Last Updated: [TODO: ATTORNEY — date of attorney-approved version]
Effective: [TODO: ATTORNEY]
Notice
This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.
[TODO: ATTORNEY — REQUIRED HIPAA NOTICE STRUCTURE]
1. Our pledge regarding medical information
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2. How we may use and disclose medical information
- For Treatment
- For Payment
- For Health Care Operations
- Required uses and disclosures
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3. Other uses and disclosures requiring your authorization
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4. Your rights regarding medical information
- Right to inspect and copy
- Right to amend
- Right to accounting of disclosures
- Right to request restrictions
- Right to confidential communications
- Right to paper copy of notice
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5. Complaints
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6. Other information
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7. Changes to this notice
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8. Contact information
For HIPAA-related questions: privacy@theresetage.com