NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
TeleMed2U is required by law to provide you with this Notice so that you will understand how we may use or share your information from your Designated Record Set. The Designated Record Set includes financial and health information referred to in this Notice as “Protected Health Information” (“PHI”) or simply “health information.” We are required to adhere to the terms outlined in this Notice. If you have any questions about this Notice, please contact the TeleMed2U Privacy Officer.
UNDERSTANDING YOUR HEALTH RECORD AND INFORMATION
Each time you are treated by TeleMed2U, a record of your treatment stay is made containing health and financial information. Typically, this record contains information about your condition, the treatment we provide and payment for the treatment. We may use and/or disclose this information to:
- plan your care and treatment
- communicate with other health professionals involved in your care
- document the care you receive
- educate heath professionals
- provide information for medical research
- provide information to public health officials
- evaluate and improve the care we provide
- obtain payment for the care we provide
Understanding what is in your record and how your health information is used helps you to:
- ensure it is accurate
- better understand who may access your health information
- make more informed decisions when authorizing disclosure to others
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
The following categories describe the ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall into one of the categories.
- For Treatment. We may use or disclose health information about you to provide you with medical treatment. We may disclose health information about you to doctors, nurses, therapists or other health care personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.
- For Payment. We may use and disclose health information about you so that the treatment and services you receive may be billed to you, an insurance company or a third party. For example, in order to be paid, we may need to share information with your health plan about services provided to you.
- For Health Care Operations. We may use and disclose health information about you for our day-to-day health care operations. This is necessary to ensure that all patients receive quality care. For example, we may use health information for quality assessment and improvement activities and for developing and evaluating clinical protocols.
OTHER ALLOWABLE USES OF YOUR HEALTH INFORMATION
- Health-Related Benefits and Services and Reminders. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
- Fundraising Activities. We may use health information about you to contact you in an effort to raise money as part of a fundraising effort. We may disclose health information to a foundation related to TeleMed2U so that the foundation may contact you in raising money for such foundation. We will only release contact information, such as your name, address and phone number and the dates you received treatment or services from TeleMed2U. You may be contacted for fundraising, but you can request not to be contacted for this purpose again.
- Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose health information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care.
- As Required By Law. We will disclose health information about you when required to do so by federal, state or local law.
- To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you to prevent a serious threat to your health and safety or the health and safety of the public or another person. We would do this only to help prevent the threat.
- Organ and Tissue Donation. If you are an organ donor, we may disclose health information to organizations that handle organ procurement to facilitate donation and transplantation.
- Workers' Compensation. We may disclose health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Reporting Public Health and Safety Issues. Federal and state laws may require or permit TeleMed2U to disclose certain health information related to the following:
- Prevention or control of disease
- Reporting suspected abuse, neglect, or domestic violence
- Reporting adverse reactions to medications or problems with products
- Notifying people of recalls of products
- Coroners, Medical Examiners and Funeral Directors. We may disclose medical information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also disclose medical information to funeral directors as necessary to carry out their duties.
- Correctional Institution: If you are an inmate of a correctional institution or under the custody of law enforcement officials, we may disclose to the institution or its agents or law enforcement officials health information necessary for your health and the health and safety of others.
- Miscellaneous: In these cases, we will never share you information, unless you give us written permission: (1) marketing purposes; (2) sale of your information; and (3) most sharing of psychotherapy notes.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Although your health record is the property of TeleMed2U, the information belongs to you. You have the following rights regarding your health information:
- Right to Inspect and Copy. With some exceptions, you have the right to review and copy your health information.
You must submit your request in writing to Privacy Officer, Telemed2U, 3400 Douglas Blvd. Suite #225, Roseville, CA 95661, or by e-mail to firstname.lastname@example.org. We may charge a fee for the costs of copying, mailing or other costs associated with your request.
- Right to Amend. If you feel that health information in your record is incorrect or incomplete, you may ask us to amend the information. You have this right for as long as the information is kept by or for TeleMed2U.
You must submit your request in writing to Privacy Officer, Telemed2U, 3400 Douglas Blvd. Suite #225, Roseville, CA 95661, or by e-mail to email@example.com. In addition, you must provide a reason for your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the health information kept by or for TeleMed2U; or
- Is accurate and complete.
- Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures". This is a list of certain disclosures we made of your health information, other than those made for purposes such as treatment, payment, or health care operations.
You must submit your request in writing to Privacy Officer, Telemed2U, 3400 Douglas Blvd. Suite #225, Roseville, CA 95661, or by e-mail to firstname.lastname@example.org. Your request must state a time period which may not be longer than six years from the date the request is submitted and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you. For example, you may request that we limit the health information we disclose to someone who is involved in your care or the payment for your care. You could ask that we not use or disclose information about a surgery you had to a family member or friend.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information would affect your care.
You must submit your request in writing to Privacy Officer, Telemed2U, 3400 Douglas Blvd. Suite #225, Roseville, CA 95661, or by e-mail to email@example.com. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
- 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. We will say “yes” unless a law requires us to share that information.
- Right to Request Alternate Communications. You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box.
You must submit your request in writing to Privacy Officer, Telemed2U, 3400 Douglas Blvd. Suite #225, Roseville, CA 95661, or by e-mail to firstname.lastname@example.org. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time.
- You may obtain a copy of this Notice at our website, https://www.telemed2u.com.
To obtain a paper copy of this Notice, contact Privacy Officer, Telemed2U, 3400 Douglas Blvd. Suite #225, Roseville, CA 95661, or by e-mail to email@example.com.
- Right to Choose someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will ensure the person has this authority and can act for you before we take any action.
- Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with TeleMed2U or with the Secretary of the Department of Health and Human Services. To file a complaint with TeleMed2U, contact Privacy Officer, Telemed2U, 3400 Douglas Blvd. Suite #225, Roseville, CA 95661, or by e-mail to firstname.lastname@example.org. All complaints must be submitted in writing.
- You can file 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/.
- You will not be retaliated against for filing a complaint.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice on the TeleMed2U website. The Notice will specify the effective date on the first page, in the top right-hand corner. In addition, if material changes are made to this Notice, the Notice will contain an effective date for the revisions and copies can be obtained by contacting the TeleMed2U Privacy Officer, Telemed2U, 3400 Douglas Blvd. Suite #225, Roseville, CA 95661, or by e-mail to email@example.com.