Effective Date: August 19, 2021
THIS NOTICE DESCRIBES HOW MEDICAL / HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
Each time you visit a hospital, physician, dentist, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information is often referred to as your health or medical record, which serves as a basis for planning your care and treatment and serves as a means of communication among the many health professionals who contribute to your care. Understanding what is inyour record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and helps you make more informed decisions when authorizing disclosure to others.
In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records.
We are required to maintain the privacy of your protected health information (PHI). In addition, we are required to provide you with a notice of our legal duties and privacy practices with respect to information we collect and maintain about you. We must abide by the terms of this notice. We reserve the right to change our practices and to make the new provisions effective for all the protected health information (PHI) we maintain. If our information practices change, a revised notice will be available upon request on our website, or in our office. Your health information will not be used or disclosed without your written authorization, except as described in this notice. Except as noted above, you may revoke your authorization, in writing, at any time.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions about this notice or would like additional information, you may contact our Privacy Officer at the email, telephone, or address below. If you believe that your privacy rights have been violated,you have the right to file a complaint with BoobFairy’s Privacy Officer or with the Secretary of the Department of Health and Human Services. We will take no retaliatory action against you if you make suchcomplaints.
The contact information for both is included below.
U.S. Department of Health and Human Services
Office for Civil Rights
Centralized Case Management Operations
200 Independence Ave., S.W.
Suite 515F, HHH BuildingWashington, D.C. 20201
Toll Free: 1-800-368-1019
Fax: (202) 619-3818TDD: (800) 537-7697
Email: email@example.com (Please note that communication by unencrypted email presents a risk that personally identifiable information contained in such an email, may be intercepted by unauthorized third parties)
HHS Instructions on filing a complaint: https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html
HHS Complaint Portal Assistant: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf
David Feldsott – Privacy Officer
1789 West Union Boulevard Bethlehem, PA 18018