HIPAA Notice of Privacy Practices

This notice describes how protected health information (PHI) about you may be used and disclosed and how you can get access to this information. Please review it carefully. This template is provided as a placeholder and should be reviewed by qualified counsel before publication.

Uses and Disclosures

We may use or disclose your PHI for treatment, payment, and healthcare operations. Other uses or disclosures will be made only with your written authorization unless otherwise permitted or required by law.

Your Rights

• Right to inspect and copy your PHI
• Right to request an amendment to your record
• Right to request restrictions on certain uses and disclosures
• Right to receive a paper copy of this notice
• Right to file a complaint without retaliation

Our Responsibilities

• We are required by law to maintain the privacy of your PHI
• We must abide by the terms of this notice currently in effect
• We will notify you of any breach of unsecured PHI as required

Contact

Direct any questions about this notice to our Privacy Officer at info@icryosouthjordan.com or (801) 601-1107.