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TERMS AND CONDITIONS
DBA Telmdfirst.com, TELEMED SERVICES (Aquarius Media LLC HEREIN COLLECTIVELY REFERRED TO AS Telmdfirst.com).
These Terms and Conditions Are Our Entire Agreement. These Terms and Conditions, subject to amendment from time to time, represent the entire understanding and agreement between you and Telmdfirst.com with respect to the subject matter of the same, and supersede all other negotiations, understandings and representations (if any) made by and between you and Telmdfirst.com. These Terms and Conditions shall not be construed more strongly against Telmdfirst.com despite Telmdfirst.com responsibility for its preparation. Any updates to these Terms and Conditions will be posted on Telmdfirst.com.
BY PLACING AN ORDER FOR Telmdfirst.com PRODUCTS AND OR ENROLLING IN OUR Telmdfirst.com TELEMED SERVICE. (TELEMED SERVICES) YOU AGREE /ACCEPT AND UNDERSTAND THE TERMS OF THE OFFER BELOW (AGREEMENT – WE URGE YOU TO READ THE TERMS OF OFFER CAREFULLY. WE HAVE THE RIGHT TO REFUSE SERVICE BASED ON LOCAL STATE OR FEDERAL LAWS. WE DO NOT PRESCRIBE CONTROLLED SUBSTANCES. F YOU HAVE ANY QUESTIONS, CALL OUR CUSTOMER SERVICE TEAM AT 888-215-2154.
TELEMED SERVICE MEMBERSHIP
Membership in the Telemed (Tele-Medicine) service is open to individuals who are legal residents of the continental U.S. (excluding Hawaii, Alaska and the U.S. Virgin Islands), who are at least age 18 as of the date of enrollment and have the capacity to enter into a binding contract. The Telemed service is void elsewhere and where prohibited. Telmdfirst.com members gain access to telemedicine service through Telmdfirst.com at very special rates.
AUTOMATIC BILLINGS. As a member of the Telemed Service you will receive exclusive benefits at the recurring term (monthly, quarterly, bi-annually, annually) price disclosed to you and selected by you at the point of purchase. You will continue to be charged each membership cycle you selected for the following cycle (monthly, quarterly, bi-annually, annually) until you contact customer service to discontinue your service or discontinue your service online. Any discontinuation or suspension of the membership service will discontinue future billings. We are unable to provide refunds or credits for the current membership terms. Although, you will have fourteen calendar days from the date of last billing to downgrade any membership term to a shorter term but not less than a monthly term. In such cases any financial adjustments will be made to your selected form of payment. ANY REFUND REQUESTS FOR MEMBERSHIP BILLINGS MUST BE RECEIVED BY US EITHER ONLINE OR BY PHONE WITHIN 24 HOURS OF MEMBERSHIP BILLING FOR THAT CYCLE. EXCEPT A MEMBERSHIP BILLING THAT HAS A TERM LONGER THEN ONE MONTH WILL HAVE 24 HOURS TO REQUEST A FULL REFUND FOR THAT MEMBERSHIP BILLING AND 14 CALENDAR DAYS (FROM THAT BILLING DATE) TO REQUEST A REFUND ON ANY UNUSED FUTURE TERMS LESS THAT MONTH IN THAT BILLING CYCLE.
RECURRING MEMBERSHIP PAYMENTS. All recurring charges will be automatically charged to the credit or debit card you provided upon enrollment Telmdfirst.com is not responsible for any fees or other charges (including, without limitation, overdraft fees charged by your bank) resulting from the charges you have authorized in this Agreement.
USE OF TELEMED SERVICE MEMBERSHIP. Your Telemed membership is non-transferable. You agree that only you and your Immediate Family may use the Telemed membership. Immediate Family means you, your spouse or partner and your children living at your home. Participation in the Telemed service is subject to this Agreement, as well as policies and procedures that Telmdfirst.com may adopt or modify from time to time. Any failure to abide by this Agreement or any policies or procedures implemented by Telmdfirst.com any conduct detrimental to Telmdfirst.com, or any misrepresentation or fraudulent activities in connection with the Telemed service program, may result in termination of membership in the Telemed service program, as well as any other rights or remedies available to Telmdfirst.com. If we suspend or terminate membership for any reason specified in this Section 11, we reserve the right to not refund any fees paid by you.
MODIFICATION OR TERMINATION OF THE TELEMED SERVICE. Your membership in the Telemed service is offered at the discretion of Telmdfirst.com, and it reserves the right to modify these terms and conditions, condition of participation, or any other aspect of the Telemed service, in whole or in part, at any time, with or without notice to you (except as otherwise specified herein).
MONTH TO MONTH SUBSCRIPTIONS: By signing up for a month to month subscription, you are agreeing to a 3 month long commitment. Monthly subscriptions include up to 2 visits per-month and not more than 10 visits per-calendar year. You can cancel your monthly subscription any time after your 3 month long commitment has ended. You may notify us of your intent to cancel at any time. If your cancellation request comes before the completion of your three month commitment, your payment method will automatically be processed until the end of the three month term from the beginning of your subscription and you will not receive a refund for the first three months of payment. If your cancellation request comes after the three month commitment has concluded, your cancellation will become effective at the end of your current monthly billing period. You will not receive a refund for that month; however your subscription access and/or delivery and accompanying subscriber benefits will continue for the remainder of the current monthly billing period. If your cancellation is within the first month of service you will be subject to a one-time visit fee of $79.95.
YEARLY SUBSCRIPTIONS: When cancelling a yearly subscription, all future charges associated with future years of your subscription will be cancelled. You may notify us of your intent to cancel at any time; your cancellation will become effective at the end of your current annual billing period. Annual memberships include up to 10 visits per-year. Additional visits will cost $19 per-visit. You will not receive a refund, prorated or otherwise, for the remainder of the annual term. However, your subscription access and/or delivery and accompanying subscriber benefits will continue for the remainder of the current annual billing period. In order to change or cancel your subscription please contact firstname.lastname@example.org
PRODUCTS AND SERVICES. (1) Telemedicine services consisting of- (a) Free access to nurses by phone, 24/7 (b) Speak with a licensed nurse for guidance or to get started with the clinical intake (c) Receive a call back from a nurse and U.S. Board Certified doctor to conduct the tele-consult. (d) If medically necessary, the nurse will coordinate and help facilitate any orders for prescription medications, lab tests, or imaging studies written by the doctor. (e) 48 hour follow up by licensed Nurse.
LIMITATION ON LIABILITY AND DISCLAIMER OF WARRANTIES. By placing an order and/or participating in the Telemed service, you agree Telmdfirst.com and its owner(s), parent, subsidiaries, affiliates, agents, representatives, and employees will have no liability whatsoever for any injuries, losses, claims, damages or any special, exemplary, punitive, Indirect, incidental or consequential damages of any kind, whether based in contract, tort, strict liability or otherwise, resulting from any use Telemed service or the our service affiliates and partners products and services, any failure or delay by Telmdfirst.com in connection with the Telemed service, the performance or non-performance of the Telemed service by Telmdfirst.com or any other products or services provided by Telmdfirst.com, its licensors, or any other third parties, even if Telmdfirst.com has been advised of the possibility of damages. Telmdfirst.com shall have the right to choose its service partners and affiliate in its sole and absolute discretion. In the event of a disruption in service from a partner or affiliate Telmdfirst.com shall have the right in its sole and absolute discretion to substitute that partner or affiliate with another partner or affiliate. Notwithstanding this disclaimer, if Telmdfirst.com is found liable for any loss or damage which arises out of, or is in any way connected with, any of the occurrences described in this paragraph, then its liability will in no event exceed, in total, the sum of $100.00.
NOTICE OF PRICE CHANGE. As a member of the Telemed service you have the right to receive written notice of all price increases that vary from the amount you previously authorized. If we decide to increase the price, we will notify you by posting it on Telmdfirst.com or via email or via mail and give you an opportunity to cancel your membership before such changes take effect. However, we do reserve the right to lower your membership price at any point in time without notification.
Telmdfirst.com makes no warranty of any kind regarding the Telemed service or the Telmdfirst.com products or services, which are provided on an as is and as available basis. Telmdfirst.com expressly disclaims all warranties, including implied warranties of merchantability, fitness for a particular purpose, title, non-infringement, and those arising by statute or otherwise in law or from a course of dealing or usage of trade. Telmdfirst.com is not responsible or liable for any warranty, representation, or guarantee, express or implied, in fact or in law, relative to the Telemed service or the Telmdfirst.com products and services, including without limitation that the Telemed service or Telmdfirst.com products and services will be error-free, or as to the accuracy, completeness and timeliness of any content or information distributed with respect to the Glue or Telmdfirst.com products and services. SOME STATES DO NOT ALLOW THE LIMITATION OF LIABILITY AND DISCLAIMER OF IMPLIED WARRANTIES, SO THE DISCLAIMERS AND LIMITATIONS ABOVE MAY NOT APPLY TO YOU.
ENTIRE AGREEMENT. This Agreement contains all of the terms of the program, and no representations, inducements, promises or agreements concerning the Telemed service program not included in this Agreement shall be effective or enforceable. If any of the terms of this Agreement shall become invalid or unenforceable, the remaining terms shall remain in full force and effect.
GOVERNING LAW. THIS AGREEMENT AND THE TERMS OF THE TELEMED SERVICE SHALL BE GOVERNED AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF FLORIDA WITHOUT GIVING EFFECT TO THE CHOICE OF LAW PROVISIONS THEREOF.
ARBITRATION. ANY CLAIM OR CONTROVERSY ARISING OUT OF OR RELATING TO YOUR USE OF THE Telmdfirst.com WEB SITE, YOUR MEMBERSHIP IN THE TELEMED SERVICE, YOUR USE OF THE Telmdfirst.com PRODUCTS. OR TO ANY ACT OR OMISSION FOR WHICH YOU MAY CONTEND
In the event of a dispute between you and Telmdfirst.com, you and Telmdfirst.com agree that a prompt and fair resolution, without the time and expense of formal court proceedings, would be in both parties€™ mutual interests. All disputes shall be submitted to final and binding arbitration to be conducted in Orange County, Florida, or a location closest to Orange County, Florida if no such location for the chosen arbitration body exists there. MANDATORY ARBITRATION REPLACES THE RIGHT OF EITHER PARTY TO GO TO COURT AND DEMAND A JURY TRIAL. The party filing the arbitration must choose one of the following three arbitration firms and follow its rules and procedures for initiating and pursuing an arbitration:
American Arbitration Association, 335 Madison Avenue, Floor 10, New York, NY 100174605 (phone: 8007787879) (http://www.adr.org) .National Arbitration Forum, P.O. Box 50191, Minneapolis, MN 554050191 (phone: 8004742371) (http://www.arbforum.com) .JAMS, 1920 Main Street, Suite 300, Irvine, CA 92614 (phone: 9492241810) (http://www.jamsadr.com)
In the event that the selected firm cannot administer the arbitration, the party filing the arbitration will select another of the firms. Each party will bear its own expenses, except that the arbitrator will be entitled to award a different allocation of costs and fees where the arbitrator determines that a filed claim is frivolous. The arbitrator will not have the power to award punitive damages or other damages not measured by the prevailing party€™s actual damages, except as may be required by statute. Any award in arbitration initiated under this clause will be limited to monetary damages and will include no injunction or direction to any party other than the direction to pay a monetary amount, except as required by statute or to comply with the terms of the contract. Any award rendered by the arbitrator will be final and binding upon each of the parties, and judgment thereon may be entered in any court having jurisdiction thereof. The Federal Arbitration Act will govern the interpretation and enforcement of this section. During the dependency of such arbitration and until final judgment thereon has been entered, these Terms and Conditions will remain in full force and effect unless otherwise terminated as provided hereunder. If a provision of this clause is held to be invalid, the remainder of the clause will remain in full force and effect, and, to this end, the provisions of this clause are severable. In the event that any State or Federal court rules that this arbitration provision is defective in whole or part or permits an action to be filed in a State or Federal court then the parties agree to have their dispute heard before a court located nearest to Orange County, Florida. The parties also agree to have any such dispute heard before a Judge and waive any rights to a Trial By Jury.
THAT Telmdfirst.com IS LIABLE, INCLUDING BUT NOT LIMITED TO ANY CLAIM OR CONTROVERSY AS TO ARBITRABILITY (DISPUTE, SHALL BE FINALLY AND EXCLUSIVELY SETTLED BY BINDING ARBITRATION. JUDGMENT UPON ANY AWARD RENDERED BY THE ARBITRATOR MAY BE ENTERED BY ANY STATE OR FEDERAL COURT HAVING JURISDICTION NEAREST TO ORANGE COUNTY FLORIDA THE ARBITRATOR SHALL NOT HAVE THE POWER TO AWARD DAMAGES IN CONNECTION WITH ANY DISPUTE IN EXCESS OF ACTUAL COMPENSATORY DAMAGES AND SHALL NOT MULTIPLY ACTUAL DAMAGES OR AWARD CONSEQUENTIAL, PUNITIVE OR EXEMPLARY DAMAGES, AND EACH PARTY IRREVOCABLY WAIVES ANY CLAIM THERETO. NEITHER YOU NOR USA BENEFITS ADVA NTAGE SHALL BE ENTITLED TO JOIN OR CONSOLIDATE CLAIMS IN ARBITRATION BY OR AGAINST OTHER CONSUMERS OR ARBITRATE ANY CLAIM AS A REPRESENTATIVE OR MEMBER OF A CLASS OR IN A PRIVATE ATTORNEY GENERAL CAPACITY. BOTH YOU AND Telmdfirst.com VOLUNTARILY AND KNOWINGLY WAIVE ANY RIGHT THEY HAVE TO A JURY TRIAL.
ASSIGNMENT. Assignment of Rights and Obligations Under These Terms and Conditions. Telmdfirst.com may assign its rights and obligations pursuant to these Terms and Conditions without prior notice. You may not assign your Membership or your rights or obligations pursuant to these Terms and Conditions.
CANCELLATION POLICY. Cancellation policy – 1) Based on our records If you have not accessed the services of a doctor or provider you may cancel within 24 hours after your initial enrollment into the membership for a full refund. After 24 hours we will discontinue future billing which means you will have access to the services for the remaining term of your membership paid and we will stop future billings. For terms longer than one month after 24hrs from enrollment you will have 14 days from the date of enrollment to request a credit on any unused months remaining in that term. 2) Based on our records If you have accessed the services of a doctor or provider then the 24 hour rule will not apply for refunds and we will discontinue future billings. For terms longer than one month you will have 14 days from enrollment or renewal term to request a credit on any unused months remaining in that term.
COMMUNICATION BETWEEN US. Call Monitoring/Recording/Prerecorded Messaging/Predictive Dialing/Electronic messaging including but not limited to SMS, Text, MMS, Chat, IM, and Email. You understand that Telmdfirst.com may monitor, tape and/or record any conversation that may occur between us. However, Telmdfirst.com is not obligated to do so and it may choose not to do so. You authorize Telmdfirst.com its and its related companies and affiliates to contact you at their discretion by using prerecorded messaging, Predictive Dialing devices, and electronic messaging including but not limited to SMS, Text, MMS, Chat, IM, and Email. If you choose not to be contacted by this method, please contact Member Services.
HIPPA NOTICE OF PRIVACY RIGHTS
Telemedicine HIPAA Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Telemedicine HIPAA Notice of Privacy Practices (the “Notice”) is being provided to you by Aquarius Media, LLC d/b/a TelMDFirst, as that entity or its subsidiaries and affiliated entities may be formed and incorporated in your state, and the employees and practitioners that work at such entity and/or for such practices (collectively referred to herein as “We” or “Our”). It contains important information regarding your medical information. You also 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, you are still entitled to a paper copy of this Notice upon your request. You can request a paper copy of our current Notice from the Privacy Officer at 888-215-2154, or you can access it on our website at telmdfirst.com/terms.
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) imposes numerous requirements on health care practices such as ours, defined as Covered Entities, regarding how certain individually identifiable health information – known as protected health information or “PHI” – may be used and disclosed. We understand that medical information about you and your health is personal. We are committed to protecting medical information about you and will use it to the minimum necessary to accomplish the intended purpose of the use, disclosure or request of it. As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of PHI. This notice also discusses the uses and disclosures we will make of your PHI. 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 PHI we maintain.
PERMITTED USES AND DISCLOSURES:
We can use or disclose your PHI for purposes of treatment, payment, and health care operations. For each of these categories of uses and disclosures, we have provided a description and examples below. However, not every particular use or disclosure in every category will necessarily be listed.
- “Treatment” means the provision, coordination, or management of your health care, including consultations between health care providers, including with skilled nursing, assisted living, short-term rehabilitation, hospital, and other long-term care providers, relating to your care and referrals for health care from one health care provider to another.
For example, an attending physician at the skilled nursing facility where you reside treating you for diabetes may need to know if you have a psychiatric disorder or are taking psychotropic medications because such disorders or medications may have disease-disease or drug-disease interactions with diabetes. In addition, the physician may need to contact another provider for purposes of treating a psychiatric disorder or condition when our providers are not available to provide your care.
