Monogram Health takes the security of our website and your data extremely seriously. Monogram Health does not capture and store any personal information about individuals who access our website(s), except where you voluntarily choose to give us your personal details by email, or ordering our services and products. In these cases, the information you give us is used exclusively by Monogram Health to provide you with information about our products and services. We do not pass any of your personal data to any other organization, except with your express consent. Monogram Health does not store cookies on your computer that last any longer than your browsing session, and these are only used to provide essential functionality to the site.
The Monogram Health site(s) only monitors the IP addresses of visitors to the site to assess the popularity of pages, IP addresses are not linked to any personal information, and visitors will remain anonymous.
If you have voluntarily given us information, you have the right to know about the personal information we hold about you, and you have a right to have your data corrected or deleted. Please address all your requests and/or queries about our data protection policy to firstname.lastname@example.org.
PRIVACY PRACTICES NOTICE
We reserve the right to change our privacy practices and the terms of this notice at any time, as allowed by law. This includes the right to make changes in our privacy practices and the revised terms of our notice effective for all personal
and health information we maintain. This includes information we created or received before we made the changes. When we make a significant change in our privacy practices, we will change this notice and send the notice to our health plan subscribers.
What is personal and health information?
Personal and health information - from now on referred to as “information” - includes both medical information and individually identifiable information, like your name, address, telephone number, or Social Security number. The term “information” in this notice includes any personal and health information created or received by a healthcare provider or health plan that relates to your physical or mental health or condition, providing healthcare to you, or the payment for such healthcare. We protect this information in all formats including electronic, written and oral information.
How do we protect your information?
In keeping with federal and state laws and our own policy, we have a responsibility to protect the privacy of your information. We have safeguards in place to protect your information in various ways including:
Limiting who may see your information
Limiting how we use or disclose your information
Informing you of our legal duties about your information
Training our associates about company privacy policies and procedures
How do we use and disclose your information?
We must use and disclose your information:
To you or someone who has the legal right to act on your behalf
To the Secretary of the Department of Health and Human Services
Where required by law.
We have the right to use and disclose your information:
To a doctor, a hospital, or other healthcare provider so you can receive medical care
For payment activities, including claims payment for covered services provided to you by healthcare providers and for health plan premium payments
For healthcare operation activities including processing your enrollment, responding to your inquiries and requests for services, coordinating your care, resolving disputes, conducting medical management, improving quality, reviewing the competence of healthcare professionals, and determining premiums
To your plan sponsor to permit them to perform plan administration functions such as eligibility, enrollment and disenrollment activities. We will not share detailed health information to your plan sponsor unless you provide us your permission or your plan sponsor has certified they agree to maintain the privacy of your information.
To contact you with information about health-related benefits and services, appointment reminders, or about treatment alternatives that may be of interest to you if you have not opted out as described below
To your family and friends if you are unavailable to communicate, such as in an emergency
To your family and friends or any other person you identify, provided the information is directly relevant to their involvement with your health care or payment for that care. For example, if a family member or a caregiver calls us with prior knowledge of a claim, we may confirm whether or not the claim has been received and paid.
To public health agencies if we believe there is a serious health or safety threat
To appropriate authorities when there are issues about abuse, neglect, or domestic violence
In response to a court or administrative order, subpoena, discovery request, or other lawful process
For law enforcement purposes, to military authorities and as otherwise required by law
To assist in disaster relief efforts
For compliance programs and health oversight activities
To fulfill our obligations under any workers’ compensation law or contract
To avert a serious and imminent threat to your health or safety or the health or safety of others
For research purposes in limited circumstances
For procurement, banking, or transplantation of organs, eyes, or tissue
To a coroner, medical examiner, or funeral director.
Will we use your information for purposes not described in this notice?
In all situations other than described in this notice, we will request your written permission before using or disclosing your information. You may revoke your permission at any time by notifying us in writing.
We will not use or disclose your information for any reason not described in this notice without your permission. The following uses and disclosures will require an authorization:
Most uses and disclosures of psychotherapy notes
Sale of protected health information
What do we do with your information when you are no longer a member or you do not obtain coverage through us?
Your information may continue to be used for purposes described in this notice when your membership is terminated or you do not obtain coverage through us. After the required legal retention period, we destroy the information following strict procedures to maintain the confidentiality.
What are my rights concerning my information?
