Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO IT. PLEASE REVIEW THIS NOTICE CAREFULLY.
Effective Date: March 14, 2020.
This Telemedicine Notice of Privacy Practices (the “Notice”) is provided to you by Plant Based Telehealth LLC (PBTH), as PBTH or its subsidiaries and affiliated entities may be formed, incorporated, or operating in your state, and on behalf of independently-contracted, lifestyle telemedicine physicians, including your physician (collectively, “Physician”) that work with PBTH. PBTH is not a healthcare entity. It is a management service organization that performs marketing, business, and administrative services on behalf of Physicians. For ease of reference, however, PBTH and these independent physicians are collectively referred to in this Notice as “We” or “Our.” This reference does not and is not intended to imply any physician is an employee of PBTH, or that PBTH is providing or intends to provide medical or medical practice services in any form, all of which are exclusively provided by Physician in Physician’s sole and exclusive discretion.
This Notice contains important information regarding your medical information. You have the right to receive a paper copy of this Notice and may ask Us to give you a copy of this Notice at any time. If you received this Notice electronically, We will still provide a paper copy to you upon request. You can request a paper copy from Our Privacy Officer at (908) 455-8080, or you can access a current version on Our website at https://plantbasedtelehealth.com/privacy-policy/ .
We are committed to protecting medical information about you. We will use it to the minimum extent necessary to accomplish the intended purpose of the use, disclosure or request of it. This Notice provides you with information about your rights and Our privacy practices with respect to your protected health information (“PHI”). This Notice also discusses the uses and disclosures We will make of your PHI. We reserve the right to change the terms of this Notice from time-to-time and to make any revised notice effective for all PHI We then use, have access to, or control.
We can use or disclose your PHI for purposes of treatment, payment, and healthcare operations. The following descriptions may not describe every particular use or disclosure in every category. The purposes of any given use may also vary pursuant to PBTH or Physician’s role. For example, PBTH cannot and will not provide medical advice, diagnosis, or treatment, and therefore will not use your PHI for direct medical purposes. PBTH will use your information, however, for billing or administrative purposes related to your treatment with Physician.
- TREATMENT – the provision, coordination, or management of your healthcare, including consultations between healthcare providers.
- PAYMENT – the activities We undertake to obtain reimbursement for healthcare provided to you, including billing, collections, case management, and other utilization review activities.
- HEALTHCARE OPERATIONS – support functions for Our management services and providers, related to: referral; facilitating the telemedicine connection and visit; care coordination; compliance, training, or quality review programs Physician may institute; treatment; payment; receiving and responding to patient comments and complaints; audits; and other business planning, development, management, legal, and administrative activities.
We may also use your PHI in the following ways:
- To provide appointment reminders and schedule your treatment.
- To tell you about or recommend possible treatment alternatives or other health-related benefits and services that may be of interest to you.
- To your family, personal representative (“PR”), power of attorney, guardian, or any other individual identified by you to the extent directly related to such person’s involvement in your care or the payment for your care. We may use or disclose your PHI to notify, or assist in the notification of, a family member, a PR, or another person responsible for your care, of your general condition or death. If you are available, We will give you an opportunity to object to these disclosures, and We will not make these disclosures if you object. If you are not available, incapacitated, or unable to make informed consent decisions about your healthcare We will determine whether a disclosure to your family or PR is permitted or required by law, in your best interests, taking into account the circumstances, and act based upon Our professional judgment.
- When permitted by law, We may coordinate Our uses and disclosures of PHI with public or private entities authorized by law to assist in disaster relief efforts.
- We will allow your family and friends to act on your behalf, , to pick-up filled prescriptions, when We determine, in Physician’s professional judgment, that it is in your best interest to make such disclosures.
- In certain cases, We will provide your information to contractors, agents, and other parties who need the information in order to perform a service for Us (Our “Business Associates”), including, without limitation, to obtain payment for healthcare services, technology services providers, or carrying out other business operations. In those situations, PHI will be provided to those contractors, agents, and other parties as is needed to perform their contracted tasks. Business Associates will enter into an agreement requiring them to maintain the privacy of the PHI released to them. PBTH and Physician are currently engaged in a business associate agreement.
- We may share your information with a law firm or risk management organization in order to maintain professional advice about how to manage risk and legal liability, including for potential or actual legal claims.
- When required to disclose PHI by applicable law.
- 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.
Subject to the requirements of applicable law, We will make the following uses and disclosures of your PHI:
- Emergencies. In emergencies and as necessary to avoid serious harm or death.
