Data Breach Notifications

Entity Information

  • Type of Organization: Healthcare
  • Entity Name: Test 123
  • Street Address: 122 Large Rd
  • City: Washington
  • State, or Country if outside the US: DC
  • Zip Code: 20001

Submitted By

  • Name: Will K
  • Title: Test
  • Firm name (if different than entity):
  • Telephone Number: 9137087777
  • Email Address: william.krouse@gmail.com
  • Relationship to entity whose information was compromised: Test

Breach Information

  • Total number of persons affected (including residents): 1
  • Total number of Maine residents affected: 1
  • If the number of Maine residents exceeds 1,000, have the consumer reporting agencies been notified: No
  • Date(s) Breach Occured: 09/14/2020
  • Date Breach Discovered: 09/14/2020
  • Description of the Breach:
    • Inadvertent disclosure, Internal system breach
  • Information Acquired - Name or other personal identifier in combination with: Financial Account Number or Credit/Debit Card Number (in combination with security code, access code, password or PIN for the account)

Notification and Protection Services

  • Type of Notification: Written
  • Date(s) of consumer notification: 09/14/2020
  • Copy of notice to affected Maine residents:
  • Date of any previous (within 12 months) breach notifications:
  • Were identity theft protection services offered: No
  • If yes, please provide the duration, the provider of the service and a brief description of the service: