Consumer Health Privacy Rights Request Form

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If you are a resident of Nevada or Washington, subject to limitations under applicable law, you have certain rights with respect to your personal health information.

To submit a request as an authorized agent for another individual, please email us at privacy@alsac.stjude.org.

For more information about our processing of personal information, visit our U.S. Privacy Notice and our Consumer Health Privacy Notice.

Residents of Nevada or Washington: Please complete the form below.

First name:

Last name:

Email:

Phone:

Address:

City:

ZIP:

State:

As a resident of Nevada or Washington, subject to limitations under applicable law, you have certain rights with respect to your personal health information.

To exercise your rights, check below:

Access my personal health information

Correct my personal health information

Delete my personal health information

Appeal a decision

We do not sell your personal health data in exchange for monetary compensation. We may share your personal health data to provide goods or services in a manner consistent with the purpose for which the personal health data was collected, in accordance with our Consumer Health Privacy Notice. Please visit our U.S. Privacy Notice and our Consumer Health Privacy Notice for more information about your privacy rights and our privacy practices.

Consumer Health Privacy Rights Request Form

Thank you for your request.

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