Notice of Privacy Practices

Effective date: November 3, 2026

Your Information. Your Rights. Our Responsibilities.

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.

This notice applies to Interventional Pain Services of Palm Beach (Jane Bistline MD Interventional Pain, LLC), its physicians, other providers and staff, at 2031 Palm Beach Lakes Blvd, Suite 100, West Palm Beach, FL 33409.

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. Ask us how to do this.
• We will provide a copy or a summary of your health information in a timely manner, and no later than 30 days after your request. We may charge a reasonable, cost-based fee. We will not hold your records because of an unpaid bill for care.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• 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, office or cell 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,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.
• 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 someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting our Privacy Officer, Dianna Rankin, at 561-681-9808 or dianna@ips-pb.com, or by writing to Dianna Rankin, Privacy Officer, Interventional Pain Services of Palm Beach, 2031 Palm Beach Lakes Blvd, Suite 100, West Palm Beach, FL 33409.
• 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 visiting www.hhs.gov/hipaa/filing-a-complaint.
• 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 or payment for your care
• Share information in a disaster relief situation

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. 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
• 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. If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.

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: Your primary care doctor or a surgeon who referred you asks us about the results of your procedure.

Run our practice
We can use and share your health information to run our practice, improve your care and contact you when necessary, including appointment reminders.
Example: We use health information about you to manage your treatment and services, and we may call you or, if you have agreed, send you a text message to remind you of an appointment. See our SMS Privacy Policy for how we handle text messages.

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.

In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

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 as permitted by law. Under Florida law, we share identifiable records for research only with your written permission; otherwise, information is de-identified.

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 when required by law (for example, mandatory reports) or in response to a court subpoena with proper notice to you, as Florida law requires
• 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, subject to the Florida requirements described below.

Florida Law

Florida law gives you some protections that go beyond federal law. When Florida law is stricter, we follow it.

• Your medical records. Except as permitted by Florida law, we will not share your records or discuss your medical condition with anyone other than you, your legal representative or the other health care providers involved in your care unless you give us written authorization. In a court case, we will release your records in response to a subpoena from a court only after you or your legal representative have been given proper notice by the party seeking the records (Florida Statutes section 456.057).
• Copies of your records. We will provide copies of your records in a timely manner, without delays for legal review, and we will not charge more than Florida law allows (Florida Statutes section 456.057).
• Prescription drug monitoring. Before prescribing most controlled substances to patients age 16 or older, Florida law requires us to review your controlled substance dispensing history in the state’s prescription drug monitoring program, E-FORCSE (Florida Statutes section 893.055).

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 your 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 in this notice 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.
• Information we share with others as allowed by law may be shared again by the recipient and may no longer be protected by federal privacy law.

For more information, see the U.S. Department of Health and Human Services page Notice of Privacy Practices.

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 website.

Contact Our Privacy Officer

Dianna Rankin, Privacy Officer
Interventional Pain Services of Palm Beach
2031 Palm Beach Lakes Blvd, Suite 100
West Palm Beach, FL 33409
Phone: 561-681-9808
Email: dianna@ips-pb.com

A paper copy of this notice is available at our office.