SQUARE FARE
NOTICE OF PRIVACY PRACTICES, HIPAA NOTICE
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices is mandated by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). It describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition; related health care services; or related to the past, present, or future payment for the provision of health care to you.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. Any such new notice will be effective for all protected health information that we maintain at that time. Upon your request, you may obtain any revised Notice of Privacy Practices by calling us and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next visit. You acknowledge receipt of this notice by accepting Terms & Conditions for using the Services provided by Square Fare.
1. Uses and Disclosures of Protected Health Information
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION BASED UPON YOUR WRITTEN CONSENT
Your protected health information may be used and disclosed by Square Fare and its affiliates (collectively, “Square Fare”) and others outside Square Fare that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed as necessary to otherwise support the operation of Square Fare.
Set forth below are examples of the types of uses and disclosures of your protected health care information that Square Fare is permitted to make. These examples are not meant to be exhaustive, but rather to describe for you the types of uses and disclosures that may be made by Square Fare,
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the normal business activities of Square Fare. Examples of these activities include, but are not limited to, creation of custom meal plans, creation of custom meal recommendations, quality assessment activities, employee review activities, training, licensing, and conducting or arranging for other business activities.
We also may need to share your protected health information with certain of our “business associates” or other third parties that perform various activities (e.g., providing nutrition recommendations, software development) for Square Fare. Whenever an arrangement between Square Fare and a business associate involves the use or disclosure of your protected health information, we will have in place the legally required safeguards to protect the privacy of your health information.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION BASED UPON YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke your authorization, at any time, in writing, except to the extent that Square Fare has taken an action in reliance on the use or disclosure indicated in the authorization.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT
There are other circumstances in which we may have to use or disclose your protected health information, even without your consent or authorization. These situations include:
Disclosure Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a government agency that is collaborating with the public health authority.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements; or to conduct post marketing surveillance, as required.
Legal or Administrative Proceedings or Investigations: We may disclose protected health information in the course of any judicial or administrative proceeding or investigation, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process or request.
Law Enforcement: We may disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include requests: (1) pursuant to legal processes or as otherwise required by law; (2) for limited information for identification and location purposes; (3) pertaining to potential victims of a crime; (4) relating to suspicion that a death has occurred as a result of criminal conduct; (5) in the event that a crime occurs at Square Fare; or (6) relating to a medical emergency (not at Square Fare) and it is necessary to alert law enforcement regarding a potential crime.
Research. We may use or disclose your protected health information without your consent or authorization if an Institutional Review Board or Privacy Board approves a waiver of authorization for such disclosure.
Information Not Personally Identifiable. We may use or disclose your protected health information in ways that do not personally reveal your identity.
2. Your Rights
Set forth below is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that Square Fare uses regarding your care.
Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. In some circumstances, you may have a right to review a decision that denies you access to information. Please contact our Privacy Contact if you have questions about access to your health information.
You have the right to request a restriction on the use or disclosure of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of healthcare operations.
You have the right to request to receive confidential communications of your protected health information from Square Fare by alternative means or at an alternative location. We will accommodate reasonable requests. We also may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make such requests in writing to our Privacy Officer.
You may have the right to have Square Fare amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. Please contact our Privacy Contact below if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right does not apply to all disclosures; in particular, it does not apply to disclosures for purposes necessary to carry out healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you. The right to receive this information is subject to additional exceptions, restrictions and limitations. We also are required to notify you following a breach of your health information, if that information is unsecured.
3. Electronic Communications
You may always contact us at team@getsquarefare.com and choose to communicate with us electronically. However, we warn you that we can make no guarantee that the email will be or will remain encrypted during the data transfer, and that there may be some level of risk that the information in the email could be read by a third party. By communicating with us via email, and, especially by making a request(s) to receive your information via unencrypted email, you acknowledge that you are aware that email is not a secure method of communication, and that you agree to the risks.
4. Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Contact of your complaint. We will not retaliate against you or you for the filing of such a complaint.
You may reach our Privacy Officer at Square Fare, 260 18 street, Brooklyn, NY 11215 or contact us at team@getsquarefare.com, and we can provide further information about this Notice and the policies and procedures set forth herein.
Last Updated: April 23, 2021