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The knowledge you submit on this type can be used internally for the needs of processing and responding to your request. It might be routed internally so as to discover probably the most acceptable member of employees to deal with your request and your contact info will solely be used to reply to your inquiry for those who point out permission to take action.
As well as, the data submitted could grow to be part of the affected person’s everlasting chart or remedy report at The Emily Program upon their utilization of The Emily Program providers, and this info could also be used within the planning of remedy and care offered to the affected person. On the time the affected person makes use of The Emily Program providers, The Emily Program’s Discover of Privateness Practices and different HIPAA and knowledge privateness and safety insurance policies will apply to the data submitted on this type and to some other info that The Emily Program maintains in regards to the affected person and the care offered to the affected person.