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Your Privacy is Paramount

Your Health Information. Your Rights. Our Responsibilities.

This Notice explains how your health information is used and disclosed at ShapeInRx, and how you can access this information. Please review it carefully.

1. Your Rights

  • Access Your Information: You have the right to request a copy of your medical record, either electronically or on paper.
  • Correct Your Information: If you believe your medical record contains inaccurate or incomplete information, you can request a correction.
  • Request Confidential Communication: You can specify how we contact you (e.g., home phone, office phone) or request mail delivery to a specific address.
  • Limit Information Use or Disclosure: You can request us to restrict the use or disclosure of your health information for treatment, payment, or healthcare operations. We are not obligated to agree, but will explain our decision in writing.
  • Obtain a Disclosure List: You can request a list of disclosures made with your health information for the past six years, including who received the information and the reason for disclosure.
  • Receive a Copy of this Privacy Notice: You can request a paper copy of this notice at any time.
  • Appoint a Representative: You can designate someone to act on your behalf regarding your health information, such as a healthcare power of attorney or legal guardian.
  • File a Complaint: If you believe your privacy rights have been violated, you can file a complaint with us or the U.S. Department of Health and Human Services Office for Civil Rights.

2. Your Choices

For certain situations, you have the right to choose how we disclose your health information.

  • Disclose to Family, Friends, or Caregivers: You can authorize disclosure to family members, close friends, or others involved in your care.
  • Disaster Relief Situations: You can authorize disclosure in a disaster relief situation.
  • Hospital Directory: You can choose to be included in the hospital directory.

 

If you are unable to express your preference (e.g., unconscious), we may disclose your information if we believe it is in your best interest or to address a serious health or safety threat. Marketing purposes, selling your information, and most sharing of psychotherapy notes require your written permission.

3. Our Uses and Disclosures

We typically use and disclose your information for the following purposes:

  • Treatment: We can share your information with other healthcare professionals involved in your care.
  • Healthcare Operations: We can use your information to manage your treatment and services, and to operate our practice effectively.
  • Billing: We can use your information to bill and receive payment from health plans or other entities.

 

Mobile Information Sharing: We will not share your mobile information with third parties for marketing purposes. Information may be shared with subcontractors for support services like customer service, but not for marketing.

4. Other Uses and Disclosures

We are permitted or required to disclose your information under certain circumstances, often to benefit public health or research. We must meet strict legal requirements before doing so. More information can be found at: HHS_GOV_Consumer_Summary.pdf

OR

HHS_GOV_Privacy

  • Public Health and Safety: We may disclose your information to prevent disease, report adverse reactions to medications, or report suspected abuse or neglect.
  • Research: We may use your information for health research purposes.
  • Legal Compliance: We will disclose your information if required by state or federal law.
  • Organ and Tissue Donation: We may disclose your information to organ procurement organizations.
  • Medical Examiners/Funeral Directors: We may disclose your information to a coroner, medical examiner, or funeral director when necessary.
  • Government Requests: We may disclose your information for workers’ compensation claims, law enforcement purposes, or other authorized government functions.
  • Lawsuits and Legal Actions: We may disclose your information in response to a court order or subpoena.

5. Our Responsibilities

We are legally obligated to maintain the privacy and security of your protected health information. We will notify you promptly if a breach occurs that may have compromised your information. 

We are committed to following the duties and privacy practices described in this notice and providing you with a copy. We will not use or disclose your information other than as described here unless you provide written authorization, which you can revoke at any time.

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