Notice of Privacy Practices (HIPAA)

What a complete notice covers

Use this list to check that the text you paste covers everything it needs to. Each item below is required in a compliant Notice of Privacy Practices.

• How we may use and disclose your protected health information for treatment, payment and health care operations
• Your written authorisation for anything else, and how to withdraw it
• Your rights: to see and get a copy of your record, to ask us to correct it, to ask for confidential communication, to ask us to limit what we share, to get a list of disclosures, and to get a paper copy of this notice
• Our duties, including that we must protect your information and notify you if a breach affects you
• How to complain to us, and to the U.S. Department of Health and Human Services Office for Civil Rights
• Who to contact with questions, and the date the notice takes effect

Getting a paper or downloadable copy

You have the right to a paper copy of this notice at any time, even if you received it electronically. Use the “Print this page” button at the top of this page, or call 850-940-4325 and we will post or email you a copy.

[ADD A LINK TO A DOWNLOADABLE PDF VERSION OF YOUR FINALISED NPP]

Privacy contact and complaints

Privacy officer: [ADD PRIVACY OFFICER NAME, TITLE, PHONE AND EMAIL]

If you believe your privacy rights have been violated, you can complain to us using the contact above, or to the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr or 1-800-368-1019 (TDD 1-800-537-7697). You will not be penalised or refused care for filing a complaint.

Notice effective date

[ADD THE EFFECTIVE DATE OF YOUR FINALISED NPP]

Related pages: Website Privacy Policy · Patient Rights & Responsibilities · Nondiscrimination & Accessibility Notice