HIPAA NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations Promulgated Pursuant to the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
SMS Terms and Conditions:
Product Description
By providing your mobile phone number, you consent to receive SMS messages from (Company Name) related to [describe the purpose(Do not include marketing or promotional/Offers type, e.g., "order updates, , or account notifications"].
Message Frequency
Message frequency may vary.
Message and Data Rates
Standard message and data rates may apply depending on your carrier.
Opting Out
You may opt out of receiving SMS messages at any time by replying with "STOP" to any SMS message you receive from us. After opting out, you will receive a confirmation message, and we will cease sending SMS messages to your number.
Help and Support
If you need assistance or have questions about our SMS service, reply with "HELP" to any SMS message you receive, or contact our customer support team at [support contact information].
Privacy Policy
Your phone number will be handled in accordance with our Privacy Policy. We do not share SMS opt-in consent with any third parties for solicitation purposes.
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.
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 (TPO) and for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected health information. “Protected health information” 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.
Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by
our organization, our office staff and others outside of our office that are involved in your care and treatment for the
purpose of providing health care services to you, to pay your health care bills, to support the operation of the
organization, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health
care and any related services. This includes the coordination or management of your health care with a third party. For
example, we would disclose your protected health information, as necessary, to a home health agency that provides care
to you. For example, your protected health information may be provided to a physician to whom you have been referred
to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For
example, obtaining approval for equipment or supplies coverage may require that your relevant protected health
information be disclosed to the health plan to obtain approval for coverage.
Healthcare Operations: We may use or disclose, as‐needed, your protected health information in order to support the
business activities of our organization. These activities include, but are not limited to, quality assessment activities,
employee review activities, accreditation activities, and conducting or arranging for other business activities. For example,
we may disclose your protected health information to accrediting agencies as part of an accreditation survey. We may
also call you by name while you are at our facility. We may use or disclose your protected health information, as
necessary, to contact you to check the status of your equipment.
We may use or disclose your protected health information in the following situations without your
authorization: as Required By Law, Public Health issues as required by law, Communicable Diseases, Health Oversight,
Abuse or Neglect, Food and Drug Administration requirements, Legal Proceedings, Law Enforcement, Criminal Activity,
Inmates, Military Activity, National Security, and Workers’ Compensation. Required Uses and Disclosures: Under the law,
we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures Will Be Made Only with Your Consent, Authorization or
Opportunity to Object, unless required by law.
You may revoke this authorization, at any time, in writing, except to the extent that your physician or this organization
has taken an action in reliance on the use or disclosure indicated in the authorization.
Your Rights: Following is a statement of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information. Under federal law, however, you may not
inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in,
Therapy Works of SWLA, LLC