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, a Texas professional limited liability company, Telehealth Physician Network, P.C., a California professional corporation, and Dennington Physician, PLLC, a New York professional limited liability company, and the employees and health care providers who work at such professional entities (collectively referred to herein as “We” or “Our”). We understand that your medical information is private and confidential. We will share your medical information with one another, as necessary, to carry out treatment, payment or health care operations relating to the services to be rendered. This notice also discusses the uses and disclosures we will make of your medical information. 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 medical information we maintain. You can always request a written copy of our most current medical information privacy notice from 1315 South Adams Street, Fort Worth, Texas 76104 or you can access it on our website at timelycare.com.
PERMITTED USES AND DISCLOSURES. We will use or disclose your medical information 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.
- Treatment means the provision, coordination or management of your health care, including consultations between health care providers relating to your care and referrals for health care from one health care provider to another. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to contact a physical therapist to create the exercise regimen appropriate for your treatment.
- Payment means the activities we undertake to obtain reimbursement for the health care provided to you, including billing, collections, claims management, determinations of eligibility and coverage and other utilization review activities. For example, we may provide your PHI to companies who assist us in obtaining payment for our services. Federal or state law may require us to obtain a written release from you prior to disclosing certain specially protected medical information for payment purposes, and we will ask you to sign a release when necessary under applicable law.
- Health care operations means the support functions of the providers, related to treatment and payment, such as quality assurance activities, case management, receiving and responding to patient comments and complaints, physician reviews, compliance programs, audits, business planning, development, management and administrative activities. For example, we may use your medical information to evaluate the performance of our staff when caring for you. We may also combine medical information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose medical information for review and learning purposes. In addition, we may remove information that identifies you so that others can use the de-identified information to study health care and health care delivery without learning who you are.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION. We may also use your medical information in the following ways:
- To provide appointment reminders for treatment or medical care.
- 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 or friends 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 medical information to notify, or assist in the notification of, a family member, a personal representative, or another person responsible for your care, of your location, 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, we will determine whether a disclosure to your family or friends is in your best interest, taking into account the circumstances and based upon our professional judgment.
- When permitted by law, we may coordinate our uses and disclosures of medical information with public or private entities authorized by law or by charter to assist in disaster relief efforts.
- We will allow your family and friends to act on your behalf to pick-up filled prescriptions, medical supplies, X-rays, and similar forms of medical information, when we determine, in our professional judgment, that it is in your best interest to make such disclosures.
- We may use or disclose your medical information for research purposes, subject to the requirements of applicable law. For example, a research project may involve comparisons of the health and recovery of all patients who received a particular medication. All research projects are subject to a special approval process which balances research needs with a patient’s need for privacy. When required, we will obtain a written authorization from you prior to using your medical information for research.
- In certain cases, we will provide your information to contractors, agents and other parties, such as the onsite/campus medical clinic or counseling center, who may need the information in order to perform a service for us, including, without limitation, Timely Telehealth, LLC, such as obtaining payment for health care services or carrying out business operations. Another example is that we may share your information with an insurance company, law firm or risk management organization in order to maintain professional advice about how to manage risk and legal liability, including insurance or legal claims. However, you should know that in these situations, we require third parties to provide us with assurances that they will safeguard your information.
- We will use or disclose medical information about you when required to do so by applicable law.
- In accordance with applicable law, we may disclose your medical information to your employer if we are retained to conduct an evaluation relating to medical surveillance of your workplace or to evaluate whether you have a work-related illness or injury.
SPECIAL SITUATIONS. Subject to the requirements of applicable law, we may make the following uses and disclosures of your medical information:
- Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or transplantation as necessary to facilitate organ or tissue donation and transplantation.
- Military and Veterans. If you are a member of the Armed Forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
- Worker’s Compensation. We may release medical information about you for programs that provide benefits for work-related injuries or illnesses.
- Public Health Activities. We may disclose medical information about you for public health activities, including disclosures:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to persons subject to the jurisdiction of the 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;
- 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;
- to notify the appropriate government authority if we believe that an adult patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if the patient agrees or when required or authorized by law.
- Health Oversight Activities. We may disclose medical information to federal or state agencies that oversee our activities (e.g., providing health care, seeking payment, and civil rights).
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information subject to certain limitations.
- Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
- 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
- In emergency circumstances, to report a crime, the location of the crime or the victims, or the identity, description or location of the person who committed the crime.
- Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. We may also release medical information about patients to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, other national security activities authorized by law or to authorized federal officials so they may provide protection to the President or foreign heads of state.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
- Serious Threats. As permitted by applicable law and standards of ethical conduct, we may use and disclose medical information if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or is necessary for law enforcement authorities to identify or apprehend an individual.
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. Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization, which authorization may only be revoked in writing.
- We permit you to request restrictions on our uses and disclosures of medical information for treatment, payment and health care operations. However, we are not required to agree to your request. To request a restriction, you may make your request in writing to the Privacy Officer.
- We permit you to reasonably request to receive confidential communications of your medical information by alternative means or at alternative locations. To make such a request, you may submit your request in writing to the Privacy Officer.
- We permit you to inspect and copy the medical information contained in our provider records, subject to certain exceptions under applicable law:
In order to inspect or obtain a copy your medical information, 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 medical information under certain circumstances.
- We permit you to request an amendment to your medical information, subject to certain exceptions under applicable law. 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 medical information, you must submit your request in writing to the custodian of your Medical Records, along with a description of the reason for your request.
- We permit you to request an accounting of disclosures of medical information 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 medical information, 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.
6. We will notify you in the event that there is a breach of your medical information, which requires notification under applicable laws.
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 1-833-484-6359. We will not take action against you for filing a complaint.
CONTACT PERSON. If you have any questions or would like further information about this notice, please contact the Privacy Officer at 1-833-484-6359.
This notice is effective as of March 30, 2021.
Last Updated: August 14, 2023