Terms and Conditions

Disclaimer/Terms and Conditions Governing General Use of the Today Clinic Forms and Website

The following terms and conditions apply to the Today Clinic (“the clinic”, “we”) Website and forms. Please read these terms and conditions carefully each time you access this site or any of our other Websites, as the terms may change from time to time.

Agreement.

todayclinic.com (“the clinic Website”, “this Web Site”) is an Internet-based online information and communication service provided by Today Clinic (“the clinic”, “we”). It is sometimes referred to in this Agreement as the Service. You agree to be bound by the terms and conditions of this Agreement. The clinic may modify this Agreement at any time. You agree to review this Agreement periodically to ensure that you are aware of any modifications. Your continued access or use of the clinic Website after the modifications have become effective shall be deemed as evidence of your acceptance of the modified Agreement.

License.

We hereby grant you the right to view and use this Web site subject to the terms and conditions of this Agreement. You may download and/or print a copy of information provided in this Web site for your personal use only. Permission to reprint or electronically reproduce any document or graphic in whole or in part for any other purpose is expressly prohibited, unless prior written consent is obtained from the respective copyright holder(s). Our designated contact for obtaining written consent is:

Today Clinic

701 NE 36th St

Oklahoma City, OK 73105

405-631-0611

Privacy.

We take your personal privacy seriously. In addition to the publicly accessible pages on this Web site, there are sections on the site where you can request more information or submit personal information to be considered for a specific employment opportunity with the clinic.

For information about how we secure personal information, please read section 12. Security below. In addition to these policies, this site fully complies with the clinic’s Notice of Privacy Practices as required by the Health Insurance Portability & Accountability Act of 1996 (HIPAA).

Links to Other Sites

While visiting this Web site, you may leave the site and access certain third party Web sites. Today Clinic neither reviews nor controls the content and accuracy of these Web sites, and therefore will not be responsible for their content and accuracy. Your access to third party Web sites is at your sole risk.

Other Websites on the Internet may contain unedited, sexually explicit, violent, racist or other types of material, which may be offensive to you. Please access other Web sites at your own discretion.

Warranty

In our content areas, information is provided for educational purposes only and should not be interpreted as a recommendation for a specific treatment plan, product or course of action. The content areas should not be relied upon for specific medical advice for you. We and our suppliers assume no responsibility for how you use the information provided through this Service. You should always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Health Information

The health information on this Web site is provided by the clinic solely for informational purposes as a public service to enhance customer service for our customers and to promote consumer health. It does not constitute medical advice and is not intended to be a substitute for proper medical care provided by a qualified health care professional. The clinic assumes no responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information supplied on this site. Always consult with your health care professional for appropriate examinations, treatment, testing, and care recommendations. Do not rely on information on this site as a tool for self-diagnosis. If you have a specific medical condition, please contact your healthcare provider. Use of this Web site does not replace medical consultations with a qualified health or medical professional to meet the health and medical needs of you or a loved one. Please check with a physician or health professional if you suspect you are ill.

You exercise your own judgment when using or purchasing any product or selecting a health care professional through any site or service linked to this Web site. In addition, while the clinic frequently updates its contents, medical information changes rapidly and therefore, some information may be out of date, and/or contain inaccuracies or typographical errors. Neither the clinic nor its Web site endorses any medical or professional service obtained through information provided on this site or any links to this site.

Viruses, Worms, Use of Files

The clinic cannot and does not guarantee or warrant that files available for downloading from this site are free of viruses, worms, Trojan horses or other code that has contaminating or destructive properties. The clinic does not make any express or implied warranties, representations or endorsements whatsoever (including without limitation warranties of title, non-infringement or fitness for a particular purpose) with respect to the files available for downloading from this site. In no event will the clinic be liable to you or to anyone else for any decision made or action taken by you or anyone else in reliance on results obtained from use of files downloaded from this site. These files may be downloaded and/or reprinted for personal use only. Permission to reprint or electronically reproduce any document or graphic in whole or in part for any reason except for personal use is expressly prohibited, unless prior written consent is obtained from the appropriate Today Clinic copyright holder.

General Disclaimer.

