Common use of Right to be Notified of a Breach Clause in Contracts

Right to be Notified of a Breach. You have the right to be notified in the event that We (or one of our business associates) discover a breach of unsecured PHI. Right to a Paper Copy of This Notice: You may request a copy of this notice at any time. Changes to This Notice We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for PHI We already have about you as well as any information We receive in the future. We will post a copy of the current Notice at the front desk of each clinical site and on our respective websites. Complaints If you believe your privacy rights have been violated, you may file a complaint with Us or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint. Other Uses of Protected Health Information Other uses and disclosures of PHI not covered by this Notice or the laws that apply to Us will be made only with your written permission. If you provide Us permission to use or disclose your PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, We will no longer use or disclose your PHI for the reasons covered by your written authorization. We are unable to take back any disclosures We have already made with your permission, and We are required to retain our records of the care that We provide to you. Incidental Disclosure We make reasonable efforts to avoid incidental disclosures of your PHI. An example of an incidental disclosure is conversations that may be overheard between you and Our team members. Contact TGH To Request a Copy of Records, Amendment, Restrictions, or Confidential Communications: TGH Health Information Management Dept., Attn: Director, P.O. Box 1289, Tampa, FL 33601, (000) 000-0000. To Request an Accounting of Disclosure or a Paper Copy of this Notice, or to File a Complaint: TGH Corporate Compliance & Privacy Dept., P.O. Box 1289, Tampa, FL 33601, (000) 000-0000 or Xxxxxxx@xxx.xxx. Contact USF To Request a Copy of Records: USFPG Clinical Operations Health Information Management, Attn.: HIM Administration, 00000 Xxxxx Xxxxx X. Xxxxx Blvd., MDC 33, Tampa, FL 33612, (000) 000-0000. To Request an Amendment, Accounting of Disclosure, Restrictions, Confidential Communications or a Paper Copy of this Notice: USF Health Clinical Operations Health Information Management, Attn.: HIM Administration, 00000 Xxxxx Xxxxx X. Downs Xxxx., XXX 00, Xxxxx, XX 00000, (000) 000-0000 or (000) 000-0000; fax your written signed request to (000) 000-0000. To File a Complaint: USF Health Professional Integrity Office, 00000 Xxxxx Xxxxx X. Xxxxx Blvd., MDC 74, Tampa, FL 33612, (000) 000-0000. Non-discrimination TGH and USF Health do not discriminate on the basis of race, color, national origin, age, disability or sex. TGH Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 0-000-000-0000. French Creole (Haitian Creole) ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis xx xxx xxxx ki disponib gratis pou ou. Rele 0-000-000-0000. Vietnamese 0-000-000-0000. Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 0-000-000-0000. 注注注注注注注注注注注注注注注注注注注注注注注注注注注注注注 Chinese 0-000-000-0000. French ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 0-000-000-0000. Tagalog PAUNAWA: Kung nagsasalita xx xx Tagalog, maaari kang gumamit ng mga serbisyo ng tulongsa wika nang walang bayad. Tumawag sa 0-000-000-0000. Russian 0-000-000-0000. Italian 0-000-000-0000 Arabic

Right to be Notified of a Breach. You have the right to be notified in the event that We (or one of our business associates) discover a breach of unsecured PHI. Right to a Paper Copy of This Notice: You may request a copy of this notice at any time. Changes to This Notice We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for PHI We already have about you as well as any information We receive in the future. We will post a copy of the current Notice at the front desk of each clinical site and on our respective websites. Complaints If you believe your privacy rights have been violated, you may file a complaint with Us or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint. Other Uses of Protected Health Information Other uses and disclosures of PHI not covered by this Notice or the laws that apply to Us will be made only with your written permission. If you provide Us permission to use or disclose your PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, We will no longer use or disclose your PHI for the reasons covered by your written authorization. We are unable to take back any disclosures We have already made with your permission, and We are required to retain our records of the care that We provide to you. Incidental Disclosure We make reasonable efforts to avoid incidental disclosures of your PHI. An example of an incidental disclosure is conversations that may be overheard between you and Our team members. Contact TGH To Request a Copy of Records, Amendment, Restrictions, or Confidential Communications: TGH Health Information Management Dept., Attn: Director, P.O. Box 1289, Tampa, FL 33601, (000) 000-0000. To Request an Accounting of Disclosure or a Paper Copy of this Notice, or to File a Complaint: TGH Corporate Compliance & Privacy Dept., P.O. Box 1289, Tampa, FL 33601, (000) 000-0000 or Xxxxxxx@xxx.xxx. Contact USF To Request a Copy of Records: USFPG Clinical Operations Health Information Management, Attn.: HIM Administration, 00000 Xxxxx Xxxxx X. Xxxxx Blvd., MDC 33, Tampa, FL 33612, (000) 000-0000. To Request an Amendment, Accounting of Disclosure, Restrictions, Confidential Communications or a Paper Copy of this Notice: USF Health Clinical Operations Health Information Management, Attn.: HIM Administration, 00000 Xxxxx Xxxxx X. Downs Xxxxx Xxxx., XXX 00, Xxxxx, XX 00000, (000) 000-0000 or (000) 000-0000; fax your written signed request to (000) 000-0000. To File a Complaint: USF Health Professional Integrity Office, 00000 Xxxxx Xxxxx X. Xxxxx Blvd., MDC 74, Tampa, FL 33612, (000) 000-0000. Non-discrimination TGH and USF Health do not discriminate on the basis of race, color, national origin, age, disability or sex. TGH Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 0-000-000-0000. French Creole (Haitian Creole) ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis xx xxx xxxx ki disponib gratis pou ou. Rele 0-000-000-0000. Vietnamese 0-000-000-0000. Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 0-000-000-0000. 注注注注注注注注注注注注注注注注注注注注注注注注注注注注注注 Chinese 0-000-000-0000. French ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 0-000-000-0000. Tagalog PAUNAWA: Kung nagsasalita xx xx Tagalog, maaari kang gumamit ng mga serbisyo ng tulongsa wika nang walang bayad. Tumawag sa 0-000-000-0000. Russian 0-000-000-0000. Italian 0-000-000-0000 Arabic