Sample Mock Privacy Documents

Birch Personal Health Information Facts

In a PHR, you can make choices about who can see or use your personal or health information.

As a PHR vendor, Birch Health must use and share your personal information. Different PHR vendors have different policies. You can compare the choices in this notice with other PHRs.

In the information tables below, Y means Yes, N means No, and C means you have choices. Click on any  for further information.

Birch Health provides this PHR as:
N an employer	Y a healthcare provider	N a health insurer	N an independent vendor
Birch Health does not charge a fee for this PHR.

Using and sharing your personal information

• Use the chart below to see where you have choices about how Birch Health uses and shares your information.

• Y means Yes, Birch Health will use or share your information in that way.

• N means No, Birch Health will not use or share your information in that way.

• C means you have choices about we do with your personal information. You will make these choices when you join or use Birch Health’s PHR.

		Your Identifiable Personal Information 	De-identified or Limited Set Information 	With Limitations on Further Use 
Birch Health uses your personal information for:
	PHR operations and PHR systems management
	Marketing products and services to you
Birch Health shares or sells your personal information to:
	Companies that advertise or market to you
	Pharmacies or pharmaceutical companies
	Healthcare providers
	Insurance companies or pharmacy benefits management companies
	Companies that provide or develop third-party applications
	Data brokers and data warehouses
	Medical researchers
	Your employer
	Law enforcement and government, as required by U.S. law

Additional facts about the Birch Health PHR

• You can close your PHR.

• You can transfer your information to another compatible PHR system.

• If the PHR is close, Birch Health retains your data for ___________.

• Birch Health will notify you in the event of a merger, sale, change in business, or change in our policies.

• To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. Birch Health will notify you of security breaches as required by law.

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Definitions

Personal Information

Some examples of information in your PHR system are:

• Contact: your name, home address, and Social Security number

• Computer: your email, computer IP address, and web browsing information

• Groups: your age, gender, and ethnicity

• Financial: your healthcare bills, health insurance, and benefits

• Medical: your illnesses, diseases, lab results, medications, doctors and pharmacies

Your Identifiable Data

Identifiable information could include your name, specific contact information, or other information that may make it easy to know who you are.

De-identified and Limited Set Data

De-identified information does not include your name and other specific information that makes it less easy to know who you are. Limited set data has had certain pieces of your personal information removed to make it less easy to know who you are.

With Limitations on Further Use

Birch Health has data use agreements with other companies about PHR data. The agreements contractually limit these companies to use and share PHR data in ways that follow Birch Health’s policies.

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Questions? Contact us at info@BircchPHR.com

For the full printable version, go to www.BirchPHR.com/printversion

For more comprehensive information about PHRs, go to www.hhs.gov/onc/phrinfo