HIPAA Notice of Privacy Practices
Our Notice of Privacy Practices provides information about how Safeter Inc. may use or disclose your protected health information related to the information you provide in the Safeter Inc. application.
You have the right to restrict how your protected health information is used and disclosed. The HIPAA (Health Insurance Portability and Accountability Act of 1996) law allows for the use of the information for treatment, payment, or healthcare operations.
The notice contains a patient’s rights section describing your rights under the law. You ascertain that by your signature that you have reviewed our notice before signing this consent.
The terms of the notice may change. If so, you will be notified to update your signature/date.
By signing this form, you consent to the Company’s use and disclosure of your protected healthcare information only to the extent of what is provided in Safeter Inc. You have the right to revoke this consent in writing, signed by you. However, such a revocation will not be retroactive.
By signing this form, you understand that:
- Protected health information may be disclosed or used for treatment (including the protection of your co-workers), payment, or healthcare operations.
- The patient has the right to revoke this consent in writing at any time and all full disclosures will then cease.
- The Company and Safeter Inc. may condition use of this service upon execution of this consent.