Privacy Policy

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Get more information or file a complaint

• You can request more information regarding your information (such as an accounting of disclosures of your information) or file a complaint if you feel we have violated your rights by contacting Bespoke’s Compliance Officer, Nicole Lewis.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 5 days of your request.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home, cell or office phone) or to send mail to a different address.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

File a complaint if you feel your rights are violated

• You can request more information regarding your information (such as an accounting of disclosures of your information) or file a complaint if you feel we have violated your rights by contacting Bespoke’s Compliance Officer, Nicole Lewis.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation Include your information in a hospital directory

Treat you

• Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

• Example: We use health information about you to manage your treatment and services.

Bill for your services

Respond to lawsuits and legal actions

Our Responsibilities

• We are required by law to maintain a level of privacy and security of your protected health information and we also take additional cyber security measures at Bespoke.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice