DRAFT — pending legal review. HIPAA prescribes specific required content for this notice. Not reviewed by counsel. Do not rely on it.

Notice of Privacy Practices

Issued by [AFFILIATED PROFESSIONAL ENTITY, P.C.]  ·  Effective [DATE]

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.

This is a different document from our Privacy Policy. The Privacy Policy covers information collected through the website, including waitlist emails. This notice covers protected health information ("PHI") created when a clinician treats you, and is governed by HIPAA. If the two ever conflict as to PHI, this notice controls.

Who this notice applies to

This notice is issued by [AFFILIATED PROFESSIONAL ENTITY, P.C.] and the licensed clinicians practicing through it ("we," "us"), who are responsible for your clinical care.

[LEGAL ENTITY NAME] ("OH!") provides technology and administrative support to the professional entity and acts as its business associate under HIPAA. OH! is contractually bound to protect your PHI on the same terms described here.

Our legal duties

We are required by law to maintain the privacy of your PHI, to give you this notice describing our legal duties and privacy practices, to notify you following a breach of unsecured PHI, and to follow the terms of the notice currently in effect.

How we may use and disclose your health information without your authorization

Treatment

To provide, coordinate, and manage your care. For example, your clinician reviews your intake to determine whether treatment is appropriate, and shares your prescription with the dispensing pharmacy.

Payment

To bill and collect payment for services. For example, sharing the minimum necessary information with a payment processor.

Health care operations

For quality assessment, clinician review, training, compliance, and administration of the practice.

Business associates

We disclose PHI to vendors who perform functions on our behalf — including OH!, our pharmacy partner, and our records platform — each under a written business associate agreement requiring them to safeguard it.

As required or permitted by law

Uses that always require your written authorization

We will never do any of the following without your separate, signed authorization:

  • Sell your PHI.
  • Use your PHI for marketing where we receive payment from a third party.
  • Share psychotherapy notes, except as narrowly permitted by law.
  • Use your PHI for advertising or ad targeting.

You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Your rights

You have the right to:

To exercise any of these rights, email privacy@getoh.co.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us at privacy@getoh.co, or with the U.S. Department of Health and Human Services, Office for Civil Rights, at 200 Independence Avenue SW, Washington, DC 20201, or at hhs.gov/ocr/complaints.

We will not retaliate against you for filing a complaint. Ever. Your care will not be affected.

Changes to this notice

We may change this notice and make the new terms effective for all PHI we maintain, including information created before the change. The current notice will always be posted here with its effective date.

Contact

Privacy Officer
[AFFILIATED PROFESSIONAL ENTITY, P.C.]
[MAILING ADDRESS]
privacy@getoh.co