Effective Date: February 1, 2015
Bespoke Treatments, LLC & Bespoke Treatments Physical Therapy, PC
Your Information. Your Rights. Our Responsibilities.
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.
You have the right to:
- Get a copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
We understand that medical information about you and your health is personal. We are committed to protecting your medical information. This includes all records of your care generated by the office, including by your therapists or by our office personnel. We are required by law to make sure that your medical information that identifies you is kept private. We are required by law to provide you with this notice of our legal duties and privacy practices with respect to your medical information. This notice describes your rights and certain obligations we have regarding the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
You have some choices in the way that we use and share information as we:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you:
- 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 30 days of your request. We may charge a reasonable, cost-based fee.
- 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.
- Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
- 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 list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
- 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.
- Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
- File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us using the information at the bottom.
- 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.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
|In these cases, you have both the right and choice to tell us to:
|In these cases we never share your information unless you give us written permission:
Our Uses and Disclosure
We never market or sell personal information
How do we typically use or share your health information?
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
- Respond to lawsuits and legal actions
- We can share health information about you in response to a court or administrative order, or in response to a subpoena.
How else can we use or share your health information?
We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- Do research
- We can use or share your information for health research.
- Comply with the law
- We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
- Respond to organ and tissue donation requests
- We can share health information about you with organ procurement organizations.
- Work with a medical examiner or funeral director
- We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
- Address workers’ compensation, law enforcement, and other government requests
- We are required by law to maintain the privacy and security of your protected health information.
- 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.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
Bespoke Treatments Attn Privacy Officer
295 Madison Ave, Suite 1826, New York, NY 10017
Effective Date of Notice: February 1, 2015
Version March 11, 2021.
Information that We Collect
We may collect all or any of the following information in the course of providing the Service (collectively, “User Information”):
“Personal Information”, which you provide us when registering for or using the Service, such as your first name, last name, email address, age, gender, height, weight, the sports you participate in, your workout habits and other information relevant to your training, your user ID and password, and payment information.
“Usage Information”, such as the browser name, the type of computer or phone a User is using, technical information about a User’s means of connecting to the Service, such as the operating system and the Internet or mobile service providers utilized, and other similar information.
“User-Generated Content”, which includes all information generated by a User and shared with Bespoke, either privately or through public forums, such as messages, photos, audio, video, texts, data and other visual or audio content.
“Voluntarily-Provided Information”, which is information voluntarily provided by Users in response to surveys, polls and similar forms through which information may be requested on or through the Service (other than Personal Information and User-Generated Content).
We may collect any of the foregoing information from Users in a variety of ways, including but not limited to when Users register for the Service, use or otherwise access the Service, fill out a survey or other form, purchase our products, subscribe to a newsletter, mailing list or other communication tool, contact us via email, and in connection with other activities, services, features or resources we make available through the Service from time to time.
How We Use the Information that We Collect
Personal Information. We use Personal Information for purposes of delivering the Service, sending you promotional materials and news from Bespoke and its affiliates and partners, and for other communications relating to the Service. We will not disclose Personal Information to any third party except to our third party service providers that we engage to provide services to us (“Contractors”) who are bound by written obligations of confidentiality.
Usage Information. We use your Usage Information for a variety of purposes, such as to understand how our Users as a group use the Service, to improve the Service, to personalize User experience, and to process transactions. We will not disclose your Usage Information except to our Contractors, in order to analyze the performance of the Service and the behavior of users, and to operate and improve the Service.
User-Generated Content. We use User-Generated content to more effectively respond to your customer service requests and support needs, to improve customer service, and for similar purposes.
Voluntarily-Provided Information. We use Voluntarily-Provided Information to send Users information that they agree to receive about topics that may be of interest to them, and to share User information with third parties, including for marketing or other purposes. You may unsubscribe to some or all promotional notices at any time.
Collecting Personal Information
- Examples of Personal Information collected: version of web browser, IP address, time zone, cookie information, what sites or products you view, search terms, and how you interact with the Site.
- Purpose of collection: to load the Site accurately for you, and to perform analytics on Site usage to optimize our Site.
- Source of collection: Collected automatically when you access our Site using cookies, log files, web beacons, tags, or pixels.
- Disclosure for a business purpose: shared with our processor Biostrap.
