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USES AND DISCLOSURE OF HEALTH INFORMATION TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

Company uses and discloses your protected health information for treatment, payment, and health care operations. Some examples of when our office may use or disclose your health care information for these purposes include:

 OTHER USES AND DISCLOSURES

Company may also use or disclose your protected health information, in compliance with guidelines outlined by law, for the following purposes:

 AUTHORIZATION FOR OTHER USES

Company will make other uses and disclosure of your protected health information only after obtaining your written authorization. If you authorize a use not contained in this notice, you may revoke your authorization at any time by notifying us that you wish to revoke your authorization.

YOUR RIGHTS REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION

Subject to limitations outlined by law, you have certain rights related to use and disclosure of your protected health information, including the right to:

COMPANY’S DUTIES REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION

Subject to limitations outlined by law, Company has certain duties related to your protected health information, including:

CONCERNS

If you believe your privacy rights have been violated, you may make a complaint by contacting:

Tribe Intensive

Phone: (772) 208-5425

Email: admissions@tribeintensive.com

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