All Material including any link to other sites and content found at linked sites is provided “as is” and without any express or implied warranties including warranties of merchantability or fitness for a particular purpose. Due to the nature of the Internet, we do not warrant that access to this Web site or any of its pages will be uninterrupted or error free. The clinic does not warrant or make any representations regarding the usefulness of or the expected results of the material contained on this Web site. Note that some jurisdictions may not allow the exclusion of implied warranties so some of the above exclusions may not apply to you. Please check your local laws for any such restrictions.

Limitation of Liability.

You agree by accessing this Web site that under no circumstances or any theories of liability under international or civil, common or statutory law including but not limited to strict liability, negligence or other tort theories or contract, patent or copyright laws, will the clinic be liable for damages of any kind occurring from the use of this Web site or any information, goods or services obtained on this Web site including direct, indirect, consequential, incidental, or punitive damages (even if the clinic has been advised of the possibility of such damages), to the fullest extent permitted by law. Some jurisdictions do not allow the exclusion or limitation of certain damages so some of these limitations may not apply to you.

User Representations & Responsibilities.

You represent and warrant that you are at least 18 years of age and that you possess the legal right and ability to enter into this Agreement and to use this Web site in accordance with this Agreement. You agree to be financially responsible for your use of this Web site and to comply with your responsibilities and obligations as stated in this Agreement.

User Submissions

As a user, you are responsible for your own communications and are responsible for the consequences of their posting. You must not, and by using this Web site you agree not to, do the following things: post highly confidential information as described in the Notice of Privacy Practices, post material that is copyrighted, unless you are the copyright owner or have the permission of the copyright owner to post it; post material that reveals trade secrets, unless you own them or have the permission of the owner; post material that infringes on any other intellectual property rights of others or on the privacy or publicity rights of others; post material that is obscene, defamatory, threatening, harassing, abusive, hateful, or embarrassing to another user or any other person or entity; post a sexually-explicit image or statement; post advertisements or solicitations of business, post chain letters or pyramid schemes; impersonate another person; or post material that contains viruses, Trojan horses, worms, time bombs, cancelbots or other computer programming routines or engines that are intended to damage, detrimentally interfere with, surreptitiously intercept or expropriate any system, data or information.

The clinic has taken reasonable steps and has employed industry-standard practices and technology to ensure the integrity and confidentiality of your personally identifiable information; however, since even the most secure system can be violated, the clinic cannot guarantee security.

Completion and submission of the form provided under Contact Us for use in providing personal information for the purpose of obtaining additional information from the facility or applying for a job opportunity serves as conclusive acceptance of the terms in the Site Disclaimer, Website Privacy Policy, and Notice of Privacy Practices.

Minors and Child Online Privacy Protection Act

This Web site does not direct content to Minors and does not intend to collect personal information from Minors and therefore is not subject to the Child Online Privacy Protection Act.

If you allow your minor child, or a child for whom you are legal guardian (a “Minor”), to access and use this Web site, you agree that you will be solely responsible for: (i) the online conduct of such Minor; (ii) monitoring such Minor’s access to and use of this Web site; and (iii) the consequences of any use.

The Digital Millennium Copyright Act.

We reserve the right, but not the obligation, to terminate your access to this Web site if it determines in its sole and absolute discretion that you are involved in infringing activity, including alleged acts of first-time or repeat infringement, regardless or whether the material or activity is ultimately determined to be infringing. The clinic may deliver notice to you under this Agreement by means of electronic mail, a general notice on this Web site or by written communication delivered by first class U.S. mail to your address on record in the clinic’s account information, if any.

This clinic does not interfere with standard technical measures used by copyright owners to protect materials. We have implemented procedures for receiving written notification of claimed infringements and for processing such claims in accordance with the Act. Our designated agent to receive notification of claimed infringement is:

Today Clinic

701 NE 36th St

Oklahoma City, OK 73105

405-631-0611

Any written notice regarding any infringement of copyright or of other proprietary rights, should be sent to our designated agent, listed above, and must include the following information:
A physical or electronic signature of a person authorized to act on behalf of (i) the owner of an exclusive right that is allegedly infringed or (ii) the person defamed.
Identification of the copyrighted work claimed to have been infringed, or, if multiple copyrighted works at a single online site are covered by a single notification, a representative list of such works at that site.
Identification of the material that is claimed to be infringing, or to be the subject of infringing activity, including information reasonably sufficient to permit us to locate the material.
Information reasonably sufficient to permit us to contact you, such as your address, telephone number, and/or electronic mail address.
A statement that you have a good faith belief that use of the material in the manner complained of is not authorized by the copyright or other proprietary right owner, its agent, or the law.

If you choose to access this Web site from outside the United States you do so on your own initiative and are responsible for compliance with U.S. and local laws, if and to the extent that local laws are applicable. Software is subject to United States export controls. No software may be downloaded or otherwise exported or re-exported (i) into (or to a national resident of) Cuba, Iraq, Libya, North Korea, Iran, Syria, or any other country to which the U.S. has embargoed goods, or (ii) to anyone on the U.S. Treasury Department list of Specially Designated Nationals or the U.S. Commerce Department’s Table of Deny Orders. You represent and warrant that you are not located in, under the control of, or a national resident of any such country or on any such list. You agree to comply with U.S. export control laws and that you will not transfer any software or other content from this Web site to a foreign national or foreign country in violation of those laws.

Trademarks.

There are references throughout this Web site to various trademarks or service marks and these, whether registered or not, are the property of their respective owners.

Changes and Applicable Law.

We reserve the right to make changes to this Web site and our Legal Disclaimer/Conditions of Use. We encourage you to review the Web site and these terms periodically for any updates or changes. Your continued access or use of this Web site shall be deemed your acceptance of these Legal Disclaimers/Conditions of Use and any changes and the reasonableness of these standards for notice of changes. Use of this Web site and purchases of products from this Web site will be governed by and construed in accordance with the laws of the State of Tennessee, without giving effect to its conflict of law provisions. You agree that any legal action or proceeding between you and this Web site will be brought exclusively in a federal or state court of competent jurisdiction sitting in the State of Tennessee. If any provision of this agreement shall be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this agreement and shall not affect the validity and enforceability of any remaining provisions. Any cause of action or claim you may have with respect to the clinic must be commenced within one (1) year after the claim or cause of action arises. The clinic’s failure to insist upon or enforce strict performance of any provision of this Agreement shall not be construed as a waiver of any provision or right. Neither the course of conduct between the parties nor trade practice shall act to modify any provision of this Agreement. The clinic may assign its rights and duties under this Agreement to any party at any time without notice to you.

Security.

We will only use the information you submit to provide you with the services you have requested and as otherwise described in this Website Privacy Policy.

We use secure technology

In addition to our Website Privacy Policy, we also take the technical side of security seriously. Any personally identifying information you submit is stored on a secure server in a way that maximizes security and confidentiality. Our servers are behind a complex series of firewalls to add an extra layer of security.

Access to the information you submit

Information you submit is limited to those employees and staff who have a need to use the information in the following manner:

Direct response to your inquiry. If you send a non-urgent inquiry through the Contact Us section of this Web site, or submit a form, information is limited to those individuals authorized to review, research and respond to your inquiry and have access to that information.
Website Maintenance. Sometimes our technical staff may view data in the course of their work. They are governed by special rules to assure accesses are for legitimate reasons and we monitor the access to all Web technology.

Who we are

Our website address is: https://todayclinic.com.

What personal data we collect and why we collect it

Comments

When visitors leave comments on the site we collect the data shown in the comments form, and also the visitor’s IP address and browser user agent string to help spam detection.

An anonymized string created from your email address (also called a hash) may be provided to the Gravatar service to see if you are using it. The Gravatar service privacy policy is available here: https://automattic.com/privacy/. After approval of your comment, your profile picture is visible to the public in the context of your comment.

Media

If you upload images to the website, you should avoid uploading images with embedded location data (EXIF GPS) included. Visitors to the website can download and extract any location data from images on the website.

Contact forms

Cookies

If you leave a comment on our site you may opt-in to saving your name, email address and website in cookies. These are for your convenience so that you do not have to fill in your details again when you leave another comment. These cookies will last for one year.

