Request for Protected Health Information

Information Requested

Under the Health Insurance Portability and Accountability Act (“HIPAA”) you have the right to access the protected health information (“PHI”) Adaptive maintains about you in a designated record set. A “designated record set” is a group of records that comprises, among other things, the records used, in whole or in part, by or for the covered entity to make decisions about individuals.

To request your information, please fill out this PDF form completely and follow the instructions in the form.

Questions

Email at privacy@adaptivebiotech.com or mail to:

Adaptive Biotechnologies Corporation
1165 Eastlake Ave E
Seattle, Washington 98109