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.
Our duties
The clinic you visit, supported by ClearIntake software, is required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice, and to follow the privacy practices described here.
How we may use and disclose your PHI
- Treatment: to share your intake with the clinician treating you.
- Payment: to bill and collect payment for services rendered.
- Operations: for internal quality, training, and administration.
- As required by law:including public health reporting, court orders, and reporting of abuse or neglect.
Uses that require your authorization
We will obtain your written authorization before using or disclosing your PHI for marketing, before selling it, or for most uses of psychotherapy notes.
Your rights
- Inspect and copy your PHI.
- Request a correction of your PHI.
- Request a list of certain disclosures we have made.
- Request restrictions on certain uses and disclosures.
- Request confidential communications.
- Receive a paper copy of this notice even if you agreed to receive it electronically.
- File a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights without retaliation.
Breach notification
You will be notified if a breach occurs that may have compromised the privacy or security of your PHI.
Changes to this notice
We may change this notice at any time. The new notice will be effective for all PHI we maintain and will be posted in our facilities and on this page.
Contact
Privacy Officer · privacy@clearintake.example · Or speak to staff at the clinic where you received care.