NOTICE OF PRIVACY PRACTICES
Belkis Z. Musalen, D.M.D., P.A.
Effective Date: February 10, 2026
This Notice describes how your medical and dental information may be used and disclosed and how you can access this information. Please review it carefully.
We are committed to protecting the privacy of your health information. We create and maintain records of your care in accordance with federal law (HIPAA), Florida law, and professional standards.
OUR LEGAL DUTIES
We are required by law to:
- Maintain the privacy and security of your PHI
- Provide you with this Notice of Privacy Practices
- Notify you in the event of a breach of unsecured PHI
- Follow the terms of this Notice currently in effect
- Inform you if we change this Notice in the future.
HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
We may use or disclose your Protected Health Information (PHI) for the following purposes without obtaining your written authorization:
1. Treatment - Sharing information with specialists, labs, pharmacies, or other healthcare professionals involved in your care.
2. Payment - Submitting claims to your dental or medical insurance, determining eligibility, obtaining pre-authorizations, and billing.
3. Healthcare Operations - Quality improvement, staff training, auditing, compliance activities, and accreditation.
4. Other Uses and Disclosures Required or Permitted by Law -
Other uses may include:
- Public health reporting
- Reporting abuse or neglect
- Health oversight activities
- Responding to court orders, subpoenas, or law enforcement requests
- Required notices of data breach, unauthorized acquisition, access or disclosure of your health information
- Workers’ compensation claims
- Coroner/medical examiner requests
- Preventing serious threats to health or safety
- Specialized government functions, where applicable.
USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION
You may provide written authorization for us to use or disclose your medical information for any purpose. Once you give us authorization to release your medical information, we cannot guarantee that the person to whom the information is provided will not disclose that information. We may disclose relevant medical information to family members, friends, or others you identify as being involved in your care or payment for care. We may also use or disclose your name, location, and general condition to notify or assist in locating a person responsible for your care in emergency situations or disaster relief efforts. You may revoke this authorization at any time, except to the extent we have already relied on it. Without your written authorization, we will not use or disclose your medical information except as described in this notice or as required by law.
Special protections for SUD records: Substance Use Disorder (SUD) Treatment records have enhanced protections. They cannot be used in legal proceedings without your consent or court order.
Additional Restrictions on use and disclosure: Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. “Highly Confidential Information” may include confidential information under Federal laws governing reproductive rights, sexually transmitted diseases, alcohol and drug abuse, mental health, and genetic information.
COMMUNICATIONS & ELECTRONIC CONTACT
We may contact you via phone, voicemail, text message, postal mail, or email for appointment reminders, billing matters, or treatment information. It is our policy to leave a message on any voicemail that may be attached to a number that you provide. Electronic communications may carry privacy risks; by choosing these methods, you accept those risks. You may opt out at any time.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
1. Right to Access - You may request to see or receive a copy of your dental and medical records.
2. Right to Request Amendments - You may request corrections to your records if you believe information is incomplete or inaccurate.
3. Right to Request Restrictions - You may request limits on how we use or disclose your PHI. We are not required to agree, but if we do, we will honor the restriction.
4. Right to Request Confidential Communications - You may request that we contact you using a specific phone number, mailing address, or email.
5. Right to an Accounting of Disclosures - You may request a list of certain disclosures we have made of your PHI.
6. Right to a Paper Copy of This Notice - You may request a printed copy at any time.
7. Right to Be Notified of a Breach - We will notify you of any breach of unsecured PHI as required by federal and Florida law.
8. Right to Complain - If you believe your privacy rights may have been violated, you may complain to this practice and to the Department of Health and Human Services.
HOW TO FILE A QUESTION OR COMPLAINT
If you have concerns about your privacy rights, you may contact:
Privacy Officer: Belkis Musalen Jones, DMD
Phone: 863-648-1030
Address: 5406 Strickland Avenue, Lakeland, FL 33812
You may also file a complaint with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
ACKNOWLEDGMENT OF RECEIPT
We will request that you sign a separate form acknowledging receipt of this Notice.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time. Any changes will apply to all PHI we maintain and will be posted in our office and on our website.