HIPPA Privacy Practices
Notice of Privacy Practices for Your Service Animal
Effective Date: January 27th, 2025
This notice describes how Your Service Animal may use and disclose your protected health information (PHI) and outlines your rights regarding that information. Please read it carefully. If you have any questions or concerns, please contact us at [Your Contact Information].
Our Role and Use of Your Health Information
As a Business Associate under the Health Insurance Portability and Accountability Act (HIPAA), we are not legally required to maintain or provide this notice. However, we are committed to transparency and believe it’s important to inform you about how we handle your Protected Health Information (PHI). In partnership with our independently contracted network of therapists and clinicians (“Clinicians”).
How We Protect Your Health Information
We understand that your health information is personal and confidential. We are committed to securing your PHI through administrative, physical, and technical safeguards in accordance with federal and state laws.
Collection and Maintenance of Your Health Information
The types of health information we may collect and maintain include:
- Personal Information: Your name, age, email address, username, password, and other registration details.
- Medical History and Health Status: Information you provide about your medical or health history, health status, test results, diagnostic images, and other related data.
- Clinical Information: Health information prepared or obtained by our Clinicians and support staff, such as medical records, treatment notes, and remote monitoring data.
- Billing Information: Payment details you provide, such as credit card information, or information received from your health plan or other healthcare benefit providers.
How We Use and Disclose Your Health Information
We may use and disclose your PHI for purposes of treatment, payment, and healthcare operations without your explicit permission, as permitted by law:
- Treatment
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- We maintain records of the health information you provide, which may include diagnoses, medications, test results, and responses to therapies.
- We may share this information with other healthcare providers, laboratories, or facilities involved in your care to ensure you receive appropriate treatment.
- Payment
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- We document the services and supplies provided to you so that we can bill you, your insurance company, or other third parties.
- We may inform your health plan about upcoming treatments or services that require prior approval.
- Healthcare Operations
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- We use your health information to improve the quality of our services, train our staff, conduct business management, perform quality assessments, and provide customer service.
- For example, we may review your information to evaluate the performance of our staff or to plan new services.
Other Uses and Disclosures Permitted or Required by Law
We may use or disclose your PHI in the following situations without your authorization, as required or permitted by law:
- Legal Compliance: To comply with federal, state, or local laws that mandate disclosure.
- Health Oversight Activities: For audits, investigations, inspections, or licensure purposes by government agencies that oversee the healthcare system.
- Judicial and Administrative Proceedings: In response to a court or administrative order, subpoena, or other lawful processes.
- Law Enforcement Purposes: To assist law enforcement officials in their duties.
- Research: For research purposes under strict oversight to ensure the protection of your privacy.
- Treatment Alternatives and Health-Related Benefits: To inform you about treatment options, services, or health-related benefits that may be of interest to you.
- Communication Within Our Organization: For treatment, payment, or healthcare operations purposes.
- Communication with Other Entities: With other healthcare providers or health plans for their treatment or payment activities, or for certain healthcare operations activities.
- Business Associates: To third parties with whom we contract to perform services on our behalf, provided they agree to safeguard your information.
Who Follows This Notice
This notice describes the privacy practices of:
- All healthcare professionals authorized to access and/or enter information into your health records through Your Service Animal.
- All departments and units of Your Service Animal that provide telehealth and in-person health services.
- All affiliated entities, volunteers, and staff who assist in delivering our services.
Uses and Disclosures Requiring Your Authorization
For all other uses and disclosures not described in this notice, we will obtain your written authorization before using or disclosing your PHI. This includes:
- Marketing Purposes: We will not use or disclose your PHI for marketing without your explicit consent.
- Sale of PHI: We will not sell your PHI without your authorization.
- Psychotherapy Notes: Use or disclosure of psychotherapy notes beyond treatment purposes.
You may revoke your authorization at any time by submitting a written request to us. This revocation will not affect any uses or disclosures made prior to the revocation.
Your Rights Regarding Your Health Information
You have the following rights concerning your PHI:
- Right to Inspect and Copy
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- You may request access to your medical and billing records and other information used to make decisions about your care.
- We may deny your request under certain circumstances. If denied, you may request a review of the denial.
- You may request that we provide your records in an electronic format.
- Fees may apply to cover the costs of copying, mailing, or other supplies.
- Right to Request Amendments
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- If you believe that the information we have about you is incorrect or incomplete, you may request an amendment.
- We may deny your request if we believe the information is accurate and complete or for other reasons permitted by law.
- If denied, you have the right to submit a statement of disagreement.
- Right to an Accounting of Disclosures
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- You may request a list of certain disclosures we have made of your PHI over the past six (6) years.
- This does not include disclosures made for treatment, payment, or healthcare operations.
- Fees may apply for more than one request in a 12-month period.
- Right to Request Restrictions
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- You may ask us to limit how we use or disclose your PHI for treatment, payment, or healthcare operations.
- We are not required to agree to your request unless it pertains to services you have paid for in full out-of-pocket and you request that we do not disclose information to your health plan.
- Right to Confidential Communications
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- You may request that we communicate with you through specific means or at specific locations (e.g., only at your home or only via mail).
- Right to a Paper Copy of This Notice
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- You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically.
How to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.
- To File a Complaint with Us
- Email: hipaa@yourserviceanimal.com
- Phone: Coming Soon
- Address: 1309 Coffeen Avenue STE 16934, Sheridan Wyoming 82801
- To File a Complaint with the Secretary of Health and Human Services
- Mail: 200 Independence Avenue, S.W., Washington, D.C. 20201
- Phone: 1-800-537-7697
- Online:
https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf
Contact Information
For questions, requests, or more information regarding this notice or our privacy practices, please contact:
- Email: hipaa@yourserviceanimal.com
- Phone: Coming Soon
- Address: 1309 Coffeen Avenue STE 16934, Sheridan Wyoming 82801
Note: This notice is provided to inform you about how Your Service Animal handles your protected health information. We are committed to working closely with you and your Clinicians to ensure your information is managed appropriately and confidentially.