Notice of Privacy Practices

HIPAA NOTICE TEXT:

Your health information is personal. This notice explains how we protect it and the rights you have over it.

1. About this notice

This notice applies to TelevisitMD, its workforce, and the licensed healthcare providers who care for you through TelevisitMD (together, “we”). It describes how we may use and disclose your protected health information (“health information”) — information that identifies you and relates to your health, your care, or payment for your care — and your rights regarding it.

Providers who practice through a separate clinical practice may also give you their own notice. You may receive this notice electronically; you have the right to a paper copy at any time.

2. Our duties

We are required by law to:

• maintain the privacy and security of your health information;
• give you this notice of our legal duties and privacy practices;
• follow the terms of the notice currently in effect; and
• notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.

3. How we use and disclose your health information

For treatment

We use and share your information with the providers involved in your care. *Examples:* your Provider reviews your intake answers to evaluate your injuries; we send referral letters to a physical therapist, orthopedic specialist, imaging center or medical-equipment supplier; we send a prescription to your pharmacy; and we escalate urgent symptoms to in-person care.

For payment

We use and share your information to bill and get paid for the services you receive. *Example:* we prepare your bills and send them to your attorney for payment under your Letter of Protection.

For health care operations

We use and share your information to run our services, improve your care and contact you when necessary. *Examples:* quality and safety reviews, training and compliance checks.

With our business associates

We share information with companies that perform services for us — such as secure forms and electronic signatures, medical records, messaging, secure hosting, billing and documentation tools. They must sign agreements to protect your information and use it only as we permit.

Communications about your care

We may contact you by email, phone or text message about your forms, appointments, records and prescriptions.

4. People involved in your care

Unless you object, we may share information with a family member, friend or other person you identify who is involved in your care or payment for your care, limited to what is relevant to their involvement. If you are not able to tell us your preference — for example, in an emergency — we may share information if we believe it is in your best interest.

5. Other uses and disclosures allowed or required by law

We may use or share your information, within the limits the law sets, to:

• comply with federal, state or local law;
• respond to a court or administrative order, subpoena, discovery request or other lawful process;
• help with public-health and safety issues, such as reporting adverse reactions to medications or preventing disease;
• report suspected abuse, neglect or domestic violence;
• prevent or reduce a serious threat to anyone's health or safety;
• work with health-oversight agencies for audits, investigations, inspections and licensure;
• respond to law-enforcement requests in limited circumstances;
• respond to workers' compensation claims, as the law allows;
• work with a medical examiner, coroner or funeral director;
• respond to organ- and tissue-donation requests;
• support research that meets legal privacy requirements; and
• assist with specialized government functions, such as military, national security and protective services.

6. Uses that require your written authorization

We will also obtain your written authorization before we:

• use or share psychotherapy notes (except in limited cases the law allows);
• use or share your information for marketing purposes; or
• sell your information.

Any other use or disclosure not described in this notice will be made only with your written authorization. You may revoke an authorization at any time by writing to our Privacy Officer. Revocation does not affect uses or disclosures already made in reliance on it. We will not contact you for fundraising.

7. Information with extra protection

Some state and federal laws give additional protection to certain information — for example, mental-health and behavioral-health records, HIV/AIDS and other communicable-disease information, genetic information, and substance-use-disorder treatment records. Where those laws are more protective than HIPAA, we follow them.

If we receive substance-use-disorder treatment records protected by federal law (42 C.F.R. Part 2), we will not use or disclose them in any civil, criminal, administrative or legislative proceeding against you unless you give written consent or a court order and subpoena meeting Part 2 requirements permit it.

8. Your rights

When it comes to your health information, you have the right to:

• Get a copy of your records. Ask to see or get an electronic or paper copy of your medical and billing records. We will respond within 30 days (or as the law otherwise requires) and may charge a reasonable, cost-based fee.
• Ask us to correct your records. If you believe information is incorrect or incomplete, ask us in writing to amend it. We may say “no,” but we will tell you why in writing within 60 days, and you may submit a statement of disagreement.
• Request confidential communications. Ask us to contact you in a specific way (for example, by email only) or at a different address. We will agree to all reasonable requests.
• Ask us to limit what we use or share. Ask us not to use or share certain information for treatment, payment or operations. We are not required to agree, and may say “no” if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will agree unless the law requires us to share it.
• Get a list of those with whom we have shared information. Ask for an accounting of the times we shared your information in the six years before your request, who we shared it with and why — excluding disclosures for treatment, payment and operations, and certain others (such as those you authorized). We provide one accounting a year free of charge and may charge a reasonable, cost-based fee for additional requests within 12 months.
• Get a copy of this notice. You may ask for a paper copy at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights. We will confirm their authority before we act.
• File a complaint if you feel your rights have been violated (see the next section).

To exercise any of these rights, contact our Privacy Officer at hello@televisitmd.com or (470) 369-0476.

9. Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

• Us: contact our Privacy Officer using the details in the last section of this notice.
• The U.S. Department of Health and Human Services, Office for Civil Rights, by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

10. Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The current notice, with its effective date, is always available on this page, and we will provide a copy on request.

11. Privacy Officer contact

Privacy Officer, TelevisitMD
400 Interstate North Parkway, Suite 1125, Atlanta, GA 30339
Email: hello@televisitmd.com
Phone: (470) 369-0476