SafeLane Health 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.
This Notice applies to SafeLane Health, Inc. (herein “SafeLane” or “We”) and its employees. SafeLane Health has developed an Assessment tool to help identify those who are more likely to have COVID-19. As part of this survey, SafeLane is collecting medical information which will be shared with management of your organization, however the information shared will only be in aggregate (individual responses will not be accessible). Protecting your health information is important to SafeLane Health. SafeLane follows federal laws that require us to maintain the confidentiality of your health information. SafeLane will never sell your information. Nor will SafeLane ever use your information for fundraising or marketing purposes.
The Information Collected
SafeLane will collect personal information including health information about you – such as your name, address, telephone number, email address and health information when you fill out the Covid-19 Assessment. SafeLane will also follow-up with you via e-mail to track your progress and symptoms.
How The Information Collected Is Used And With Whom It Will Be Shared
Your protected health information may be released and or used in the following ways:
- To assist in public health activities such as tracking diseases. Specifically, the information provided by you will be analyzed by our team of epidemiologists and physicians to assist in its efforts to combat the Covid-19 pandemic.
- If applicable, to assist in identifying you for COVID-19 testing.
- To administer your account. In order to administer your account, SafeLane may share the information with third parties with whom SafeLane does business, such as electronic record storage providers and IT providers. However, in these situations, SafeLane requires third parties to provide us with assurances that they will safeguard your information.
- To report a breach of health information privacy to government agencies or other affected parties.
- To communicate with your healthcare providers.
- To send you emails or secure electronic messages pertaining to the responses you give in filling out the Covid-19 assessment and to follow-up on your progress.
- To comply with certain federal, state or local laws that require or allow for disclosure.
- To comply with federal and state health oversight such as Medicare and Medicaid fraud investigations.
- To conduct limited-data health research, where patient identifiable information is kept confidential.
- To inform coroners, medical examiners and funeral directors of information necessary for them to fulfill their duties.
- To assist law enforcement officials and for law enforcement purposes.
- To avert a serious threat to health or safety through reporting to government authorities.
- To assist in specialized governmental functions such as national security, intelligence and protective services.
- To respond to a court or administrative order or subpoena.
Your Rights Regarding Your Health Information
- You have a right to receive a paper copy of our current Notice of Privacy Practices. To request a copy, you must contact: firstname.lastname@example.org
- You have the right to view or download a copy, or receive a written copy of your completed Assessment. To request a copy of your Assessment you must contact: email@example.com
- You have the right to request an electronic copy of your Assessment. If the form and format are not readily producible, we will work with you to create a reasonable electronic form or format.
You have to request to correct or amend your health information – You may ask us to correct your health information. SafeLane will consider all requests and may deny your request for legitimate reasons, for example, if we determine that the record is accurate and complete. To request a correction, you must contact:
- You have the right to be notified of any breach of your health information by SafeLane or its business associates.
- You have the right to request in writing that restrictions be placed on how your health information is used or shared. SafeLane will consider all requests and may deny your request for legitimate reasons, for example if we determine that information is legally required to be shared. To request a restriction on us or sharing, you must contact: firstname.lastname@example.org
- You have the right to request a list of certain disclosure we have made of your health information for the previous 6 years. This information will not include disclosures for treatment, health care operations, disclosures you have authorized and certain other disclosures. To request this list of disclosures you must submit your request in writing to SafeLane Health, 1095 East 2100 South, Suite 270. Salt Lake City, UT 84106 and must identify the time period for which you would like the accounting. If you request more than one accounting an any 12-month period, we may charge you a reasonable fee.
- You have the right to ask us to contact you in an alternative form (other than email). We will attempt to comply with all reasonable requests.
- You may revoke this authorization in writing at any time, although your right to revoke will be limited if the entity you have authorized to disclose information has taken action in reliance on this authorization. This revocation must be submitted in writing to SafeLane at the following address: 1095 East 2100 South, Suite 270. Salt Lake City, UT 84106
- You can have someone with medical power of attorney or a legal guardian exercise your rights and make choices about your health information. SafeLane will make sure the person has this authority and can act for you before we take any action.
- You may instruct SafeLane to share your health information with family, friends or others.
How SafeLane Secures and Retains Your Information
SafeLane has put in place technical, physical, and administrative safeguards to protect the Personal Health Information that we collect. We will not share your information other than as described here unless you give consent for other disclosures. If you tell us we can make other disclosures, you may change your mind and inform us at any time.
Contact SafeLane Health
Please send us an email using the Contact Us link of our site if you have any questions about this Notice of Privacy Practices or the Personal Information we maintain about you.
You can also contact SafeLane Health’s Privacy Officer at: 1095 East 2100 South, Suite 270. Salt Lake City, UT 84106
Even if you do not register with or provide any Personal Information to SafeLane Health, we collect Non-Personal Information about your use of the SafeLane Health Web Sites. “Non-Personal Information” means information that we cannot use to identify or contact you. We may also acquire Non-Personal Information about our users from external sources. While you may use some of the functionality of SafeLane Health without registration, many of the specific tools and services on the SafeLane Health Web Sites require that you register with SafeLane Health.
Cookies and Web Beacons
What Choices Do I Have?
If you do not want your Personal Information used by SafeLane Health as provided in this Notice, you should not complete the questionnaire or register for an account.
What if I have a Complaint?
If you believe that your privacy has been violated, you may file a complaint with us or with the Secretary of Health and Human Services in Washington, D.C. SafeLane will not retaliate or penalize you for filing a complaint with us or with the Secretary. To file a complaint with us or receive more information contact: email@example.com
To file a complaint with the Secretary of Health and Human Services, write to 200 Independence Ave., S.E., Washington, D.C. 20201 or call 1-877-696-6775.
Changes to the Terms of This Notice
SafeLane can change the terms of this notice, and the changes will apply to all information SafeLane has about you. The new Notice will be available upon request and on our website.