- Organ and Tissue Donation. If you are an organ donor, to organizations handling organ procurement or transplantation and as necessary to facilitate tissue donation and transplantation.
- Military and Veterans. If you are a member of the Armed Forces, as required by military command authorities.
- Public Health Activities. We may disclose PHI about you for public health activities, including disclosures:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report suspected elder or child abuse or neglect in accord with applicable legal obligations;
- to persons subject to the jurisdiction of the U.S. Food and Drug Administration (FDA) for activities related to the quality, safety, or effectiveness of FDA-regulated products or services, and to report reactions to medications or problems with products; or
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- Health Oversight Activities. to federal or state agencies that oversee Our activities.
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, or a guardianship proceeding, We may disclose PHI subject to certain limitations and only to the extent permissible by law.
- Law Enforcement. to a law enforcement request:
- In response to a court order, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime under certain limited circumstances;
- About a death We believe may be the result of criminal conduct;
- About criminal conduct on Our premises or during Our services; or
- In emergency circumstances, to report a crime, the location of the crime or victims, or the identity, description, or location of the person suspected of committing the crime.
- Coroners, Medical Examiners, and Funeral Directors. to a coroner, medical examiner, or funeral director, as necessary for them to carry out their duties.
- National Security and Intelligence Activities. to authorized federal officials for intelligence, counterintelligence, other national security activities authorized by law.
- Inmates. to a correctional institution about a patient in the custody of a law enforcement official as necessary to: (1) provide the patient with healthcare; (2) protect the patient’s health and safety or the health and safety of others; or (3) protect the safety and security of the correctional institution or law enforcement.
- Serious Threats. As permitted by applicable law and standards of ethical conduct, We may use and disclose PHI if we, in good faith, believe the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person.
Certain uses and disclosures of PHI will be made only with your written authorization, including uses or disclosures:
- for marketing purposes; and
- the sale of PHI, as defined by applicable law.
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 and except to the extent We already have taken action in reliance on your authorization.
You have the right to request restrictions on Our uses and disclosures of PHI for treatment, payment, and healthcare operations. We will not agree to your request, however, unless the PHI pertains solely to your healthcare 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.
You have the right to reasonably request to receive confidential communications of your PHI by alternative means or at alternative locations, including electronically. To make such a request, you may submit your request in writing to the Privacy Officer (contact info below).
Exceptions. You have the right to inspect and copy the PHI contained in Physician records, except for:
- Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding;
- PHI involving lab tests or charting when your access is restricted by law; or
- If you are an 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.
Requests. In order to inspect or obtain a copy of your PHI, you may submit your request in writing to the Privacy Officer (contact info below). 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 such as 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.
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:
- 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;
- Is not part of your medical or billing records or other records used to make decisions about you;
- Is not available for inspection as set forth above; or
- 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 Privacy Officer (contact info below), along with a description of the reason for your request.
Upon your request, we will provide you accounting of disclosures of PHI made by Us to individuals or entities other than to you for the six (6) years prior to your request, except for disclosures:
- To carry out treatment, payment, and healthcare operations as provided above;
- Incidental to a use or disclosure otherwise permitted/required by applicable law;
- Pursuant to your written authorization;
- To persons involved in your healthcare or for other notification purposes as provided by law;
- For national security or intelligence purposes as provided by law; or
- To correctional institutions or law enforcement officials 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 year). 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.
You have the right to receive a notification, in the event that there is a breach of your unsecured PHI.
We may use electronic software, services, and equipment, including without limitation email, video conferencing technology, cloud storage and servers, internet communication, cellular network, voicemail, facsimile, electronic health record, and related technology to share PHI with you or third-parties subject to the rights and restrictions in this Notice. In any event, certain unencrypted storage, forwarding, communications and transfers may not be confidential. We will take measures to safeguard the data transmitted, as well as to ensure its integrity against intentional or unintentional breach or corruption. In rare circumstances, however, security protocols could fail, causing a breach of your privacy or PHI.
We reserve the right to change this Notice at any time and for any reason permissible by law. We reserve the right to make the revised Notice effective for PHI and 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 at https://plantbasedtelehealth.com/privacy-policy/ . The Notice will contain the effective date on the first page.
If you believe that your privacy rights have been violated, you should immediately contact the Privacy Officer at email@example.com. 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, where applicable.
If you have any questions or would like further information about this Notice, please contact the Privacy Officer at firstname.lastname@example.org.