Public Website Contact Form
Legacy Home Health uses a Jotform contact form on this website to collect basic inquiry information such as your name, email address, phone number, and a general message. This public website form is intended for initial contact only.
Please do not submit medical records, diagnoses, prescription details, Social Security numbers, insurance member numbers, or other protected health information through this public website form unless Legacy has specifically instructed you to do so through an approved process.
Our Commitment to Patient Privacy
Legacy Home Health is committed to protecting the privacy and security of protected health information in accordance with applicable federal and state requirements. When patient care begins, privacy practices, documentation, and communications may include additional notices, permissions, and operational safeguards appropriate to clinical care.
How Protected Health Information May Be Used
As a healthcare provider, Legacy Home Health may use and disclose protected health information as permitted or required by law for treatment, payment, healthcare operations, care coordination, quality improvement, legal compliance, public health and safety activities, and other authorized or required purposes.
Your Privacy Rights
- Request access to certain health information we maintain
- Request corrections to information you believe is incomplete or inaccurate
- Ask us to communicate with you in a specific confidential way when appropriate
- Request restrictions on certain uses or disclosures when allowed by law
- Request a copy of applicable privacy notices
- File a complaint if you believe your privacy rights have been violated
Our Responsibilities
- Maintain reasonable safeguards to protect protected health information
- Follow applicable privacy and security requirements
- Limit public website collection to general inquiry information
- Update privacy practices and notices when required
- Provide breach notifications when required by law
Jotform and Online Inquiry Collection
Our public website currently uses Jotform only to collect basic contact details and general inquiry messages. According to Jotform's official HIPAA materials, a HIPAA-enabled Jotform account and a Business Associate Agreement are available for covered entities that enable Jotform's HIPAA compliance features. If online collection practices expand beyond general contact information, the form setup should be reviewed and configured accordingly before sensitive health information is collected online.
Questions or Complaints
If you have questions about privacy practices at Legacy Home Health, please contact us at info@lhhservice.com or 801.805.0199.
