Effective Date: January 24, 2026
DRAFT TEMPLATE: This document is a draft template for HIPAA-covered entities. Must be reviewed and customized by a healthcare attorney and compliance officer before use.
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.
1. Our Commitment to Your Privacy
DoctorSaliva is committed to protecting the privacy and security of your personal health information (PHI). This Notice of Privacy Practices describes our legal duties and privacy practices with respect to your health information.
We are required by law to:
- Maintain the privacy of your protected health information
- Provide you with this notice of our legal duties and privacy practices
- Follow the terms of the notice currently in effect
- Notify you if we are unable to accommodate a requested restriction
- Notify you in the event of a breach of your unsecured PHI
2. How We May Use and Disclose Your Health Information
2.1 For Treatment, Payment, and Healthcare Operations
Treatment: We may use and disclose your health information to provide, coordinate, or manage your healthcare education and related services.
Payment: We may use and disclose your health information to process payments for services provided through the Platform.
Healthcare Operations: We may use and disclose your health information for our business operations, including quality improvement, staff training, and research.
2.2 Other Permitted and Required Uses
We may use or disclose your health information without your authorization for:
- As Required by Law: When required by federal, state, or local law
- Public Health Activities: To prevent or control disease, injury, or disability
- Health Oversight Activities: For audits, investigations, inspections, or licensing
- Legal Proceedings: In response to court orders, subpoenas, or legal processes
- Law Enforcement: When required by law enforcement officials
- To Avert Serious Threat: To prevent a serious threat to health or safety
- Research: For research purposes when approved by an institutional review board
2.3 Uses and Disclosures Requiring Authorization
Other uses and disclosures of your health information not covered by this notice or applicable laws will be made only with your written authorization. You may revoke such authorization at any time in writing.
3. Your Rights Regarding Your Health Information
3.1 Right to Inspect and Copy
You have the right to inspect and obtain a copy of your health information maintained by DoctorSaliva. To request access, submit a written request to the contact information below. We may charge a reasonable fee for copying and mailing costs.
3.2 Right to Request Amendment
If you believe that health information we maintain about you is incorrect or incomplete, you may request an amendment. We may deny your request in certain circumstances, but will provide you with a written explanation.
3.3 Right to an Accounting of Disclosures
You have the right to request an accounting of certain disclosures of your health information made by us during the six years prior to your request (or a shorter period if you specify).
3.4 Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to your request except in limited circumstances required by law.
3.5 Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. We will accommodate reasonable requests.
3.6 Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically.
3.7 Right to Notification of Breach
You have the right to be notified in the event of a breach of your unsecured protected health information.
4. Security Safeguards
DoctorSaliva maintains physical, technical, and administrative safeguards to protect your health information:
- Physical Safeguards: Secure facilities with controlled access
- Technical Safeguards: Encryption of data in transit and at rest, firewalls, access controls, and audit logs
- Administrative Safeguards: Privacy and security policies, workforce training, and incident response procedures
- Monitoring: Regular security assessments and vulnerability testing
5. Business Associates
We may disclose your health information to business associates who perform services on our behalf. These business associates are required by contract to implement appropriate safeguards to protect your health information and may only use or disclose it as permitted by their agreements with us.
6. Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
You will not be retaliated against for filing a complaint.
7. Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice on our Platform. The Notice will contain the effective date on the first page.
8. Contact Information
For more information about this Notice or to exercise your rights, please contact:
DoctorSaliva Privacy Officer
Email: support@doctorsaliva.com
Phone: [Phone Number - To Be Added]
[Physical Address - To Be Added]
Acknowledgment: I acknowledge that I have received a copy of this Notice of Privacy Practices.
[Signature and date fields to be implemented in electronic consent flow]
