This Notice of Privacy Practices (Notice) is being provided to you on behalf of TeleMed2U Inc., and the Telemedicine Group Professional Corporations (collectively referred to herein as “we” or “our”) and describes how your medical information may be used and disclosed and how you can access this information.
Your Rights Regarding Protected Health Information (PHI)
1. An electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your medical record and PHI. Most PHI is available in your Member Portal; however, you may also request the records in writing. Mail your written request to: TeleMed2U, Inc., Attn: Records Request, 3400 Douglas Blvd., Suite 225, Roseville, CA 95661 or by sending an email to firstname.lastname@example.org.
- TeleMed2U, Inc. will provide your health information, usually within 30 days of your request. A fee may be imposed for mailing the records as well as for the labor involved in producing the records.
2. Changes in your medical record
- You can ask us to change or correct PHI that you think is incorrect or incomplete. All requests must be submitted in writing with a reason to support the changes requested. TeleMed2U may deny this request, and any denial will be sent a reply in writing. Mail your written request to: TeleMed2U, Inc., Attn: Records Request, 3400 Douglas Blvd., Suite 225, Roseville, CA 95661 or by sending an email to email@example.com.
3. Request confidential communications
- You can request TeleMed2U to contact you in a specific way or to send mail to a different address. We will accommodate all reasonable requests. This request for alternative communication must be made in writing to: firstname.lastname@example.org.
4. Request to restrict sharing information
- You have the right to request TeleMed2U, Inc. not to use or share PHI for treatment, payment, or our operations. If restricting information sharing will affect your care, TeleMed2U may decline the request. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
- You also have the right to request that TeleMed2U, Inc. restrict its disclosures of PHI to only certain individuals involved in your care or the payment of your care. However, if TeleMed2U, Inc. agrees to comply with your request, it will be bound by such agreement, except when otherwise required by law or in the event of an emergency.
- You must submit your request in writing to TeleMed2U, Inc., and TeleMed2U, Inc. is not required to comply with your request. Mail your written request to: TeleMed2U, Inc., Attn: Records Request, 3400 Douglas Blvd., Suite 225, Roseville, CA 95661 or by sending an email to email@example.com.
- TeleMed2U is a Participant in Manifest MedEx (MX), a Health Information Exchange that facilitates the electronic sharing of health information between healthcare providers to support better-informed, safer healthcare.You may choose not to have your health information shared through MX by opting-out. However, doing so means MX will not make your health information available to any healthcare providers, even in circumstances of emergency. If you would like to opt-out of MX, please complete and submit the online opt-out form at https://www.manifestmedex.org/opt-out or call 1 (800) 490-7617.
- Opt-out provisions are not applicable to Patient Data which providers or health plans share to support authorization of services to patients, where those patients have already been informed of such sharing by a provider or health plan Notice of Privacy Practices.
5. Disclosures Request
- You may request an account of the times your health information has been shared for six years prior to the date you ask, who it was shared with, and why it was whared.
- TeleMed2U, Inc. will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such disclosures at your request). Your first accounting will be free of charge. However, TeleMed2U may charge you for the costs involved in fulfilling any additional request made within a period of 12 months. To make a request for an accounting of disclosures, mail your written request to: TeleMed2U, Inc., Attn: Records Request, 3400 Douglas Blvd., Suite 225, Roseville, CA 95661 or by sending an email to firstname.lastname@example.org.
6. Request a written copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. To obtain a paper copy of this notice, please contact the Privacy Officer by writing to: TeleMed2U, Inc., Attn: Privacy Officer, 3400 Douglas Blvd., Suite 225, Roseville, CA 95661 or by sending an email to email@example.com.
7. Choose someone to act for you
- If you designated someone as a medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- TeleMed2U, Inc. will verify the person has this authority and can act for you before any actions are taken.
8. File a complaint if you feel your rights are violated
- You may file a complaint if you feel your rights have been violated by contacting us at TeleMed2U, Inc. You must submit a statement in writing to: TeleMed2U, Inc., Attn: Privacy Officer, 3400 Douglas Blvd., Suite 225, Roseville, CA 95661 or by sending an email to firstname.lastname@example.org. TeleMed2U, Inc. will not retaliate against you for filing a complaint.
- If you feel your privacy rights have been violated, you may submit a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
Uses and Disclosures of PHI
TeleMed2U, Inc. may use or disclose health information in the following ways:
TeleMed2U, Inc. can use your PHI and share it with other professionals who are involved in your care.
- Organizational Operations
TeleMed2U, Inc. can use and share your health information to run our practice, improve your care, and contact you when necessary.
- Billing for services or payment
TeleMed2U, Inc. can use and share your health information to bill and get payment from health plans or other entities.
TeleMed2U, Inc. is permitted to use and disclose your health information upon your written authorization, to the extent such use or disclosure is consistent with your authorization. You may revoke an authorization at any time.
- Public health and safety issues
TeleMed2U, Inc. can share health information about you for certain situations such as: disease prevention, product recalls, adverse event reporting, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety. If your provider perceives you may be at risk of causing serious bodily harm to yourself or another person, they may contact your emergency contact or emergency services.
- As required by the law
TeleMed2U, Inc. will share information about you if state or federal laws require it.
- Organ and tissue donation requests
TeleMed2U, Inc. can share health information about you with organ procurement organizations.
- Medical examiner or funeral director
TeleMed2U, Inc. can share health information with a coroner, medical examiner, or funeral director when an individual dies for purposes such as identification, determining the cause of death and fulfilling duties relating to decedents.
- Workers’ compensation
TeleMed2U, Inc. may disclose your PHI to the extent necessary to comply with workers’ compensation programs and other similar programs relating to work-related illnesses or injuries.
- Government requests
TeleMed2U, Inc. can use or share health information about you:
- With a law enforcement official
- With health oversight agencies or for authorized activities such as audits, investigations, inspections, licensing and disciplinary actions relating to the healthcare system or government benefit programs.
- For special government functions such as military, national security, presidential protective services, or intelligence and national security purposes.
- Lawsuits and legal actions
TeleMed2U may share PHI about you in response to a court or administrative order, or in response to a subpoena.
- Notification of breach
TeleMed2U, Inc. will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
Changes to the Terms of this Notice
TeleMed2U, Inc. can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon written request and on our website.