may respond with a statement of disagreement that will be added to the information you want changed.  If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.



Office Manager or Records Custodian – Matilsky & Morris Medical Associates

2900 N. Military Trail, Suite 245, Boca Raton, Florida  33431

Office:  561-994-2007; Fax:  561-994-2003

If you think that we may have violated your privacy rights, contact the person named above. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services. We will not retaliate in any way if you choose to file a complaint.