THIS NOTICE DESCRIBES HOW PRESCRYPTIVE USES AND DISCLOSES MEDICAL AND FINANCIAL INFORMATION ABOUT YOU, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
At Prescryptive Health, we are committed to maintaining the confidentiality of your medical and financial information, which we refer to as your “personal information,” regardless of format: oral, written, or electronic. This Notice of Privacy Practices informs you about how we may collect, use and disclose your personal information and your rights regarding that information. The start date of this Notice is October 14, 2019. It will remain in effect until we replace it. This Notice pertains to you and your covered dependents. Please share it with your covered dependents.
OUR RESPONSIBILITIES TO PROTECT YOUR PERSONAL INFORMATION
• protect the privacy of your personal information;
• provide this Notice explaining our duties and privacy practices regarding your personal information;
• notify you following a breach of your personal information; and
• abide by the terms of this Notice.
HOW WE MAY COLLECT YOUR PERSONAL INFORMATION
We collect most of your personal information directly from you. In addition, by being our member, we may also obtain your personal information from third parties without your specific authorization. These third parties may include producers, employers, health care providers, other health plans or insurers, and state and federal agencies.
HOW WE MAY USE AND DISCLOSE YOUR PERSONAL INFORMATION
YOUR RIGHTS REGARDING PERSONAL INFORMATION
You have the following rights regarding personal information that we maintain about you. Inspection: You have the right to request inspection and to receive a copy of a record of your personal information. If we maintain the record electronically, you have the right to request the copy be in the electronic format of your choice. If we cannot readily provide your record in that format, we will provide your record in an electronic format that you and we have agreed to. Amendment: If you feel the personal information that we maintain about you is incorrect or incomplete, you have the right to request amendment to your personal information. Restriction Request: You have a right to request a restriction or limitation on the personal information we use or disclose about you for treatment, payment and health care operations activities or disclosures to individuals involved in your care. Confidential Communications: If you believe that disclosure of all or part of your personal information may endanger you, you have the right to request that we communicate with you about health matters at an alternative location. For example, you may ask that we only contact you at your work address. Accounting of Disclosures: You have the right to an accounting of disclosures we have made for purposes other than for treatment, payment, health care operations, or that you specifically authorized. Your request may be for disclosures made up to 6 years before the date of your request. The first list you request within a 12-month period will be free. For additional lists, we may charge you a reasonable fee for the costs of copying, mailing, and supplies associated with your request. All of these requests must be made in writing to firstname.lastname@example.org. Except for accounting of disclosures, we will evaluate each request and communicate to you in writing whether or not we can honor the request. There are instances when we cannot honor your request. For example, we will not amend personal information that was not created by us, unless the person or entity that created the information is no longer available to make the amendment. We may also charge a reasonable fee for the costs of copying, mailing and supplies associated with your inspection and amendment requests.
CHANGES TO THIS NOTICE
Should any of our privacy practices change, we reserve the right to change the terms of this Notice. The revised Notice would apply to all the personal information about you that we maintain. If we make any changes to our privacy practices, we will provide you with a copy of the revised Notice. We will also post the revised Notice on our web site. If you need a copy of this Notice or want more information about our privacy practices, contact us.
If you receive this Notice on our web site or by electronic mail (e-mail), you are also entitled to receive this Notice in paper form. To obtain a paper copy of this Notice, contact us.
REPORTING A PROBLEM
If you believe your privacy rights have been violated, or if you disagree with a decision we made about a request, you may file a written complaint with us or the Secretary of the Department of Health and Human Services (DHHS). You will not be penalized if you file a complaint about our privacy practices with us or with DHHS.
You may exercise any of your rights described in this Notice, or ask questions about these rights, by contacting us at: email@example.com, OR Attention:
Privacy Office Prescryptive Health, Inc.
PO Box 403
Redmond, WA 98073