Effective Date: August 6, 2021
Your Information. Your Rights. Our Responsibilities.
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
NOTE THAT WE ARE NOT A HIPAA COVERED ENTITY. WE STRIVE, HOWEVER, TO PROTECT YOUR MEDICAL RECORDS AND KEEP THEM PRIVATE IN ACCORDANCE WITH APPLICABLE LAWS. REFERENCES TO HIPAA ARE RELATED TO OUR ASPIRATIONAL UTILIZATION OF HIPAA’S FRAMEWORK TO GOVERN OUR OPERATIONS.
This Notice of Privacy Practices (the “Notice”) is a summary only. The Notice tells you about the ways we may use and disclose your protected health information (“medical information”) and your rights and our obligations regarding the use and disclosure of your medical information.
Applicable law places requirements on us, and limiters/expanders on the issues discussed in this Notice (including our uses/disclosures), that may not be obvious. For example, HIPAA’s definitions of “marketing” and “sales” and “breach” and “healthcare operations,” and the related restrictions, are technical, include exceptions, and do not apply to all situations you may personally consider to be within those definitions. For instance, if HIPAA allows, we may use/disclose your information for healthcare operations, without your authorization, for purposes you may personally believe to be marketing or sales (but which are not technically “marketing” or “sales” as defined by HIPAA). This notice is not intended to be more restrictive than applicable law unless explicitly noted.
“We” refers to, and this Notice applies to, Telehealth Group PLLC including, respectively, their providers and employees (“Medical Groups”).
1. OUR OBLIGATIONS
We are required by law to maintain the privacy and security of your protected health information (“PHI”). We will notify you promptly if a breach of unsecured PHI occurs that may have compromised the privacy or security of your information, in each case to the extent required by state and federal law. We provide you this Notice explaining our legal duties and privacy practices with respect to medical information about you. We will not use or share your information other than as noted herein unless you tell us we can do so in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
2. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe the different ways that we typically use and disclose medical information, the purposes for such uses and disclosures, and the reasons for such uses and disclosures. As noted below, we may contact you via different methods that you may approve, such as via text message, email, or through your Dermatologist Prescribed account. In most instances, your initial communication with the applicable Medical Group will be through an interaction with the Medical Group through the Dermatologist Prescribed website or app.
Specifically speaking, the applicable Medical Group may communicate with you in the following specific ways:
Email communications - E.g., To obtain information from you necessary to provide services to you, communicate with you about your diagnosis and treatment and provide you with information on special offers and deals
Texts - E.g., To obtain information from you necessary to provide services to you and communicate with you about your diagnosis and treatment
Customer Service Emails, texts, or app notifications - E.g., To provide you with updates on problems with orders, late shipments, and other questions applicable to your provider visit(s)
Tracking emails - E.g., To notify you when prescriptions have been shipped, will arrive, and other confirmations
We typically use or share your health information in these ways:
Treat you. We can use your health information and share it with other professionals who are treating you. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that we believe may be of interest to you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.
Bill for your services. We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes.
Help with public health and safety issues. We can share health information about you for certain situations such as: (i) preventing disease; (ii) helping with product recalls; (iii) reporting adverse reactions to medications; (iv) reporting suspected abuse, neglect, or domestic violence; or (v) preventing or reducing a serious threat to anyone’s health or safety.
Do research. We can use or share your information for health research.
Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests. We can use or share health information about you: (i) for workers’ compensation claims; (ii) for law enforcement purposes or with a law enforcement official; (iii) with health oversight agencies for activities authorized by law; or (iv) for special government functions such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions. We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Quality Assurance and Utilization Review. We may need to use or disclose your medical information for our internal processes to assess and facilitate the provision of quality care to our patients. We may need to use or disclose your medical information to perform a review of the services we provide in order to evaluate whether that the appropriate level of services is received, depending on condition and diagnosis.
Credentialing and Peer Review. We may need to use or disclose your medical information in order for us to review the credentials, qualifications and actions of our health care providers.
Appointment Reminders and Information about Health Related Benefits and Services. We may use and disclose medical information, in order to contact you (including, for example, contacting you by phone and leaving a message on an answering machine) to provide appointment reminders and other information. We may use and disclose medical information to tell you about health-related benefits or services that we believe may be of interest to you. See also the specific types of communications noted above.
Vendors. There are some services (such as billing or legal services) that may be provided to or on behalf of the Medical Groups through contracts with third parties, such as Dermatologist Prescribed Inc, and its subsidiaries. When these services are contracted, we may disclose your medical information to our vendor so that they can perform the job we have asked them to do. To protect your medical information, however, we require the business associate to appropriately safeguard your information.
Other Ways We Can Use/Disclose Information. Applicable law allows for additional uses and disclosures which are not all enumerated and explained above, and we will use/disclose information in any manner allowed by applicable law, including, without limitation, uses and disclosures: made at your request; for appointment reminders; to recommend treatment alternatives and healthcare-related products and services; limited data sets in certain circumstances; to avert a serious threat to health or safety; for certain public health and safety issues; to third party business associates who assist us; to coroners, medical examiners, and funeral directors if death occurs; to aggregate data and de-identify data (at which point it is not subject to HIPAA); sharing within an Organized Healthcare Arrangement we may participate in, within accountable care organizations, regional health information organizations, blue button project, or other health information exchanges (in these situations, there may be an “opt-out” right or other rights you may have); and uses and disclosures that are incidental to other permitted uses and disclosures.
3. OTHER USES OF MEDICAL INFORMATION
Authorizations. There are times we may need or want to use or disclose your medical information for reasons other than those listed above, but to do so we will need your prior authorization. Other than expressly provided herein, any other uses or disclosures of your medical information will require your specific written authorization.
Psychotherapy Notes, Marketing and Sale of Medical Information. Most uses and disclosures of “psychotherapy notes,” uses and disclosures of medical information for marketing purposes, and disclosures that constitute a “sale of medical information” under HIPAA require your authorization. The Medical Groups do not anticipate that they will obtain psychotherapy notes or sale medical information.
Right to Revoke Authorization. If you provide us with written authorization to use or disclose your medical information for such other purposes, you may revoke that authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your medical information for the reasons covered by your written authorization. You understand that we are unable to take back any uses or disclosures we have already made in reliance upon your authorization, and that we are required to retain our records of the care that we provided to you.
4. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
Certain laws and regulations provide you with certain rights regarding the medical information we have about you. The following is a summary of those rights.
Right to Inspect and Copy. Under most circumstances, you have the right to inspect and/or copy your medical information that we maintain in our possession in a designated record set, which generally includes your medical and billing records. To inspect or copy your medical information, you must submit your request to do so in writing to the applicable Medical Group at email@example.com. If you request a copy of your information, we may charge a reasonable, cost-based fee for the costs of copying, mailing, or certain supplies associated with your request. The fee we may charge will be the amount allowed by state law. If your requested medical information is maintained in an electronic format (e.g., as part of an electronic medical record, electronic billing record, or other group of records maintained by the applicable Medical Group that is used to make decisions about you) and you request an electronic copy of this information, then we will provide you with the requested medical information in the electronic form and format requested, if it is readily producible in that form and format within thirty (30) days of your request. If it is not readily producible in the requested electronic form and format, we will provide access in a readable electronic form and format as agreed to by the applicable Medical Group and you within thirty (30) days of your request. In certain very limited circumstances allowed by law, we may deny your request to review or copy your medical information. We will give you any such denial in writing. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the applicable Medical Group will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.
Right to Amend. If you feel the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by the applicable Medical Group. To request an amendment, your request must be in writing and submitted to firstname.lastname@example.org. In your request, you must provide a reason as to why you want this amendment. If we accept your request, we will notify you of that in writing. 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 (i) was not created by us (unless you provide a reasonable basis for asserting that the person or organization that created the information is no longer available to act on the requested amendment), (ii) is not part of the information kept by the applicable Medical Group, (iii) is not part of the information which you would be permitted to inspect and copy, or (iv) is accurate and complete. If we deny your request, we will notify you of that denial in writing within sixty (60) days.
