Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective date: [PENDIENTE — fecha en que la organización adopta este aviso]

Our commitment

Octavia Health Inc is required by law to protect the privacy of your health information, to give you this notice explaining our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

We take this seriously for a reason that goes beyond the law: the people we serve tell us things — a diagnosis, a fear, a program they are asking about — that they may not have told their own family.

What health information we hold

We are not a clinic and we do not treat anyone. The information we hold about you is what you give us so that we can help:

• Your name, phone number, email address and ZIP code
• The language you prefer
• Whether you have health insurance
• Which program or service you are asking about — and that alone can reveal a health condition
• Anything you choose to write to us
• Notes about the appointments we arranged for you and the providers we referred you to

How we may use and disclose it

To coordinate your care. We share the minimum necessary with the clinic, laboratory or provider we are connecting you with, so they can schedule you and attend you.

To reach you. To call or write to you about your request, an appointment, or a program you asked about.

As required by law. Public health reporting, court orders, and the other situations where the law requires disclosure.

What we do NOT do

• We do not sell your information. Ever.
• We do not share it with anyone for marketing without your written authorization.
• We do not tell your employer, your landlord, or your family anything about you without your permission.
• We do not condition our services on you letting us share your information.

Anything not described in this notice requires your written authorization, and you can revoke that authorization at any time.

Your rights

To see and get a copy of the information we hold about you.

To correct it if something is wrong or incomplete.

To ask us to limit what we use or share. We will try; where the law requires us to agree, we will agree.

To choose how we contact you — a different phone number, a different address, or asking us not to leave voicemails.

To a list of disclosures we have made outside of care coordination.

To a paper copy of this notice, even if you accepted it electronically. Ask us and we will hand it to you.

To be told if there is a breach affecting your information.

To exercise any of these, call +1 (561) 729-4870 or write to info@octaviah.org.

Complaints

If you believe your privacy rights have been violated, tell us — call or write to the contacts above. You will not be retaliated against in any way, and it will not affect the services you receive.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

• https://www.hhs.gov/ocr/complaints
• 1-800-368-1019

Changes to this notice

We may change this notice, and the changes will apply to information we already hold. The current version is always on this page, with its effective date at the top, and a copy is available at our office.

Privacy Officer

[PENDIENTE — nombre y contacto directo de la persona responsable de privacidad en la organización. HIPAA exige designar una.]