Hyperbaric Oxygen Therapy for Wellness & Recovery in Brevard County, FL

Physician Referral.

At Suntree Hyperbaric Center, we are dedicated to empowering the body's innate healing mechanisms through advanced

Hyperbaric Oxygen Therapy (HBOT).

Please take a minute and complete this form and submit through this website or print and fax to

(321) 325-2200.

Alternatively, records can be emailed or faxed.

info@suntreehyperbariccenter.com

(321) 325-2200 (Fax)

(Select email or copy & paste into your email provider)

NOTICE OF PRIVACY PRACTICES

Suntree Hyperbaric Center, LLC 6525 3rd Street, Suite 106 Rockledge, FL 32955 Phone: +1-321-334-2000 Fax: +1-321-325-2200

Effective Date: February 1, 2026]

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are required by law to maintain the privacy of your protected health information (PHI), to provide you with notice of our legal duties and privacy practices with respect to PHI, and to notify you following a breach of your unsecured PHI. PHI is information that can identify you and that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or the past, present, or future payment for the provision of health care to you.

How We May Use and Disclose Your Protected Health Information

We may use or disclose your PHI for the following purposes:

1. Treatment. We may use and disclose PHI to provide, coordinate, or manage your health care and related services. This includes sharing PHI with other health care providers involved in your care, such as physicians, technicians, or other professionals providing hyperbaric oxygen therapy or related services.

2. Payment. We may use and disclose PHI to obtain payment for the services we provide, including billing your health insurer, determining eligibility for benefits, and utilization review activities.

3. Health Care Operations. We may use and disclose PHI for our health care operations, such as quality assessment and improvement, reviewing the competence or qualifications of health care professionals, conducting training programs, business management and general administrative activities, and compliance with legal requirements.

4. Other Uses and Disclosures Allowed or Required by Law. We may use or disclose your PHI without your authorization for purposes including:

   • When required by law (e.g., reporting certain communicable diseases, abuse, or neglect).

   • Public health activities (e.g., reporting to public health authorities).

   • Health oversight activities (e.g., audits by government agencies).

   • Judicial and administrative proceedings.

   • Law enforcement purposes (under certain conditions).

   • To avert a serious threat to health or safety.

   • Specialized government functions (e.g., military, veterans, or national security).

   • Workers' compensation (as authorized by law).

   • Research (under certain protections and approvals).

   • To coroners, medical examiners, and funeral directors.

   • Organ, eye, or tissue donation purposes.

   • Incidental uses/disclosures that are secondary to permitted uses.

5. Uses and Disclosures Requiring Your Authorization. We will obtain your written authorization before using or disclosing your PHI for purposes not described above, such as marketing (except for certain communications about our services), sale of PHI, or psychotherapy notes (if maintained separately).

You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Your Rights Regarding Your Protected Health Information

You have the following rights regarding your PHI:

• Right to Inspect and Copy. You may inspect and obtain a copy of your PHI in our designated record set (with limited exceptions). We may charge a reasonable fee for copying and mailing.

• Right to Request Restrictions. You may request restrictions on how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree to all requests.

• Right to Request Confidential Communications. You may request that we communicate PHI to you in a confidential manner (e.g., at an alternative address or phone number).

• Right to Amend. You may request amendments to your PHI if you believe it is inaccurate or incomplete.

• Right to an Accounting of Disclosures. You may request a list of certain disclosures of your PHI made by us for up to six years prior to your request (with some exceptions).

• Right to a Paper Copy of this Notice. You may obtain a paper copy of this Notice at any time.

• Right to Receive Notice of a Breach. If there is a breach of your unsecured PHI, we will notify you as required by law.

To exercise these rights, contact our Privacy Officer in writing at the address above.

Our Duties

We are required to:

• Maintain the privacy of your PHI.

• Provide you with this Notice.

• Abide by the terms of the current Notice.

• Notify you if we are unable to agree to a requested restriction.

• Accommodate reasonable requests for confidential communications.

We reserve the right to change our privacy practices and update this Notice. The revised Notice will apply to all PHI we maintain. We will post the current Notice on our website (if applicable) and make copies available upon request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. Contact our Privacy Officer at the address/phone above for instructions on filing a complaint with us. You will not be retaliated against for filing a complaint.

Contact Information

If you have questions about this Notice or our privacy practices, contact: Privacy Officer Suntree Hyperbaric Center, LLC 6525 3rd Street, Suite 106 Rockledge, FL 32955 Phone: +1-321-334-2000