Right to an Accounting of Disclosures. You have the right to request a list of the times we have shared your health information ( an "accounting of disclosures") for six (6) years before the date you ask, who we shared it with, an why. We will include all the disclosures except for those disclosures about Treatment, Payment, or Health Care Operations (as described in this Notice) or disclosures made pursuant to your specific authorization (as described in this Notice), or certain other disclosures.
We will provide one (1) accounting per year for free but will charge a reasonable, cost-based fee if you ask for another accounting within twelve (12) months. 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. To request an Accounting of Disclosures, you must submit your request in writing to email@example.com. Your request must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper or electronically).
Right to Request Restrictions. You have the right to request a restriction or limitation on certain health information we use or disclose about you for Treatment, Payment, or Health Care Operations. We are not obligated to agree to your request, and we may say “no” if it would affect your care. You also have the right to request a restriction or limitation on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. Except as specifically described below in this Notice, we are not required to agree to your request for a restriction or limitation. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment.
In addition, there are certain situations where we won’t be able to agree to your request, such as when we are required by law to use or disclose your medical information. To request restrictions, you must make your request in writing to firstname.lastname@example.org. In your request, you must specifically tell us what information you want to limit, whether you want us to limit our use, disclosure, or both, and to whom you want the limits to apply. As stated above, in most instances we do not have to agree to your request for restrictions on disclosures that are otherwise allowed.
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/allows us to share that information. You should be aware that such restrictions may have unintended consequences, particularly if other providers need to know that information (such as a pharmacy filling a prescription). It will be your obligation to notify any such other providers of this restriction. Additionally, such a restriction may impact whether an insurance company will pay for related care that you may not want to pay for out of pocket (and which would not be subject to the restriction).
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a specific way or to send mail to a different address. For example, you can ask that we only contact you through a personal email address and not at work or, conversely, only at work and not a personal email address. To request such confidential communications, you must make your request in writing to email@example.com. We will not ask the reason for your request, and we will use our best efforts to accommodate all reasonable requests. Your request must specify how and where you wish to be contacted.
Right to an Email or Paper Copy of This Notice. You have the right to a paper copy of this Notice 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. To obtain a copy of this Notice, you must make your request in writing to firstname.lastname@example.org.
Right to Breach Notification. In certain instances, we may be obligated to notify you (and potentially other parties) if we become aware that your medical information has been improperly disclosed or otherwise subject to a “breach” as defined in and/or required by applicable law.
5. YOUR CHOICES
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
If you cannot tell us your preference – for example, if you are unconscious – we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
Sale of your information
Most sharing of psychotherapy notes
We may contact you for fundraising efforts, but you can tell us not to contact you again.
6. CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time, along with our privacy policies and practices. 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, along with an announcement that changes have been made, as applicable, on our website and in any physical office in which the Medical Groups practice medicine. When changes have been made to the Notice, you may obtain a revised copy by writing to email@example.com.
The Medical Groups comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently based on race, color, national origin, age, disability, sex, or other legally enumerated protected classes. We, as necessary, provide free aids and services to people with disabilities to communicate effectively with us, such as: qualified sign language interpreters, written information in other formats (large print, audio, accessible electronic formats, other formats), language services to people whose primary language is not English (e.g., qualified interpreters, information written in other languages). If you need these services, contact the chief compliance officer firstname.lastname@example.org. If you believe that the Medical Groups have failed to provide these services or discriminated in another way based on a protected class, you can file a grievance with the chief compliance officer at email@example.com. You may file a grievance by mail, fax, or email. If you need help filing a grievance, the chief compliance officer is available to help you – email: firstname.lastname@example.org.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
If you believe that your privacy rights as described in this Notice have been violated, you may file a complaint with the applicable Medical Group at email@example.com - please include the word “PRIVACY” in the title of your email.
The Medical Groups will not retaliate against any individual who files a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.
In addition, if you have any questions about this Notice, please contact firstname.lastname@example.org.
LAST UPDATED: MARCH 10, 2023
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