Notice of HIPAA Privacy Practices
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.
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Pro ESA Letter
Official Notice of Privacy Practices
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law.
This Notice describes the privacy practices of Pro ESA Letter and all its affiliated healthcare professionals, employees, staff, and other personnel. We provide emotional support animal evaluation services through telehealth consultations with licensed mental health professionals.
Legal Requirement
We are required by law to maintain the privacy of your protected health information (PHI) and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. We are also required to abide by the terms of this Notice as it is currently in effect.
Protected Health Information (PHI)
Protected Health Information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
1. For Treatment, Payment, or Health Care Operations
We may use and disclose your PHI for the following purposes without your written authorization:
Treatment
We may use your PHI to provide you with telehealth evaluation services. For example, we may disclose your PHI to the licensed mental health professional conducting your evaluation.
Payment
We may use and disclose your PHI to obtain payment for services we provide to you. For example, we may provide your payment information to our billing department.
Health Care Operations
We may use and disclose your PHI for our health care operations. For example, we may use your PHI to evaluate the quality of services you receive or to conduct business planning.
2. Other Permitted Uses and Disclosures
We may also use and disclose your PHI without your authorization for the following purposes:
| Purpose | Description | Examples |
|---|---|---|
| Required By Law | When required by federal, state, or local law | Court orders, subpoenas, mandatory reporting |
| Public Health Activities | For public health reporting as required by law | Disease control, vital statistics, FDA reporting |
| Health Oversight | To health oversight agencies for audits and inspections | State licensing boards, HIPAA compliance audits |
| Judicial Proceedings | In response to court orders or subpoenas | Legal proceedings where required by law |
| Law Enforcement | To law enforcement officials as required by law | Reporting crimes, identifying suspects |
| Serious Threat | To prevent serious threat to health or safety | Suicide prevention, harm to others |
3. Uses and Disclosures Requiring Your Authorization
For all other purposes, we will obtain your written authorization before using or disclosing your PHI. You may revoke your authorization in writing at any time, except to the extent we have already taken action based on your authorization.
Special Authorizations Required
The following uses and disclosures require your specific written authorization: Marketing communications (except face-to-face communications), sale of your PHI, most uses and disclosures of psychotherapy notes, and uses and disclosures for research purposes that are not covered by a waiver of authorization.
You have the following rights regarding the PHI we maintain about you:
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI that is contained in a designated record set. This includes medical and billing records. We may charge a reasonable fee for copying and mailing.
Right to Request Amendments
You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. We may deny your request under certain circumstances.
Right to Accounting of Disclosures
You have the right to receive an accounting of certain disclosures of your PHI made by us in the six years prior to your request. This does not include disclosures for treatment, payment, or health care operations.
Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your PHI. While we are not required to agree to all restrictions, we will comply with any restriction to which we agree.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your PHI in a certain way or at a certain location. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically.
How to Exercise Your Rights
To exercise any of these rights, please submit your request in writing to our Privacy Officer at the address provided in the Contact Information section. We will respond to your request within the timeframes required by law.
Legal Obligations
Pro ESA Letter is required by law to:
- Maintain the privacy of your PHI
- Provide you with this Notice of our legal duties and privacy practices
- Abide by the terms of the Notice currently in effect
- Notify you following a breach of unsecured PHI
- Obtain your authorization for certain uses and disclosures
Changes to This Notice
We reserve the right to change the terms of this Notice at any time. The new Notice will be effective for all PHI we maintain at that time. We will provide you with a revised Notice upon request or by posting it on our website.
Minimum Necessary Standard
We follow the "Minimum Necessary" standard, which means we will only use, disclose, or request the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure, or request.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer using the contact information provided in this Notice.
No Retaliation
You will not be penalized or retaliated against for filing a complaint about our privacy practices. We are committed to addressing any concerns you may have about the privacy of your health information.
How to File a Complaint
You may file a complaint by:
- Contacting our Privacy Officer in writing
- Calling our Privacy Officer at the number provided
- Emailing our Privacy Officer at the email address provided
- Filing directly with the Office for Civil Rights (OCR)
Acknowledgment of Receipt
By using our services, you acknowledge that you have received this Notice of Privacy Practices. We may ask you to sign an acknowledgment form when you begin receiving services from us.
Digital Acknowledgment
Contact Information
If you have any questions about this Notice or our privacy practices, please contact our Privacy Officer:
Privacy Officer
Pro ESA Letter Privacy Officer
Mailing Address
Pro ESA Letter
Attn: Privacy Officer
1234 Main Street, Suite 200
Los Angeles, CA 90012