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Notice of Privacy Rights and Practices For Your Personal Health

EFFECTIVE: January 1, 2014
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.

Our duties and pledge to protect your personal health information ("PHI")

We are required by law to maintain the privacy of your health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information.

We are required to protect the confidentiality of your PHI and will disclose your PHI to a person other than you or your personal representative only when permitted under federal or state law. This protection extends to any PHI that is oral, written or electronic, such as prescriptions transmitted by facsimile, modem or other electronic device. This Notice describes how we may use and disclose your PHI. In some circumstances, as described in this Notice, the law permits us to use and disclose your PHI without your express permission. In all other circumstances, we will obtain your written authorization before we use or disclose your PHI. This Notice also describes your rights and the obligations we have regarding the use and disclosure of your PHI. Under federal and applicable state law, we are required to follow the terms of the Notice currently in effect. In some situations, state privacy or other applicable laws may provide greater privacy protections than those stated in this Notice. For example, depending on the state in which you reside, there may be additional state law privacy protections related to communicable diseases, reproductive health, substance abuse and mental health. When appropriate, we will follow these state or other applicable laws. Please contact us by way of our Contact Information contained in this Notice if you would like a copy of the more protective privacy laws, if any, in your state.

How we may use and disclose your personal health information

How We May Use and Disclose Your PHI Without Your Permission For Treatment, Payment or Health Care Operations

Below are examples of how federal law permits use or disclosure of your PHI for these purposes without your permission:

Other Special Circumstances

In addition to the above, we are permitted under federal and applicable state law to use or disclose your PHI without your permission only in certain circumstances, as described below:

How We May Use or Disclose Your PHI for Other Purposes Only With Your Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes other than those described. You may revoke this authorization at any time by submitting a written notice to our address listed in the Contact Information below. Your revocation will not apply to information released before we receive it. You have the following rights with respect to your PHI:

Obtain a paper copy of the Notice upon request. To obtain a copy, contact us at the address and/or phone number listed in the Contact Information below.

Inspect and obtain a copy of your PHI. You have the right to access and copy your PHI contained in a "designated record set," which includes prescription records. To inspect or obtain a copy of your PHI, submit a written request to our address listed in the Contact Information below. We will respond to your request in writing within 30 days. A fee may be charged for the expense of fulfilling your request. We may deny your request in certain limited circumstances, such as if we have reasonably determined that providing access to PHI would endanger your life or safety or cause substantial harm to you or another person. If we deny your request, we will notify you in writing and provide you with the opportunity to request a review of the denial.

Request an amendment of PHI. If you feel that your PHI maintained by us in a "designated record set" is incomplete or incorrect, you may request that we amend it. To request an amendment, submit a written request to our address listed in the Contact Information below. Requests must identify: (i) which information you seek to amend, (ii) what corrections you would like to make, and (iii) why the information needs to be amended. We will respond to your request in writing within 60 days (with a possible 30-day extension). In our response, we will either: (i) agree to make the amendment, or (ii) inform you of our denial, explain our reason and outline appeal procedures. If denied, you have the right to file a statement of disagreement with the decision. We will provide a rebuttal to your statement and maintain appropriate records of your disagreement and our rebuttal.

Receive an accounting of disclosures of PHI. You have the right to request an accounting of disclosures of your PHI for purposes other than treatment, payment or health care operations. This accounting will also exclude disclosures: made directly to you, made with your authorization, made to your caregivers, and certain other disclosures. To obtain an accounting, submit a written request to our address listed in the Contact Information below. Requests must specify the time period, not to exceed six years. We will respond in writing within 60 days of receipt of your request (with a possible 30-day extension). We will provide one free accounting per 12-month period, but you may be charged for the cost of any subsequent accountings during the same period. We will notify you in advance of the cost involved, and you may choose to withdraw or modify your request at that time.

Request communications of PHI by alternative means or at alternative locations. You have the right to request that we communicate with you in a certain way or at a certain location. For example, you may request that we contact you only in writing at a specific address. To request confidential communication of your PHI, submit a written request to our address listed in the Contact Information below. Your request must state how, where or when you would like to be contacted. We will accommodate all reasonable requests.

Request a restriction on certain uses and disclosures of PHI. You have the right to request a restriction or limitation on our use or disclosure of your PHI by submitting a written request to our address listed in the Contact Information below.

You must identify in this request: (i) what particular information you would like to limit, (ii) whether you want to limit use, disclosure or both, and (iii) to whom you want the limits to apply. All requests will be carefully considered, but we are not required to agree to those restrictions. We will provide you with a written response to your request within 30 days. If we do agree to restrict use or disclosure of your PHI, we will not apply these restrictions in the event of an emergency. We also have the right to terminate the restriction if: (i) you agree orally or in writing, or (ii) we inform you of the termination, which becomes effective only with respect to your PHI created or received after we inform you of the termination.

We also do not sell customer lists.

Complaints, Questions, and Further Information

We are sincerely committed to protecting your personal privacy. We encourage you to contact us if you have any questions or concerns or want further information about this notice, our privacy practices or your privacy rights. We encourage you to contact us at the address listed in the Contact Information below if you have any complaints about our privacy practices, believe that your privacy rights have been violated, or have any complaint about your privacy rights. You may also file a complaint with the Secretary of the Office for Civil Rights. We will not retaliate in any way, shape or form for your asking questions, requesting further information or filing a complaint. You may file a complaint or contact us pursuant to the Contact Information contained in this Notice.

Contact Information

Cheeseburger Tech Inc
Privacy Department
322 North Shore Drive
Building 1B
Suite 200
Pittsburgh, Pennsylvania, 15212

Changes to this Notice

This Notice of Privacy Rights and Practices is effective JANUARY 1, 2014. We reserve the right to change jour privacy practices at any time by updating this Notice on this website. Upon request and through our Contact Information, we will provide a revised Notice to you.