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.
Effective date: [DATE]. Respirago provides respiratory care at home and by telehealth. We are required by law to keep your health information private, to give you this notice, and to follow it.
For treatment. We share information with your doctor, pulmonologist, equipment provider and others involved in your care. For example, we tell your doctor how your CPAP is working.
For payment. We use and share information to bill and collect payment from you or your insurance, and to check coverage or get approval for care.
For our operations. We use information to run our practice, train staff, check quality and follow the law.
Other ways the law allows or requires. Examples: public health reporting, reporting abuse or neglect, health oversight, court orders, law enforcement in limited situations, to prevent a serious threat to health or safety, workers' compensation, and as required by law.
With people involved in your care. We may share relevant information with a family member or caregiver you involve in your care, unless you tell us not to.
Only with your written permission. We need your written authorization for marketing, for sale of your information, for most sharing of psychotherapy notes, and for any use not described here. You can cancel an authorization at any time in writing.
We will keep your information private and secure, tell you if there is a breach that may have exposed it, follow this notice, and not use or share your information in other ways without your written permission. We may change this notice, and the new notice will apply to information we already have. We will post the new notice on this page and give you a copy on request.
Video and phone visits use secure tools chosen to protect your information. You may refuse a telehealth visit and ask for an in-person visit where available.
To ask a question, use your rights, or file a complaint with us, contact our Privacy Officer: [PRIVACY OFFICER NAME], mailing address available on request, (682) 337-3253, respirago@gmail.com.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/hipaa/filing-a-complaint or 1-800-368-1019. We will not retaliate against you for filing a complaint.
Respirago · Mobile service, no storefront · (682) 337-3253 · respirago@gmail.com
