HIPAA Notice of Privacy Practices

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) sets standards for protecting the rights of patients. To comply with HIPAA regulations, correspondence that contains protected health information (“PHI”) should be sent by encrypted (secured) systems.

It is very important you are aware that unsecured e-mail, customer relations management platforms, text messages, e-fax, online chats, virtual online meetings, third-party communications software/applications, and other forms of unsecured electronic communication (“e-communication”), even when understood to be secure, can sometimes be accessed relatively easily by unauthorized persons and hence can compromise the privacy and confidentiality of such communications. Unsecured e-communication may also be vulnerable to unauthorized access since servers or communication companies may have unlimited and direct access to all e-communications that pass through them. It is also possible that unsecured e-communications may be inadvertently sent to or received by the wrong address or device.

E-communication on your computer, laptop, tablet, phone, or other devices also has inherent privacy risks—especially when your e-communication access is provided through your employer or when access to your e-communication is not password protected.

By completing and submitting this form, you acknowledge and understand the e-communication risks identified above and willingly provide your contact information through this platform. You also agree to opt in and authorize HRC Fertility to retain, maintain, and use your contact information to contact you and market their services, promotions, and related communications, including by using your name, email address, and phone number that you provide. You understand that you may opt out of receiving marketing communications from HRC Fertility at any time by contacting HRC Fertility in writing at the address listed in the Privacy Policy or by email at marketing@havingbabies.com.

Public Health Risks: We may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:

• Maintaining vital records, such as births and deaths
• Reporting child abuse or neglect
• Preventing or controlling disease, injury or disability
• Notifying a person regarding potential exposure to a communicable disease
• Notifying a person regarding a potential risk for spreading or contracting a disease or condition
• Reporting reactions to drugs or problems with products or devices
• Notifying individuals if a product or device they may be using has been recalled
• Notifying appropriate government agencies and authorities regarding the potential abuse or neglect of an adult patient, including domestic violence; however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
• Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Lawsuits and Similar Proceedings: We may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.

Law Enforcement: Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.

Research: We may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when an Institutional Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following: (i) the use or disclosure involves no more than a minimal risk to your privacy based on the following: (a) an adequate plan to protect the identifiers from improper use and disclosure; (b) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (c) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI.

Serious Threats to Health or Safety: We may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

Military: We may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

National Security: We may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Inmates: We may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

Right to Provide an Authorization for Other Uses and Disclosures: We will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization.

Please note: we are required to retain records of your care.

Individual Rights: You have certain rights under the federal privacy standards including:

• The right to request restrictions on the use and disclosure of your protected health information
• The right to receive confidential communications concerning your medical condition and treatment
• The right to file a complaint – We will provide you with the address.
• The right to inspect and receive a copy of your protected health information – Contact the front office receptionist for the form.
• The right to amend or submit corrections to your protected health information
• The right to receive an accounting of how and to whom your protected health information has been disclosed
• The right to receive a printed copy of this notice.

If you have any questions regarding this notice or our health information privacy policies, please contact HRC Fertility at (626) 440-9161 and ask for Department of Education.

Notice of Privacy Practices 10/06/03 Revised 12/04/09, 01/15/14, 05/04/17, 05/08/19