- “Payment” means the activities we undertake to obtain reimbursement for the health care provided to you, including billing, claims management, determinations of eligibility and coverage, collections, case management, and other utilization review activities. For example, we may need to provide PHI to your insurance carrier or a party financially responsible for your care in order to determine whether the proposed course of treatment will be covered, to determine appropriate reimbursement, or to obtain payment. Federal or state law may require us to obtain a written release from you prior to disclosing certain specially protected PHI for payment purposes, and we will ask you to sign a release when necessary under applicable law.
- “Health Care Operations” means the support functions for our practice and providers, related to referral, facilitating the telemedicine connection and visit, care coordination, compliance reviews, compliance programs, treatment and payment, quality assurance activities, receiving and responding to patient comments and complaints, provider training, audits, business planning, development, management, legal, and administrative activities. For example, we may use your PHI to evaluate the performance of our provider staff when caring for you. We may also combine PHI about many patients to make clinical qualitative review decisions or decide what additional services we should offer, what services are not needed, and whether certain treatments are effective. We may also disclose PHI for review and educational purposes. In addition, we may remove, or de-identify, information that identifies you so that others can use the de-identified information to study health care, conduct research, collect population health data, and determine methods for improved health care delivery without learning who you are.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:
We may also use your PHI in the following ways:
- To provide appointment reminders and schedule your availability with partner skilled nursing staff for 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, 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 personal representative, 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 health care we will determine whether a disclosure to your family or personal representative 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 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 and similar forms of PHI, when we determine, in our professional judgment, that it is in your best interest to make such disclosures.
- We may use or disclose your PHI 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 PHI for research.
- 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 (“Business Associates”), including, without limitation, obtaining payment for health care 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 are required to enter into an agreement maintaining the privacy of the protected health information released to them under certain terms and conditions required of them by state and federal law.
- 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, in these situations, we require third parties to provide us with assurances that they will safeguard your information under terms and conditions required by applicable state and federal law. • We will use or disclose PHI about you when required to do so by applicable law, only to the extent necessary to meet such a requirement.
- In accordance with applicable law, we may disclose your PHI to your employer if we are retained to conduct an evaluation of whether you have a work-related illness or injury. You will be notified of these disclosures by your employer or the provider as required 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:
- Involuntary patients: Information regarding patients who are being treated involuntarily, pursuant to law, will be shared with other treatment providers, legal entities, third party payors and others, as necessary to provide the care and management coordination needed in compliance with state and federal law.
- Emergencies: In life threatening emergencies, we will disclose information necessary to avoid serious harm or death.
- Organ and Tissue Donation. If you are an organ donor, we may release PHI 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 PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
- Worker’s Compensation. We may release PHI about you for programs that provide benefits for work-related injuries or illnesses.
- Public Health Activities. We may disclose PHI about you for public health activities, including disclosures: o 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 PHI to federal or state agencies that oversee our activities (e.g., providing health care, seeking payment, integrity agreements, audits, and civil rights).
- 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: We may release PHI 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
- 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 PHI to a coroner or medical examiner. We may also release PHI about patients to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities: We may release PHI 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 PHI 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 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 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. CONFIDENTIALITY OF MENTAL HEALTH, HIV, ALCOHOL, AND DRUG ABUSE PATIENT RECORDS PHI related to your mental health, psychotherapy notes, HIV, genetic information, alcohol and/or substance abuse records, and other specially protected health information may enjoy certain heightened confidentiality protections under HIPAA and applicable state and federal law. Any disclosure of these types of records will be subject to these special provisions. In the case of psychotherapy notes (i.e., notes that have been recorded by a mental health professional documenting counseling sessions and have been separated from the rest of your medical record) and alcohol and/or substance abuse records, the confidentiality of such PHI maintained by us is protected by federal law and regulations. Generally, we may not say to a person outside the facility you reside in where our care occurs that you attend psychotherapy or alcohol and/or substance abuse treatment, or disclose any information identifying you as receiving psychotherapy, or as an alcohol or drug abuser, unless:
- The patient consents in writing
- The disclosure is allowed by a court order; or
- The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation. Violation of federal law and regulations by a alcohol and/or substance abuse program is a crime. Suspected violations may be reported to appropriate authorities in accordance with federal regulations. Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime.