The following are your rights with respect to your information. We are committed to responding to your rights request in a timely manner:
Access – You have the right to review and obtain a copy of your information that may be used to make decisions about you, such as claims and case or medical management records. You also may receive a summary of this health information. If you request copies, we may charge you a fee for each page, a per hour charge for staff time to locate and copy your information, and postage.
Alternate Communications – You have the right to receive confidential communications of information in a different manner or at a different place to avoid a life threatening situation. We will accommodate your request if it is reasonable.
Amendment – You have the right to request an amendment of information we maintain about you if you believe the information is wrong or incomplete. We may deny your request if we did not create the information, we do not maintain the information, or the information is correct and complete. If we deny your request, we will give you a written explanation of the denial.
Disclosure – You have the right to receive a listing of instances in which we or our business associates have disclosed your information for purposes other than treatment, payment, health plan operations, and certain other activities. We maintain this information and make it available to you for a period of six years at your request. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost- based fee for responding to these additional requests.
Notice – You have the right to receive a written copy of this notice any time you request.
Restriction – You have the right to ask to restrict uses or disclosures of your information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement. You also have the right to agree to or terminate a previously submitted restriction.
What types of communications can I opt out of that are made to me?
Treatment alternatives or other health-related benefits or services
How do I exercise my rights or obtain a copy of this notice?
All of your privacy rights can be exercised by obtaining the applicable privacy rights request forms. You may obtain any of the forms by:
Contacting us at 1-855-212-2273 at any time
Accessing our Website at Monogramhealthcare.com and going to the Privacy Practices link
E-mailing us at email@example.com
Send completed request form to:
40 Burton Hills Blvd
Nashville, TN 37215
What should I do if I believe my privacy has been violated?
If you believe your privacy has been violated in any way, you may file a complaint with us by calling us at 1-855-212-2273 any time.
You may also submit a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights (OCR). We will give you the appropriate OCR regional address on request. You also have the option to e-mail your complaint to OCRComplaint@hhs.gov. We support your right to protect the privacy of your personal and health information.
We will not retaliate in any way if you elect to file a complaint with us or with the U.S. Department of Health and Human Services.
We follow all federal and state laws, rules, and regulations addressing the protection of personal and health information. In situations when federal and state laws, rules, and regulations conflict, we follow the law, rule, or regulation which provides greater member protection.
What will happen if my private information is used or disclosed inappropriately?
You have a right to receive a notice that a breach has resulted in your unsecured private information being inappropriately used or disclosed. We will notify you in a timely manner if such a breach occurs.
Multi-Language Interpreter Services
English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call the number on your ID card (TTY: 711).
Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al número que figura en su tarjeta de identificación (TTY: 711).
繁體中文 (Chinese): 注意：如果您使用繁體中文， 您可以免費獲得語言援助服務。 請致電會員卡上的電話號碼（TTY：711）。
Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số điện thoại ghi trên thẻ ID của quý vị (TTY: 711).
한국어 (Korean): 주의 : 한국어를 사용하시는 경우 , 언어 지원 서비스를 무료로 이용하실 수 있습니다 . ID 카드에 적혀 있는 번호로 전화해 주십시오 (TTY: 711).
Tagalog (Tagalog – Filipino): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tawagan ang numero na nasa iyong ID card (TTY: 711).
Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Наберите номер, указанный на вашей карточке-удостоверении (телетайп: 711).
Kreyòl Ayisyen (French Creole): ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele nimewo ki sou kat idantite manm ou (TTY: 711).
Français (French): ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le numéro figurant sur votre carte de membre (ATS : 711).
Polski (Polish): UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Proszę zadzwonić pod numer podany na karcie identyfikacyjnej (TTY: 711).
Português (Portuguese): ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para o número presente em seu cartão de identificação (TTY: 711).
Italiano (Italian): ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero che appare sulla tessera identificativa (TTY: 711).
Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Wählen Sie die Nummer, die sich auf Ihrer Versicherungskarte befindet (TTY: 711).
توجه: اگر به زبان فارسی گفتگو می کنید، تسهیالت زبانی بصورت رایگان برای شما فراھم می باشد.
با شماره تلفن روی کارت شناسایی تان تماس بگیرید 711) .(TTY:
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم الهاتف
الموجود على بطاقة الهوية الخاصة بك (رقم هاتف الصم والبكم: .(711