✦ Legal
How your health information may be used and disclosed, and how you can access it. Please review it carefully.
Last updated: [date]. This is sample template text, not legal advice. Please have it reviewed for your jurisdiction and profession before publishing.
We are required by law to protect the privacy of your health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
Treatment: to provide and coordinate your care, including with other providers you authorize.
Payment: to bill for services and provide receipts or superbills.
Operations: for quality, training and administrative purposes within the practice.
As required by law, including: to prevent a serious threat to health or safety, to report suspected abuse or neglect, in response to a court order, or as otherwise required by your province or state.
You have the right to: see and get a copy of your records; ask us to correct them; request confidential communications; ask us to limit what we share; receive a list of certain disclosures; and get a paper copy of this notice.
If you believe your privacy rights have been violated, you can contact us or your regulatory body / the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Privacy officer: [Name], privacy@yourpractice.com.