Disclosure may be made concerning any threat made by a patient to commit imminent physical violence against another person to the potential victim who has been threatened and to law enforcement. Federal law and regulations do not protect any information about suspected child or elder abuse or neglect from being reported under applicable state law to appropriate state or local authorities. When you sign a release of information regarding your psychotherapy notes and alcohol and/or substance abuse, or an authorization, it may later be revoked, provided that the revocation is in writing. The revocation will apply, except to the extent we have already taken action in reliance thereon.
OTHER USES OF YOUR HEALTH INFORMATION:
Certain uses and disclosures of PHI will be made only with your written authorization, including uses and/or disclosures:
- of psychotherapy notes (where appropriate, as described above)
- for marketing purposes; and
- that constitute a sale of PHI under the Privacy Rule. 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, except to the extent that 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 health care operations. However, we are not required to agree to your request unless the disclosure is to a health plan in order to receive payment, the PHI pertains solely to your health care 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. You have the right to inspect and copy the PHI contained in our provider records, except for:
- psychotherapy notes, (i.e., notes that have been recorded by a mental health professional documenting counseling sessions and have been separated from the rest of your medical record); • information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding
- PHI involving laboratory tests when your access is restricted by law;
- if you are a prison 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;
- if we obtained or created PHI as part of a research study, your access to the PHI may be restricted for as long as the research is in progress, provided that you agreed to the temporary denial of access when consenting to participate in the research;
- PHI contained in records kept by a federal agency or contractor when your access is restricted by law; and
- PHI obtained from someone other than us under a promise of confidentiality when the access requested would be reasonably likely to reveal the source of the information. In order to inspect or obtain a copy of your PHI, you may submit your request in writing to the Privacy Officer or Medical Records Custodian. 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 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 Medical Record Custodian, along with a description of the reason for your request. You have the right to receive an accounting of disclosures of PHI made by us to individuals or entities other than to you for the six years prior to your request, except for disclosures:
- to carry out treatment, payment and health care operations as provided above;
- incidental to a use or disclosure otherwise permitted or required by applicable law; • pursuant to your written authorization;
- to persons involved in your care or for other notification purposes as provided by law; • for national security or intelligence purposes as provided by law;
- to correctional institutions or law enforcement officials as provided by law;
- as part of a limited data set 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). The first accounting you request within a twelve (12) month period will be free. For additional accountings within twelve (12) months of the first request, 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. You have the right to receive a notification, in the event that there is a breach of your unsecured PHI, which requires notification under the Privacy Rule.
NOTICE REGARDING USE OF TECHNOLOGY:
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 (“Technology”) to share PHI with you or third-parties subject to the rights and restrictions contained herein. 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 ensure its integrity against intentional or unintentional breach or corruption. However, in very rare circumstances security protocols could fail, causing a breach of privacy or PHI.
CHANGES TO THIS NOTICE:
We reserve the right to change this Notice at any time, for any reason permissible by law. We reserve the right to make the revised or changed 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 http://www.meditelecare.com/NOPP and provide copies to the facilities we provide care at. The Notice will contain on the first page, in the top right-hand corner, the effective date.
If you believe that your privacy rights have been violated, you should immediately contact the Privacy Officer at 888-215-2154. 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.
If you have any questions or would like further information about this Notice, please contact the Privacy Officer at 888-215-2154 This notice is effective as of January 1, 2022.
What personal data (excluding PHI) we collect and why we collect it:
When visitors leave comments on the site we collect the data shown in the comments form, and also the visitor’s IP address and browser user agent string to help spam detection.
An anonymized string created from your email address (also called a hash) may be provided to the Gravatar service to see if you are using it. The
Media (excluding PHI)
If you upload images to the website, you should avoid uploading images with embedded location data (EXIF GPS) included.
If you leave a comment on our site you may opt-in to saving your name, email address and website in cookies. These are for your convenience so that you do not have to fill in your details again when you leave another comment. These cookies will last for one year.
If you visit our login page, we will set a temporary cookie to determine if your browser accepts cookies. This cookie contains no personal data and is discarded when you close your browser.
When you log in, we will also set up several cookies to save your login information and your screen display choices. Login cookies last for two days, and screen options cookies last for a year. If you select “Remember Me”, your login will persist for two weeks. If you log out of your account, the login cookies will be removed.
