Notice of Privacy Practices

Our responsibilities

• 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. You may change your mind at any time.

How we may use and share your information

• Treatment: to provide and coordinate your care, including sharing information with the specialists on your care team and with other doctors who treat you.
• Payment: to bill and get payment for the services you receive, and to prepare documents you can submit to your insurer.
• Health care operations: to run our practice, improve your care and contact you when necessary.
• Obtaining your records: with your authorization, to request your records from hospitals, clinics and health information networks so your team has your complete history.
• Family and caregivers: with people you choose to involve in your care, and you can change who has access at any time.
• As required or permitted by law: for example, for public health and safety, health oversight, legal proceedings, law enforcement, or to prevent a serious threat to health or safety.

We will never sell your information or use it for marketing without your written permission.

Your rights

• Get an electronic or paper copy of your medical record.
• Ask us to correct your medical record if you think it is incorrect or incomplete.
• Request confidential communications, for example at a different address or phone number.
• Ask us to limit what we use or share. We are not always required to agree, but we must agree if you pay for a service in full out of pocket and ask us not to share it with your health insurer.
• Get a list of those with whom we've shared your information.
• Get a copy of this notice at any time.
• Choose someone to act for you, such as a legal guardian or someone with medical power of attorney.
• File a complaint if you feel your rights are violated.

Complaints

If you believe your privacy rights have been violated, you can contact our Privacy Officer at info@blueclayhealth.com, or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Changes to 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 on our website and on request.

Contact

Privacy Officer: [Name], [mailing address], [phone].

Questions? Email info@blueclayhealth.com.