Notice of Privacy Practices
Last updated [Date]
This page is awaiting approved text from [Client Legal Counsel]. The headings below are the structure a HIPAA notice of privacy practices requires; the bracketed blocks are empty slots. This notice is not in effect and describes no current practice. Required content, the model-notice format and the effective date must all come from [Client Legal Counsel] and the client’s privacy officer.
Our Responsibilities
[Approved text — responsibilities and duty to abide by this notice]
How Health Information May Be Used and Disclosed
[Approved text — permitted uses and disclosures, with examples]
Uses and Disclosures Requiring Your Authorization
[Approved text — authorization and revocation]
Other Permitted or Required Disclosures
[Approved text — disclosures required or permitted by law]
Your Rights Regarding Health Information
[Approved text — individual rights and how to exercise each]
Complaints
[Approved text — complaint process and no-retaliation assurance]
Changes to This Notice
[Approved text — right to change this notice and how it is distributed]
Effective Date
[Effective Date]
Contact
[Contact] · [Email Address] · [Phone Number] · [Mailing Address]