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 is demonstration text for a fictional provider. Replace it with your organization’s own notice, prepared with your compliance team.
We are required by law to keep your protected health information private, to give you this notice of our legal duties and privacy practices, and to notify you if a breach affects your unsecured health information.
Treatment. To provide and coordinate your care, including with other providers involved in it.
Payment. To bill and get paid by you, your insurer or another payer.
Health care operations. To run our clinics, improve care and train our staff.
As the law requires. For public health, health oversight, legal proceedings and law enforcement in limited circumstances.
We will not use or share your information for marketing, or sell it, without your written permission.
See and get a copy of your medical record.
Ask us to correct your medical record.
Ask for confidential communications, such as at a different address.
Ask us to limit what we use or share.
Get a list of those with whom we have shared your information.
Get a copy of this notice, and choose someone to act for you.
File a complaint if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.
Our privacy officer can be reached at privacy@example.com or by calling the main number listed on this website.