COMING SOON!
NOTICE OF PRIVACY PRACTICES
Effective Date: [Insert Date, e.g., August 2, 2026]
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. [1, 2, 3, 4]
1. Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your Protected Health Information (PHI). We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices described in this Notice while it is in effect. [1, 2, 3, 4, 5]
2. How We May Use and Disclose Your Health Information
We may use and disclose your PHI for treatment, payment, and healthcare operations without your explicit written authorization: [1, 2, 3]
For Treatment: We may disclose your PHI to a physician, nurse, or other healthcare provider providing clinical treatment to you via our telehealth platform, or to a pharmacy to fulfill your prescriptions. [1, 2, 3, 4, 5]
For Payment: We may use and disclose your PHI to bill and collect payment from you, your insurance company, or third-party payers for the medical services you received. [1, 2, 3, 4, 5]
For Healthcare Operations: We may use your PHI to support our business activities, such as quality assessment reviews, internal auditing, clinician performance evaluations, and licensing compliance. [1, 2, 3, 4, 5]
Other Permitted Uses and Disclosures Without Your Authorization
As Required by Law: We will disclose PHI when required to do so by federal, state, or local authorities.[1, 2, 3, 4]
Public Health Risks: We may disclose PHI to public health authorities to prevent or control disease, injury, disability, or child abuse and neglect. [1, 2, 3, 4, 5]
Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose PHI in response to a court or administrative order, subpoena, or discovery request. [1, 2, 3, 4]
Law Enforcement: We may release PHI if asked by a law enforcement official for law enforcement purposes, such as identifying a suspect or fugitive. [1, 2, 3]
3. Uses and Disclosures That Require Your Written Authorization
Your explicit written authorization is strictly required for: [1, 2]
Marketing: Most uses and disclosures of PHI for marketing communications.
Sale of PHI: Any disclosure that constitutes a sale of your protected health information.
Psychotherapy Notes: Most uses and disclosures of psychotherapy notes, if applicable to our services. [1, 2, 3, 4, 5]
Note: You may revoke an authorization in writing at any time, but it will not affect any actions we took before you revoked it. [1, 2, 3]
4. Your Individual Rights Regarding Your PHI
You possess the following statutory rights regarding the health information we maintain about you:
Right to Inspect and Copy: You have the right to look at and obtain an electronic or paper copy of your medical records and billing records.
Right to Amend: If you feel that the clinical or personal information we have about you is incorrect or incomplete, you may request an amendment in writing. We may deny your request under specific legal criteria.
Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI for purposes other than treatment, payment, or healthcare operations.
Right to Request Restrictions: You have the right to request a restriction on the PHI we use or disclose about you. We are not required to agree to your request, except if you request that we not disclose PHI to your health plan for payment purposes and you have paid for the service entirely out-of-pocket.
Right to Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location (e.g., via a specific secure email or phone number).
Right to a Paper Copy: You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically. [1, 2, 3, 4, 5]
5. Breach Notification
In the event of any unauthorized acquisition, access, use, or disclosure of your unencrypted PHI that compromises its security or privacy, we will notify you directly in accordance with federal HIPAA Breach Notification Rules. [1, 2, 3, 4]
6. Complaints
If you believe your privacy rights have been violated, you may file a formal complaint with us or with the Secretary of the U.S. Department of Health and Human Services (HHS). [1, 2, 3]
No Retaliation: We will not penalize or retaliate against you in any way for filing a complaint. [1, 2, 3]
7. Contact Information
To exercise any of your rights or to file a complaint with our organization, please contact our Privacy Officer: