Draft for review by counsel. Not final legal text. Items in yellow brackets still need real answers.
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.
Our duties
[Legal company name] ("mothermade") is required by law to keep your protected health information (PHI) private, give you this notice of our legal duties and privacy practices, and follow the notice currently in effect. We will tell you if there is a breach that affects your PHI.
How we may use and share your information
Treatment
To provide, coordinate, and manage your lactation care, including sharing information with your IBCLC, and with your doctor or other providers when you ask us to or when a referral is needed.
Payment
To check your insurance benefits, bill your plan, and collect payment, including from you.
Health care operations
To run mothermade: quality review, training, scheduling, customer support, and business planning. Vendors who help us do this sign agreements to protect your information.
Other uses allowed or required by law
- When required by law, or for public health and safety.
- To report suspected abuse or neglect.
- For health oversight, court orders, and law enforcement as the law requires [counsel: confirm current rules for sensitive reproductive and lactation-related information].
- To prevent a serious and imminent threat to someone's health or safety.
Uses that need your written permission
We need your written authorization for marketing, for sale of PHI, and for most uses of psychotherapy notes. You can take back an authorization at any time in writing.
Your rights
- See and get a copy of your records, usually within 30 days.
- Ask us to correct information you think is wrong or incomplete.
- Ask for confidential communications, for example by a different phone number or email.
- Ask us to limit how we use or share your information. We do not have to agree, except that we must agree if you pay out of pocket in full and ask us not to tell your insurer.
- Get a list of disclosures we have made, with some exceptions.
- Get a paper copy of this notice at any time.
- Choose someone to act for you, such as a legal guardian.
To use any of these rights, contact our Privacy Officer below.
Complaints
If you believe your privacy rights were violated, you can complain to us or to the U.S. Department of Health and Human Services Office for Civil Rights ([link: hhs.gov/hipaa/filing-a-complaint]). We will not retaliate against you for filing a complaint.
Changes to this notice
We can change this notice and the new terms will apply to all information we hold. The current version is always on this page and available on request.
Privacy Officer
[Name or title]
[Legal company name]
[Mailing address]
Email: [privacy@mothermade.health]
Phone: [phone]