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.
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
Ask us to correct your medical record
Request confidential communications
Ask us to limit what share
Get a list of those with whom we’ve shared information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you feel your rights are violated
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:
In these cases we never share your information unless you give us written permission:
In the case of fundraising:
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.
Run our organization
Bill 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. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
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
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. Effective Date of Notice: May 2015
This Notice of Privacy Practices applies to the following organizations.
This notice applies to Functionabilities, Inc. and its entities.
Privacy Officer: HR Manager, firstname.lastname@example.org, (801) 443-7775