At Complete My Form, your privacy is of utmost importance. We hold to the same high standards as the medical practices with whom we partner. This notice describes our duties and your rights regarding your “Protected Health Information” (PHI).

You have the right to:

• Get a copy of your records and authorization form

• Ask us to make corrections to your records

• Request different forms of 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 notice

• Choose someone to act for you

• File a complaint if you believe your privacy rights have been violated

Our Responsibilities:

• Maintain privacy and security of your PHI

• Notify you immediately if a breach occurs that may have compromised the privacy or security of your information

• We WILL NOT share your information with anyone unless you have specifically requested.