Data Subject Request Form
Itamar Medical Ltd. and its affiliates value the privacy rights of individuals. As required under applicable privacy legislation and data protection laws, including without limitations, the EU General Data Protection Regulation (“GDPR”), the Health Information Portability and Accountability Act of 1996 as amended by the Health Information Technology for Economic and Clinical Health Act (Title XIII of the American Recovery and Reinvestment Act of 2009), and their implementing rules and regulations codified at 45 C.F.R. Parts 160 and 164 (“HIPAA”), the California Consumer Privacy Act (“CCPA”) and Israeli Protection of Privacy Law, 5741 – 1981 (“Israeli Privacy Law”) (collectively, “Privacy Regulations”), individuals have certain rights regarding the processing of their personal data (which for the purposes of this form shall include protected health information (as such information is categorized under HIPAA), depending on the applicable jurisdiction).
In order to submit a data subject request (“DSR”) pursuant to the applicable Privacy Regulations, please complete and send this form to our privacy team at: email@example.com. Upon receipt of the DSR, we will process and respond within the timelines required by Privacy Regulations. If additional information is necessary, we will contact you using the contact information you provided in this form.
e-signature and time stamp: The Company shall record the individuals’ submission by an e-signature feature (or similar technology) to enable the Company to obtain a time-stamped, unfalsifiable record of the request.
Automatic Response and Confirmation: It is recommended that the Company send an automatic response via email to the data subject confirming the receipt by the Company of the form. In the event the individual sent the request via email and they did not include a form, the Company should respond with an email requesting that the data subject fill in the form (i.e., send an email with a link to the form and request that the individual fill it in and submit it to the Company). The response email should also be documented and time-stamped.