NOTICE OF PRIVACY PRACTICES
Also known as “HIPAA Policy”

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

UNDERSTANDING YOUR HEALTH / MEDICAL RECORD INFORMATION

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.

YOUR HEALTH INFORMATION RIGHTS

  1. Receive a copy of this Notice of Privacy Practices from BoobFairy Inc. upon enrollment or upon request.
  2. Request restrictions on our uses and disclosures of your protected health information (PHI) for treatment, payment, and health care operations. However, we reserve the right not to agree to the requested restriction.
  3. Request to receive communications of protected health information (PHI) in confidence.
  4. Inspect and obtain a copy of the protected health information (PHI) contained in your medical and billing records and in any other records used by us to make decisions about you. A reasonable copying charge may apply.
  5. Request an amendment to your protected health information (PHI). However, we may deny your request for an amendment, if we determine that the protected health information (PHI) or record that is the subject of the request:
    • was not created by us, unless you provide a reasonable basis to believe that the originator of the protected health information (PHI) is no longer available to act on the requested amendment;
    • is not part of your medical, healthcare, or billing records;
    • is not available for inspection as set forth above; or
    • is accurate and complete.

    In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records.

  6. Receive an accounting of disclosures of protected health information (PHI) made by us to individuals or entities other than to you, except for disclosures:
    • to carry out treatment, payment and health care operations as provided above;
    • to persons involved in your care or for other notification purposes as provided by law;
    • for public health and safety issues;to correctional institutions or law enforcement officials as provided by law;
    • for national security or intelligence purposes;
    • for lawsuits, subpoenas, and other legal actions required of us as provided by law;
    • that occurred prior to the date of compliance with privacy standards (April 14, 2003);
    • incidental to other permissible uses or disclosures;
    • that are part of a limited data set (does not contain protected health information that directly identifies individuals); made to patient or their personal representatives;
    • for which a written authorization form from the patient has been received
  7. Request access to a minor child’s protected health information (PHI) by parents acting as a child’s “personal representative” as consistent with state and federal law.
  8. Request someone to act on your behalf as a medical power of attorney (or as a legal guardian) and beallowed to exercise your rights and make choices about your health information
  9. Revoke your authorization to use or disclose health information except to the extent that we have already been taken action in reliance on your authorization, or if the authorization was obtained as a condition of obtaining insurance coverage and other applicable law provides the insurer that obtained the authorization with the right to contest a claim under the policy.
  10. Breach Notification. In the case of a breach of unsecured, protected health information (PHI), we will notify you as required by law. If you have provided us with a current e-mail address, we may use e-mail to communicate information related to the breach.

YOUR HEALTH INFORMATION RIGHTS

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: ocrmail@hhs.gov (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

BoobFairy Inc.
David Feldsott – Privacy Officer
1789 West Union Boulevard Bethlehem, PA 18018
Email: legal@boobfairy.com