Moore-Gate Technology LLC

2 East Main Street, Suite 220
Brookside, NJ 07926

Contact: info@moore-gate.net
312-999-0087

Your Information.
This notice describes how medical information about how
your information may be used and disclosed and how you can get access to this information. Please review it carefully.

You have the right to:

Get a copy of your paper or electronic medical record

Correct your paper or electronic medical record

Request confidential communication

Ask us to limit the information we share

Get a list of those with whom we've shared your information

Get a copy of this privacy notice
Choose someone to act for you

File a complaint if you believe your privacy rights have been violated

You have some choices in the way that we
use and share information as we:

Provide disaster relief 
Include you in a hospital directory 

Provide mental health care 
Market our services and sell your information

We may use and share your information as we:

Treat you
Run our organization
Bill for your services

When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you.

• Get an electronic or paper copy of your medical record
• Ask us to correct your medical record
• Request confidential communications
• Ask us to limit what we use or share
• Get a list of those with whom we've shared information
• Get a copy of this privacy notice
• Choose someone to act for you

You can ask to see or get an electronic or paper copy of your medical record and
other health information we have about you. Ask us how to do this.

We will provide a copy or a summary of your health information, usually within 30
days of your request. We may charge a reasonable, cost-based fee.

You can ask us to correct health information about you that you think is incorrect
or incomplete. Ask us how to do this.

We may say “no” to your request, but we'll tell you why in writing within 60 days.

You can ask us to contact you in a specific way (for example, home or office phone)
or to send mail to a different address.

We will say “yes” to all reasonable requests.

You can ask us not to use or share certain health information for treatment,
payment, or our operations. We are not required to agree to your request, and we
may say “no” if it would affect your care.

lf you pay for a service or health care item out-of-pocket in full, you can ask us not to
share that information for the purpose of payment or our operations with your health
insurer. We will say “yes” unless a law requires us to share that information.

You can ask for a list (accounting) of the times we've shared your health information
for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and
health care operations, and certain other disclosures (such as any you asked us to
make). We'll provide one accounting a year for free but will charge a reasonable,
cost-based fee if you ask for another one within 12 months.

You can ask for a paper copy of this notice at any time, even if you have agreed to
receive the notice electronically. We will provide you with a paper copy promptly.

If you have given someone medical power of attorney or if someone is your legal
guardian, that person can exercise your rights and make choices about your health
information.

We will make sure the person has this authority and can act for you before we take
any action.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting us using the
information on page 1.

You can file a complaint with the U.S. Department of Health and Human Services
Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W.,
Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/
privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

For certain health information, you can tell us your choices about what
we share. If you have a clear preference for how we share your information in the
situations described below, talk to us. Tell us what you want us to do, and we will follow
your instructions.

In these cases, you have e Share information with your family, close friends, or others involved in your care
both the right and choice, Share information in a disaster relief situation
to tell us to:

Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious,
we may go ahead and share your information if we believe it is in your best interest.
We may also share your information when needed to lessen a serious and imminent
threat to health or safety.
In these cases we never e Marketing purposes
share your information
unless you give us
written permission: e Most sharing of psychotherapy notes

Sale of your information

In the case of fundraising: We may contact you for fundraising efforts, but you can tell us not to
contact you again.

Our Uses and How do we typically use or share your health information?

Disclosures We typically use or share your health information in the following ways.

Treat you We can use your health information and : Example: A doctor treating you for an
share it with other professionals who are : injury asks another doctor about your
treating you. : overall health condition.

We can use and share your health : Example: We give information about you
services information to bill and get payment from : to your health insurance plan so it will pay
health plans or other entities. : for your services.

How else can we use or share your health information? We are allowed or required to share your
information in other ways — usually in ways that contribute to the public good, such as public health and research.
We have to meet many conditions in the law before we can share your information for these purposes. For more
information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health We can share health information about you for certain situations such as:
and safety issues Preventing disease

Helping with product recalls

Reporting adverse reactions to medications

Reporting suspected abuse, neglect, or domestic violence

Preventing or reducing a serious threat to anyone’s health or safety

Comply with the law We will share information about you if state or federal laws require it,
including with the Department of Health and Human Services if it wants to
see that we're complying with federal privacy law.

Respond to organ and We can share health information about you with organ procurement or tissue donation requests organizations.

Work with a medical We can share health information with a coroner, medical examiner, or funeral
examiner or funeral director director when an individual dies.

Address workers’ We can use or share health information about you:

compensation, law For workers’ compensation claims

enforcement, and other For law enforcement purposes or with a law enforcement official
government requests With health oversight agencies for activities authorized by law

For special government functions such as military, national security, and
presidential protective services
Respond to lawsuits and e We can share health information about you in response to a court or
legal actions administrative order, or in response to a subpoena.
 

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security
of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in
writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you
change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you.
The new notice will be available upon request, in our office, and on our web site.

Effective Date: December 23, 2023

This Notice of Privacy Practices applies to the following organizations.

Moore-Gate Technology LLC