Last Modified December 2019
PLEASE REVIEW THIS POLICY CAREFULLY
Instructions for Notice
• Effective Date: 12/19/2019
• Privacy Officer: Tamiqua Torres
Contact Information: 407-734-1021 email@example.com
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.
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
Our Uses and Disclosures
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
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, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
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 or office 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” if it would affect your care.
• 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 you have given someone 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 us using the information on page 1.
• 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/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
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
• Share information in a disaster relief situation
• Include your information in a hospital directory
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.
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.
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
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. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
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
We can use or share your information for health research.
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 or with a law enforcement official
• 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.
• 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 here 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.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
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 web site.
COLLECTION OF YOUR PERSONAL INFORMATION.
INTERNATIONAL PRIVACY LAWS AND YOUR RIGHTS UNDER THE GDPR
If you are a member of the European Union (EU), you have special rights under the GDPR. Those include: You have the right to object to the processing of your data and the right to portability of your data. All complaints must be sent to firstname.lastname@example.org or email address of your GDPR representative or data processor. You also have the right to erasure, rectification, access, or to seek restrictions to the processing of your personal data in our system. To the extent you provide consent to our processing of your personal data, you have the right to withdraw that consent at any time. Any withdrawal of consent does not apply to data collected lawfully prior to such consent. You have the right to lodge a complaint with a supervisory authority containing jurisdiction over GDPR related issues.
COOKIES: WHAT THEY ARE, AND WHY THEY ARE NEEDED.
MY POLICY WITH MINORS.
My Sites are not intended for individuals under the age of 18. If you are under 18, you may only use the Sites under the supervision of a parent or guardian. I do not collect or maintain information from anyone known to be under the age of 18, and no part of this website is designed to attract anyone under the age of 18. I do not sell products or services intended for purchase by children. If I discover or are otherwise notified that I have received any such information from a child in violation of this policy, I will delete that information.
I only retain Personal Data collected from Users for as long as (the User’s account is active) or otherwise for a limited period of time as long as I need it to fulfill the purposes for which I have initially collected it, unless otherwise required by law. I will retain and use information as necessary to comply with my legal obligations, resolve disputes, and enforce my agreements for a period of 7 years for billing information and 10 years for legal information.
USE OF YOUR PERSONAL INFORMATION.
The information I gather from you may be used in several ways, either now or in the future, to gain a better understanding of my Sites’ users and their usage pattern as a whole, for site administration and troubleshooting, to process transactions, contest entries and other matters you initiate, to identify preferences in content and advertising, to target editorial, advertising or other content (such as promotions, special offers or other content) I think might be of interest to you. I may also use information I gather from you to communicate changes and improvements to my website or any registration you have made.
You have the right to request access to the information we have for you. You can do this by contacting us at email@example.com We will make sure to provide you with a copy of the data we process about you In order to comply with your request, we may ask you to verify your identity. We will fulfill your request by sending your copy electronically, unless the request specifies a different method. If you believe that the information we have about it is incorrect, or if you wish to remove your private information (such as an email address provided in an opt-in), you may contact us at firstname.lastname@example.org . Any data that is no longer needed for the purposes specified herein will be deleted.
Please keep in mind that if you disclose personally identifiable information in a public manner through the Sites, this information may be collected and used by others accessing those portions of the Sites. I do not monitor information you disclose on the Sites nor do I accept any liability associated with your voluntary disclosure of the same.
You are responsible for reviewing the privacy statements and policies of other websites you choose to link to or from the Sites, so that you may understand how those sites collect, use and store your information. I am not responsible for the privacy statements, policies or content of any other websites. Websites containing co-branding (referencing my name and a third party’s name) contain content delivered by the third party and not me.
NOTICE OF PRIVACY RIGHTS TO CALIFORNIA RESIDENTS.
California law requires that I provide you with a summary of your privacy rights under the California Online Privacy Protection Act (the “Act”) and the California Business and Professions Code. As required by the Act, I will provide you with the categories of personally identifiable information that I collect through this website and the categories of third party persons or entities with whom such personally identifiable information may be shared for direct marketing purposes at your request. California law requires me to inform you, at your request: (1) the categories of personally identifiable information I collect and what third parties I share that information with; (2) the names and addresses of those third parties; and (3) examples of the products marketed by those companies. The Act further requires me to allow you to control who I can and cannot share that information with. To obtain this information, please send a request by email or standard mail to the address found below. When contacting me please indicate your name, address, email address, and what personally identifiable information you do not want me to share with third parties. Please allow thirty (30) days for a response. Also, please note that there is no charge for controlling the sharing of your personally identifiable information or requesting this notice.
By using the Sites you agree that I am not responsible for: (i) any disclosure of your personal information made by you to a third party through your use of the Sites; (ii) any disclosure of your personal information obtained illegally from me; or (iii) any accidental disclosure of your personal information made by me.
YOUR COMMENTS AND CONCERNS.
This website is operated by Latching in Love LLC, P O BOX 780154 ORLANDO, FLORIDA 32827. All other feedback, comments, requests for technical support and other communications relating to the Sites should be directed to: email@example.com
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