The following notice describes how your medical information may be used and disclosed, and how you can get access to this information. Please review carefully.

Your confidential private health care information (PHI) may be released to other health care professionals within Women’s Health Boutique for the purpose of providing you with quality health care.

Your PHI may be released to your insurance provider for the purpose of Women’s Health Boutique receiving payment for providing you with needed health care services.

 

Your PHI may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.

 

Your PHI may be released to other health care providers in the event you need emergency care.

 

Your PHI may be released to a pubic health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).

 

Your PHI may not be released for any other purpose than that which is identified in this notice.

 

Your PHI may be released only after receiving written authorization from you. You may revoke your permission to release PHI at any time.

 

You may be contacted by Women’s Health Boutique to remind you of any appointments, health care treatment options or other health services that may be of interest to you.

 

You may be contacted by Women’s Health Boutique for the purposes of raising funds to support women’s health boutique operations.

 

You have the right to restrict the use of your PHI. However, Women’s Health Boutique may choose to refuse your restriction if it is in conflict of providing you with quality health care or in the event of an emergency situation.

 

You have the right to receive confidential communication about your health services.

 

You have the right to review and photocopy any/all portions of your health care information.

 

You have the right to make changes to your health care information.

 

You have the right to know who has accessed your PHI and for what purpose.

 

You have the right to possess a copy of this Privacy Notice. This copy can be in the form of an electronic transmission or on paper. Women’s Health Boutique is required by law to protect the privacy of its customers. It will keep confidential any and all PHI and will provide customers with a list of duties or practices that protect PHI.

Women’s Health Boutique will abide by the terms of this notice. Women’s Health Boutique reserves the right to make changes to this notice and continue to maintain the confidentiality of all health care information. Customers will receive a mailed copy of any changes to this notice within 60 days of making the changes.

 

You have the right to complain to Women’s Health Boutique if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to Women’s Health Boutique. Attention: Owner.

 

All complaints will be investigated. No personal issue will be raised for filing a complaint with Women’s Health Boutique.

 

For further information about this Privacy Notice, please contact: 281.256.4100

 

Women’s Health Boutique Franchise Systems Inc. or Designee

 

This notice is effective as of Date of Effectiveness. This date must not be earlier than the date on which the notice is printed or published.