If you edit or publish an article, an additional cookie will be saved in your browser. This cookie includes no personal data and simply indicates the post ID of the article you just edited. It expires after 1 day.
Embedded content from other websites
Articles on this site may include embedded content (e.g. videos, images, articles, etc.). Embedded content from other websites behaves in the exact same way as if the visitor has visited the other website.
If you leave a comment, the comment and its metadata are retained indefinitely. This is so we can recognize and approve any follow-up comments automatically instead of holding them in a moderation queue.
For users that register on our website (if any), we also store the personal information they provide in their user profile (PHI) is not stored in your user profile. All users can see, edit, or delete their personal information at any time (except they cannot change their username). Website administrators can also see and edit that information.
What rights you have over your website data (This include website data only, for HIPPA privacy notice please read above).
If you have an account on this site, or have left comments, you can request to receive an exported file of the personal data we hold about you, including any data you have provided to us. You can also request that we erase any personal data we hold about you. This does not include any data we are obliged to keep for administrative, legal, or security purposes.
CONSENT TO TREATMENT
You have the right, as a patient, to be informed about your condition and recommended therapeutic of diagnostic procedures to be used so that you may make the decision whether or not to undergo any suggested treatment or procedures after being informed of the ricks and benefits involved.
General Consent to Treatment.
You have the right, as a patient, to be informed about Your condition and recommended therapeutic or diagnostic procedures to be used so that You may make the decision whether or not to undergo any suggested treatment or procedure after being informed of the risks and benefits involved.
This consent provides our providers network and its healthcare providers (“Providers”) your permission to perform reasonable and necessary examinations, testing and treatment for You and continues until You revoke it in writing. You have the right at any time to discontinue Healthcare Services.
You understand that the practice of medicine, practice of dentistry and practice of veterinary medicine is not an exact science and that diagnosis and treatment may involve risk of injury or even death. You understand that there are risks and benefits when receiving health care services. You understand that when You receive care, the risks and benefits of such care will be explained You and You will have the opportunity to ask Providers questions about such risks and benefits (and we encourage You to ask such questions). Unless otherwise discussed by your Provider, Services rendered by Providers are not intended to replace your primary care medical services.
You have disclosed all your known health conditions, allergies and medications You are taking, including herbal medications/supplements. You understand that certain treatment options that You may receive from or medications prescribed to You by your Provider can be dangerous and may result in medical care that is unnecessary if You have misrepresented your current health care condition and status. You have truthfully supplied information about your health care condition and status when answering any questions either on Platform or during any examination with a Provider.
Consent to remote treatment:
I hereby consent to remote diagnosis, treatment and education by TelMDFirst and it’s affiliates through the use of synchronous and asynchronous audio and video communication commonly known as telehealth or telemedicine technology (collectively, telehealth technology). I acknowledge that dianosis, treatment and education through the use of telehealth technology will involve collecting information, including protected health information. I acknowledge my health information will be transmitted, stored and reviewed in compliance with applicable laws. I acknowledge that while telehealth technology may improve access to care and treatment outcomes, as with any technology facilitated diagnosis, treatment and/or education, there are risks and results cannot be guaranteed. The risks associated with telehealth technology include, and are not limited to, technical problems and equipment malfunctions that may results in omission, loss or compromise of information necessary for my diagnosis, treatment or education and that such omission, loss or compromise of information may result in my injury or death. I understand it is my responsibility to clearly explain symptoms, medical/surgical history and allergies, and to provide any other information as needed for your treatment plan.
I acknowledge that diangosis, treatment and education using telehealth technology requires my health information, including PHI to be transmitted through audio and video technology and that my health information may be lost, compromised and/or accessed by unauthorized persons during transmission. I understand that I have a right to withhold or withdraw my consent to the use of telehealth technology in the course of my care at any time, and that doing so may terminate my treatment.
You authorize TelMDFirst and Providers providing You care to share information pertaining to health care services you receive with other individuals for treatment, payment and health care operations purposes. This authorization shall include allowing TelMDFirst and the Providers providing You care to release information pertaining to your treatment to TelMDFirst’s affiliates. By scheduling a visit using our HIPPA compliant forms or signing this Agreement, You acknowledge that this statement is Your Informed Consent to Treat, and that You have read and understand this Consent, and voluntarily request a Provider to perform reasonable and necessary examination, testing and treatment for You.