HIPAA NOTICE & CONSENT
This notice describes how medical information you provide to us through our platform, or which you otherwise provide to us (i.e., via e-mail, through our website, via a phone call, etc.) may be used and disclosed and how you can get access to this information. Please review it carefully.
OUR USES AND DISCLOSURE
We may use and share your information as we:
- Provide our services as identified at adirnow.com and in connection with the platform described above
- Run our organization
- Help with public health and safety issues
- Conduct research
- Comply with the law
- Address law enforcement and other government requests
- Respond to lawsuits and legal actions
When it comes to your 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 information you provided to us.
- You can ask to see or get an electronic or paper copy of your medical information and other information we have about you by submitting a request in writing to:
Direct Fax: 248-479-2988
- 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. You must make the request to amend in writing with a reason. The request should be requested on Request for Amendment of Health Information form and submitted to:
Direct Fax: 248-479-2988
- We may say “no” to your request, but we will 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.
- However, if you contact us in a specific manner (i.e., unsecured e-mail), we will assume that you consent to us communicating back to you, in response to your communication, via the same mechanism/manner unless you explicitly tell us otherwise.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for payment or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
Get a list of those with whom we have shared your health or medical information
- You can ask for a list (accounting) of the times we’ve shared your health or medical information for 6 years prior to the date you ask, with whom we shared it, and why.
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 by sending an email to: firstname.lastname@example.org
- 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 http://www.hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
OUR USES AND DISCLOSURES
We typically use or share your information in the following ways:
To provide our services to you
We gather certain information from you through our platform, and then make that information available to you, or any third-party at your direction (i.e., you can download the information, or you could ask us to e-mail or send the information to your doctor, health plan, caregiver or otherwise).
Run our organization
We can use and share your information to approve our services to you.
How else can we use or share your 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: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
We can use or share your information for health or medical 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 are complying with federal privacy law, or with your health plan in connection with our contractual obligations for the general purpose of providing this service.
Address law enforcement and other government requests
We can use or share information about you:
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
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.
- We never market or sell personal information
For more information
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.
Additional Important Information:
- Effective Date of this Notice : 01/01/2023
- Privacy Contact: Angela Zora, 248-321-4107, email@example.com