If you have an account and you log in to this site, we will set a temporary cookie to determine if your browser accepts cookies. This cookie contains no personal data and is discarded when you close your browser.

When you log in, we will also set up several cookies to save your login information and your screen display choices. Login cookies last for two days, and screen options cookies last for a year. If you select “Remember Me”, your login will persist for two weeks. If you log out of your account, the login cookies will be removed.

If you edit or publish an article, an additional cookie will be saved in your browser. This cookie includes no personal data and simply indicates the post ID of the article you just edited. It expires after 1 day.

Embedded content from other websites

Articles on this site may include embedded content (e.g. videos, images, articles, etc.). Embedded content from other websites behaves in the exact same way as if the visitor has visited the other website.

These websites may collect data about you, use cookies, embed additional third-party tracking, and monitor your interaction with that embedded content, including tracking your interaction with the embedded content if you have an account and are logged in to that website.

Analytics

Who we share your data with

How long we retain your data

If you leave a comment, the comment and its metadata are retained indefinitely. This is so we can recognize and approve any follow-up comments automatically instead of holding them in a moderation queue.

For users that register on our website (if any), we also store the personal information they provide in their user profile. All users can see, edit, or delete their personal information at any time (except they cannot change their username). Website administrators can also see and edit that information.

What rights you have over your data

If you have an account on this site, or have left comments, you can request to receive an exported file of the personal data we hold about you, including any data you have provided to us. You can also request that we erase any personal data we hold about you. This does not include any data we are obliged to keep for administrative, legal, or security purposes.

Where we send your data

Visitor comments may be checked through an automated spam detection service.

Notice of Privacy Practices

HIPAA Notice of Privacy Practices

Today Clinic
405-631-0611

This Notice of Privacy Practices is NOT an authorization. It describes how we, our Business Associates, and their subcontractors may use and disclose your Protected Health Information to carry
out treatment, payment, or health care operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information. “Protected Health Information” is information that identifies you individually, including demographic information that relates to your past, present, or future physical or mental health condition and related health care services.

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

We may use and disclose your Protected Health Information in the following situations:

Treatment: We may use or disclose your Protected Health Information to provide medical treatment and/or services in order to manage and coordinate your medical care. For example,
we may share your medical information with other physicians and health care providers, DME vendors, surgery centers, hospitals, rehabilitation therapists, home health providers,
laboratories, nurse case managers, worker’s compensation adjusters, etc. to ensure that the medical provider has the necessary medical information to diagnose and provide treatment to you.
Payment: Your Protected Health Information will be used to obtain payment for your health care services. For example, we will provide your health care plan with the information it requires prior to paying us for the services we have provided to you. This use and disclosure may also include certain activities that your health plan requires prior to approving a service, such as determining benefits eligibility and prior authorization, etc.
Health Care Operations: We may use and disclose your Protected Health Information to manage, operate, and support the business activities of our practice. These activities include, but are not limited to, quality assessment, employee review, licensing, fundraising, and conducting or arranging for other business activities. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your Protected Health Information, as necessary, to contact you to remind you of your appointment, and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you.
Minors: Protected Health Information of minors will be disclosed to their parents or legal guardians, unless prohibited by law.
Required by Law: We will use or disclose your Protected Health Information when required to do so by local, state, federal, and international law.
Abuse, Neglect, and Domestic Violence: Your Protected Health Information will be disclosed to the appropriate government agency if there is belief that a patient has been or is currently the victim of abuse, neglect, or domestic violence and the patient agrees or it is required by law to do so. In addition, your information may also be disclosed when necessary to prevent a serious threat to your health or safety or the health and safety of others to someone who may be able to help prevent the threat.
Judicial and Administrative Proceedings: As sometimes required by law, we may disclose your Protected Health Information for the purpose of litigation to include: disputes and lawsuits; in response to a court or administrative order; response to a subpoena; request for discovery; or other legal processes. However, disclosure will only be made if efforts have been made to inform you of the request or obtain an order protecting the information requested. Your information may also be disclosed if required for our legal defense in the event of a lawsuit.
Law Enforcement: We will disclose your Protected Health Information for law enforcement purposes when all applicable legal requirements have been met. This includes, but is not limited to, law enforcement due to identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or warrant, and grand jury subpoena.
Coroners and Medical Examiners: We disclose Protected Health Information to coroners and medical examiners to assist in the fulfillment of their work responsibilities and investigations.
Public Health: Your Protected Health Information may be disclosed and may be required by law to be disclosed for public health risks. This includes: reports to the Food and Drug Administration (FDA) for the purpose of quality and safety of an FDA-regulated product or activity; to prevent or control disease; report births and deaths; report child abuse and/or neglect; reporting of reactions to medications or problems with health products; notification of recalls of products; reporting a person who may have been exposed to a disease or may be at risk of contracting and/or spreading a disease or condition.
Health Oversight Activities: We may disclose your Protected Health Information to a health oversight agency for audits, investigations, inspections, licensures, and other activities as authorized by law.
Inmates: If you are or become an inmate of a correctional facility or under the custody of the law, we may disclose Protected Health Information to the correctional facility if the disclosure is necessary for your institutional health care, to protect your health and safety, or to protect the health and safety of others within the correctional facility.
Military, National Security, and other Specialized Government Functions: If you are in the military or involved in national security or intelligence, we may disclose your Protected Health
Information to authorized officials.
Immunizations: We will provide proof of immunizations to a school that requires a patient’s immunization record prior to enrollment or admittance of a student in which you have informally
agreed to the disclosure for yourself or on behalf of your legal dependent.
Worker’s Compensation: We will disclose only the Protected Health Information necessary for Worker’s Compensation in compliance with Worker’s Compensation laws. This information may be reported to your employer and/or your employer’s representative regarding an occupational injury or illness.
Practice Ownership Change: If our medical practice is sold, acquired, or merged with another entity, your protected health information will become the property of the new owner. However, you will still have the right to request copies of your records and have copies transferred to another physician.
Breach Notification Purposes: If for any reason there is an unsecured breach of your Protected Health Information, we will utilize the contact information you have provided us with to notify you of the breach, as required by law. In addition, your Protected Health Information may be disclosed as a part of the breach notification and reporting process.
Research: Your Protected Health Information may be disclosed to researchers for the purpose of conducting research when the research has been approved by an Institutional Review or Privacy Board and in compliance with law governing research.

Business Associates: We may disclose your Protected Health Information to our business associates who provide us with services necessary to operate and function as a medical practice. We will only provide the minimum information necessary for the associate(s) to perform their functions as it relates to our business operations. For example, we may use a separate company to process our billing or transcription services that require access to a limited amount of your health information. Please know and understand that all of our business associates are obligated to comply with the same HIPAA privacy and security rules in which we are obligated. Additionally, all of our business associates are under contract with us and committed to protect the privacy and security of your Protected Health Information.

USES AND DISCLOSURES IN WHICH YOU HAVE THE RIGHT TO OBJECT AND OPT OUT

Communication with family and/or individuals involved in your care or payment of your care: Unless you object, disclosure of your Protected Health Information may be made to a family member, friend, or other individual involved in your care or payment of your care in which you have identified.
Disaster: In the event of a disaster, your Protected Health Information may be disclosed to disaster relief organizations to coordinate your care and/or to notify family members or friends of your location and condition. Whenever possible, we will provide you with an opportunity to agree or object.

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

We will not disclose or use your Protected Health Information in the situations listed below without first obtaining written authorization to do so. In addition to the uses and disclosures listed below, other uses not covered in this Notice will be made only with your written authorization. If you provide us with authorization, you may revoke it at any time by submitting a request in writing:
Disclosure of Psychotherapy Notes: Unless we obtain your written authorization, in most circumstances we will not disclose your psychotherapy notes. Some circumstances in which we will disclose your psychotherapy notes include the following: for your continued treatment; training of medical students and staff; to defend ourselves during litigation; if the law requires; health oversight activities regarding your psychotherapist; to avert a serious or imminent threat to yourself or others; and to the coroner or medical examiner upon your death.
Disclosures for marketing purposes and sale of your Protected Health Information

PROTECTED HEALTH INFORMATION AND YOUR RIGHTS

The following are statements of your rights, subject to certain limitations, with respect to your Protected Health Information:

You have the right to inspect and copy your Protected Health Information: Pursuant to your written request, you have the right to inspect and copy your Protected Health Information in paper or electronic format. Under federal law, you may not inspect or copy the following types of records: psychotherapy notes, information compiled as it relates to civil, criminal, or administrative action or proceeding; information restricted by law; information related to medical research in which you have agreed to participate; information obtained under a promise of confidentiality; and information whose disclosure may result in harm or injury to yourself or others. We have up to 30 days to provide the Protected Health Information and may charge a fee for the associated costs.
You have a right to a summary or explanation of your Protected Health Information: You have the right to request only a summary of your Protected Health Information if you do not desire to obtain a copy of your entire record. You also have the option to request an explanation of the information when you request your entire record.
You have the right to obtain an electronic copy of medical records: You have the right to request an electronic copy of your medical record for yourself or to be sent to another individual or organization when your Protected Health Information is maintained in an electronic format. We will make every attempt to provide the records in the format you request; however, in the case that the information is not readily accessible or producible in the format you request, we will provide the record in a standard electronic format or a legible hard copy
form. Record requests may be subject to a reasonable, cost-based fee for the work required in transmitting the electronic medical records.
You have the right to receive a notice of breach: In the event of a breach of your unsecured Protected Health Information, you have the right to be notified of such breach.
You have the right to request Amendments: At any time if you believe the Protected Health Information we have on file for you is inaccurate or incomplete, you may request that we amend the information. Your request for an amendment must be submitted in writing and detail what information is inaccurate and why. Please note that a request for an amendment does not necessarily indicate the information will be amended.
You have a right to receive an accounting of certain disclosures: You have the right to receive an accounting of disclosures of your Protected Health Information. An “accounting” being a list of the disclosures that we have made of your information. The request can be made for paper and/or electronic disclosures and will not include disclosures made for the purposes of: treatment; payment; health care operations; notification and communication with family and/or friends; and those required by law.
You have the right to request restrictions of your Protected Health Information: You have a right to restrict and/or limit the information we disclose to others, such as family members, friends, and individuals involved in your care or payment for your care. You also have the right to limit or restrict the information we use or disclose for treatment, payment, and/or health care operations. Your request must be submitted in writing and include the specific restriction requested, whom you want the restriction to apply, and why you would like to impose the restriction. Please note that our practice/your physician is not required to agree to your request for restriction with the exception of a restriction requested to not disclose information to your health plan for care and services in which you have paid in full out-of-pocket.
You have a right to request to receive confidential communications: You have a right to request confidential communications from us by alternative means or at an alternative location. For example, you may designate we send mail only to an address specified by you which may or may not be your home address. You may indicate we should only call you on your work phone or specify which telephone numbers we are allowed or not allowed to leave messages on. You do not have to disclose the reason for your request; however, you must submit a
request with specific instructions in writing.
You have a right to receive a paper copy of this notice: Even if you have agreed to receive an electronic copy of this Privacy Notice, you have the right to request we provide it in paper
form. You may make such a request at any time.

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this notice and will notify you of such changes. We will also make copies available of our new notice if you wish to obtain one. We will not retaliate against you for filing a complaint.

COMPLAINTS

If at any time you believe your privacy rights have been violated and you would like to register a complaint, you may do so with us or with the Secretary of the United States Department of Health and Human Services. If you wish to file a complaint with us, please submit it in writing to our Privacy/Compliance Officer to
the address listed on the first page of this Notice.

If you wish to file a complaint with the Secretary of the United States Department of Health and Human Services, please go to the website of the Office for Civil Rights ( www.hhs.gov/ocr/hipaa/ ), call 202-619-0257 (toll free 877-696-6775), or mail to:

Secretary of the US – Department of Health and Human Services
200 Independence Ave S.W.
Washington, D.C. 20201

Today Clinic HIPAA Compliance Officer: Scott Mayer, Director
Phone:405-445-3435
Email: scott@todayclinic.com

We are required by law to provide individuals with this notice of our legal responsibilities and privacy practices with respect to Protected Health Information. We are also required to maintain the privacy of, and abide by the terms of the notice currently in effect. If you have any questions in reference to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at the number listed above.