NOTICE OF PRIVACY PRACTICES

Protected Health Information (PHI)

EFFECTIVE DATE: January 1, 2025
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

CardioAI is committed to protecting the privacy of your health information. We are required by law to:

2. How We May Use and Disclose Your Health Information

A. Treatment

We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. This includes consultation between healthcare providers regarding your care and referrals to other healthcare providers.

Example: Our AI-powered diagnostic system may share your cardiac imaging results with your cardiologist to develop a treatment plan. We may share your cardiovascular risk assessment with specialists involved in your care.

B. Payment

We may use and disclose your health information to obtain payment for services we provide. This includes billing, collections, claims management, and determinations of eligibility and coverage.

Example: We may submit claims to your health insurance company that include information about your cardiac monitoring services, diagnostic tests, and treatment received.

C. Healthcare Operations

We may use and disclose your health information for our healthcare operations, including:

Example: We may use your anonymized health data to improve our AI algorithms, train our cardiac care team, or evaluate the effectiveness of our cardiovascular risk prediction models.

D. Other Permitted and Required Uses and Disclosures

We may also use and disclose your health information without your authorization in the following circumstances:

Purpose Description
As Required By Law When federal, state, or local law requires disclosure
Public Health Activities To prevent or control disease, injury, or disability; report births, deaths, suspected abuse or neglect
Health Oversight Activities To authorized health oversight agencies for audits, investigations, inspections, and licensure
Judicial & Administrative Proceedings In response to court orders, subpoenas, or discovery requests
Law Enforcement To law enforcement officials for specific law enforcement purposes
Coroners, Medical Examiners, Funeral Directors For identification purposes, cause of death determinations, or funeral arrangements
Organ & Tissue Donation To organizations involved in procurement, banking, or transplantation
Research For research purposes when approved by an Institutional Review Board or Privacy Board
Serious Threat to Health or Safety To prevent or lessen a serious and imminent threat to health or safety
Military & Veterans If you are a member of the armed forces or veteran
Workers' Compensation For workers' compensation or similar programs
Specialized Government Functions For national security, intelligence activities, protective services, or correctional institutions

3. Your Rights Regarding Your Health Information

A. Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information that may be used to make decisions about your care. This includes medical and billing records. To request access, submit a written request to our Privacy Officer. We may charge a reasonable fee for copying and mailing costs.

B. Right to Amend

If you believe your health information is incorrect or incomplete, you may request an amendment. Requests must be made in writing and include a reason supporting your request. We may deny your request if the information:

C. 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. This does not include disclosures for treatment, payment, healthcare operations, or disclosures made with your authorization.

D. 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 the case where the disclosure is to a health plan for payment or healthcare operations purposes and the information pertains solely to a healthcare item or service for which you have paid out-of-pocket in full.

E. 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. For example, you may request that we contact you at home rather than work, or via mail rather than phone.

F. Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time, even if you have agreed to receive it electronically. You may request a copy from our Privacy Officer or download it from our website.

G. Right to Notification of a Breach

You have the right to be notified in the event that we (or a Business Associate) discover a breach of your unsecured health information.

4. Uses and Disclosures Requiring Your Written Authorization

Other than as described in this Notice, we will not use or disclose your health information without your written authorization. The following uses and disclosures require your authorization:

You may revoke any authorization you provide at any time by submitting a written revocation to our Privacy Officer. The revocation will not affect any uses or disclosures already made in reliance on your authorization.

5. Our Responsibilities

We are required by law to:

Security Measures

We implement appropriate physical, technical, and administrative safeguards to protect your health information, including:

6. Changes to This Notice

We reserve the right to change this Notice and to make the revised or changed 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 website and in our facility. The Notice will contain the effective date on the first page.

7. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.

How to File a Complaint:

With CardioAI:

With the Federal Government:

Contact Information

Privacy Officer: HIPAA Compliance Officer

Organization: CardioAI

Address: [Insert Your Address]

Phone: (614) 356-7890

Email: privacy@cardioailive.com

Website: www.cardioailive.com

Office Hours: Monday - Friday, 9:00 AM - 5:00 PM EST

8. Acknowledgment of Receipt

I acknowledge that I have received a copy of CardioAI's Notice of Privacy Practices.

Patient/Legal Representative Name (Print):

Signature:

Date:

If signed by legal representative, please indicate relationship to patient: