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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

INTRODUCTION

This Privacy Notice is being provided to you by Telehealth Physician Network, PLLC and the employees and health care providers who work at such professional limited liability company (collectively referred to herein as “We” or “Our”).  We understand that your medical information is private and confidential.  Further, we are required by law to maintain the privacy of “protected health information.” “Protected  health  information” or “PHI” includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care.  We will share protected health information with one another, as necessary, to carry out treatment, payment or health care operations relating to the services to be rendered.

As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of PHI.  This notice also discusses the uses and disclosures we will make of your PHI.  We must comply with the provisions of this notice as currently in effect, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all PHI we maintain.  You can always request a written copy of our most current privacy notice from 2833 Crockett Street, Suite 116, Fort Worth, TX, 76107 or you can access it on our website at www.timely.md.

PERMITTED USES AND DISCLOSURES

We can use or disclose your PHI for purposes of treatment, payment and health care operations.  For each of these categories of uses and disclosures, we have provided a description and an example below.  However, not every particular use or disclosure in every category will be listed.

OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

We may also use your PHI in the following ways:

Note: incidental uses and disclosures of PHI sometimes occur and are not considered to be a violation of your rights.  Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.

SPECIAL SITUATIONS

Subject to the requirements of applicable law, we will make the following uses and disclosures of your PHI:

Note:  HIV‑related information, genetic information, alcohol and/or substance abuse records,  mental health records and other specially protected health information may enjoy certain special confidentiality protections under applicable state and federal law.  Any disclosures of these types of records will be subject to these special protections.

OTHER USES OF YOUR HEALTH INFORMATION

Certain uses and disclosures of PHI will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing purposes; and (c) that constitute a sale of PHI under the Privacy Rule.  Other uses and disclosures of PHI not covered by this notice or the laws that apply to us will be made only with your written authorization.  You have the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we already have taken action in reliance on your authorization.

YOUR RIGHTS

  1. You have the right to request restrictions on our uses and disclosures of PHI for treatment, payment and health care operations.  However, we are not required to agree to your request unless the disclosure is to a health plan in order to receive payment, the PHI pertains solely to your health care items or services for which you have paid the bill in full, and the disclosure is not otherwise required by law.  To request a restriction, you may make your request in writing to the Privacy Officer.
  2. You have the right to reasonably request to receive confidential communications of your PHI by alternative means or at alternative locations.  To make such a request, you may submit your request in writing to the Privacy Officer.
  3. You have the right to inspect and copy the PHI contained in our provider records, except:

(i) for psychotherapy notes, (i.e., notes that have been recorded by a mental health professional documenting counseling sessions and have been separated from the rest of your medical record);

(ii) for information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding;

(iii) for PHI involving laboratory tests when your access is restricted by law;

(iv) if you are a prison inmate, and access would jeopardize your health, safety, security, custody, or rehabilitation or that of other inmates, any officer, employee, or other person at the correctional institution or person responsible for transporting you;

(v) if we obtained or created  PHI as part of a research study, your access to the PHI  may be restricted for as long as the research is in progress, provided that you agreed to the temporary denial of access when consenting to participate in the research;

(vi) for PHI contained in records kept by a federal agency or contractor when your access is restricted by law; and

(vii) for PHI obtained from someone other than us under a promise of confidentiality when the access requested would be reasonably likely to reveal the source of the information.

 

In order to inspect or obtain a copy your PHI, you may submit your request in writing to the custodian of your Medical Records.  If you request a copy, we may charge you a fee for the costs of copying and mailing your records, as well as other costs associated with your request.

We may also deny a request for access to PHI under certain circumstances if there is a potential for harm to yourself or others. If we deny a request for access for this purpose,  you have the right to have our denial reviewed in accordance with the requirements of applicable law.

  1. You have the right to request an amendment to your PHI but we may deny your request for amendment, if we determine that the PHI or record that is the subject of the request:

(i) was not created by us, unless you provide a reasonable basis to believe that the originator of PHI is no longer available to act on the requested amendment;

(ii) is not part of your medical or billing records or other records used to make decisions about you;

(iii) is not available for inspection as set forth above; or

(iv) is accurate and complete.

In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records.  In order to request an amendment to your PHI, you must submit your request in writing to the custodian of your Medical Records, along with a description of the reason for your request.

  1.    You have the right to receive an accounting of disclosures of PHI made by us to individuals or entities other than to you for the six years prior to your request, except for disclosures:

(i) to carry out treatment, payment and health care operations as provided above;

(ii) incidental to a use or disclosure otherwise permitted or required by applicable law;

(iii) pursuant to your written authorization;

(iv) to persons involved in your care or for other notification purposes as provided by law;

(v) for national security or intelligence purposes as provided by law;

(vi) to correctional institutions or law enforcement officials as provided by law;

(vii) as part of a limited data set as provided by law.

To request an accounting of disclosures of your PHI, you must submit your request in writing to the Privacy Officer.  Your request must state a specific time period for the accounting (e.g., the past three months).  The first accounting you request within a twelve (12) month period will be free.  For additional accountings, we may charge you for the costs of providing the list.  We will notify you of the costs involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.

  1.     You have the right to receive a notification, in the event that there is a breach of your unsecured PHI, which requires notification under the Privacy Rule.

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 medical 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 our website. The notice will contain on the first page, in the top right-hand corner, the effective date.

COMPLAINTS

If you believe that your privacy rights have been violated, you should immediately contact the Privacy Officer at[PS2]  800-274-0798.  We will not take action against you for filing a complaint.  You also may file a complaint with the Secretary of the U. S. Department of Health and Human Services.

 

CONTACT PERSON

If you have any questions or would like further information about this notice, please contact the Privacy Officer at 800-274-0798.

This notice is effective as of January 1, 2018