- Examples of Personal Information collected: name, billing address, shipping address, payment information (including credit card numbers, healthcare details, email address, and phone number.)
- Purpose of collection: to provide products or services to you to fulfill our contract, to process your payment information, arrange for shipping, and provide you with invoices and/or order confirmations, communicate with you, screen our orders for potential risk or fraud, and when in line with the preferences you have shared with us, provide you with information or advertising relating to our products or services.
- Source of collection: collected from you.
- Disclosure for a business purpose: shared with our processor Biostrap
Customer support information
- Examples of Personal Information collected: Phone Number, Email address.
- Purpose of collection: to provide customer support.
- Source of collection: collected from you.
The Site is not intended for individuals under the age of 18. We do not intentionally collect Personal Information from children. If you are the parent or guardian and believe your child has provided us with Personal Information, please contact us at the address below to request deletion.
Sharing Personal Information
We share your Personal Information with service providers to help us provide our services and fulfill our contracts with you, as described above.
- We use Biostrap to power our application. You can read more about how Biostrap uses your Personal Information here: https://biostrap.com/privacy/
- We may share your Personal Information to comply with applicable laws and regulations, to respond to a subpoena, search warrant or other lawful request for information we receive, or to otherwise protect our rights.
As described above, we use your Personal Information to provide you with targeted advertisements or marketing communications we believe may be of interest to you. For example:
- We use Google Analytics to help us understand how our customers use the Site. You can read more about how Google uses your Personal Information here: https://policies.google.com/privacy?hl=en.You can also opt-out of Google Analytics here: https://tools.google.com/dlpage/gaoptout.
- For more information about how targeted advertising works, you can visit the Network Advertising Initiative’s (“NAI”) educational page at http://www.networkadvertising.org/understanding-online-advertising/how-does-it-work.
You can opt out of targeted advertising by:
- FACEBOOK – https://www.facebook.com/settings/?tab=ads
- GOOGLE – https://www.google.com/settings/ads/anonymous
Additionally, you can opt out of some of these services by visiting the Digital Advertising Alliance’s opt-out portal at: http://optout.aboutads.info/.
If you are a resident of California, you have the right to access the Personal Information we hold about you (also known as the ‘Right to Know’), to port it to a new service, and to ask that your Personal Information be corrected, updated, or erased. If you would like to exercise these rights, please contact us through the contact information below. If you would like to designate an authorized agent to submit these requests on your behalf, please contact us at the address below.
How we Protect User Information
We adopt data collection, storage and processing practices and security measures to protect against unauthorized access, alteration, disclosure or destruction of User Information and data stored on our Service. Commercial transactions occurring on the Service are processed over a SSL secured communication channel.
User Information may be stored in United States and/or in foreign countries. Ultimately, the requirements of governments other than those of the United States may apply to User Information.
Third Party Websites
Users may find advertising or other content while using the Service that links to the sites and services of our partners, suppliers, advertisers, sponsors, licensors and other third parties. We do not control the content or links that appear on these sites and are not responsible for the practices employed by websites linked to or from the Service. In addition, these sites or services, including their content and links, may be constantly changing. These sites and services may have their own privacy policies and customer service policies. Browsing and interaction on any other website, including websites which have a link to the Service, is subject to that website’s own terms and policies.
Referral Information and Gifts
When you refer a person to Bespoke by email, or purchase the Service as a gift for another person, we may ask for that person’s email address. We (either directly or through vendors who administer such programs) will use the email address to make the referral or, as applicable, notify the person of the gift, and we will let the person know that you provided the referral or purchased the gift. By participating in a referral program, or purchasing a gift for such person, you confirm that the person has given you consent for Bespoke to communicate with them regarding the referral or the gift, as applicable.
If you use a third-party site, such as Facebook, Instagram or Twitter, to post a referral, then we may also collect information on that site, such as your profile picture, gender, username, user ID, age, language, country, network or friend lists or lists of followers) depending on your privacy settings on the applicable third-party site.
Termination of User Account
Transfer of User Information in the Event of Acquisition
Third Party Beneficiaries
For more information about our privacy practices, if you have questions, or if you would like to make a complaint, please contact us by e-mail at firstname.lastname@example.org or by mail using the details provided below:
295 Madsion Ave, Suite 1801, New York NY 10017, United States
Last updated: 03/11/2021