HIPAA Notice of Privacy Practices

Template notice: this notice is a starting draft for ProSupply RX LLC. Have it reviewed by your privacy officer or legal counsel before publishing.

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 commitment

ProSupply RX LLC and the independent clinicians, pharmacies and laboratories who treat you through the platform are required by law to keep your protected health information ("PHI") private, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your PHI

• Treatment. To provide, coordinate and manage your care, including sharing information with your treating clinician, the pharmacy filling your prescription and the laboratory running your panel.
• Payment. To process payment for the services you receive.
• Health care operations. To run the platform, improve quality and train staff.
• As required by law, for public health activities, to avert a serious threat to health or safety, and for other purposes permitted by HIPAA.

We do not sell your PHI and we do not use it for marketing without your written authorization. Any other use or disclosure requires your authorization, which you can revoke in writing at any time.

Your rights

• To inspect and receive a copy of your health records, usually within 30 days of your request.
• To request a correction to your records.
• To request restrictions on certain uses and disclosures.
• To request confidential communications by a different method or at a different address.
• To receive an accounting of certain disclosures.
• To be notified if a breach of your unsecured PHI occurs.
• To receive a paper copy of this notice on request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us at [email protected] or with the US Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Changes to this notice

We may change this notice and make the new notice apply to all PHI we maintain. The current notice is always available on this page.

Contact: ProSupply RX LLC, PO Box 00000, Your City, ST 00000 · [email protected] · (000) 000-0000