Effective Date: January 12, 2024
Contact for more information: info@mentalhealthtele.com
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.
Notice Summary
Your Rights: You have the right to:
- Get a copy of your health and claims records
- Correct your health and claims records
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we have shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
Your Choices: You have some choices in the way we use and share information as we:
- Answer coverage questions from your family or friends
- Provide disaster relief
- Market our services or disclose information for business use
Our Uses and Disclosures: We may use and share your information as we:
- Help manage the mental health care treatment you receive
- Pay for your health services
- Administer the plan
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with medical examiners or funeral directors
- Address workers’ compensation, law enforcement, and government requests
- Respond to lawsuits and legal actions
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and our responsibilities to help protect them.
Get a copy of your health and claims records:
You can ask to see or get a copy of your health and claims records. We will provide a copy or summary within 30 days of your request. A reasonable, cost-based fee may apply.
Ask us to correct your records:
If you believe any of your records are incorrect or incomplete, you may request a correction. We may deny the request, but we’ll inform you in writing within 60 days.
Request confidential communications:
You may ask us to contact you by a specific method or at a different address. We will accommodate reasonable requests, especially if you believe disclosure could cause harm.
Ask us to limit what we use or share:
You can request limits on how your health information is shared for treatment, payment, or operations. We may not be able to agree if it affects your care or compliance obligations.
Get a list of those with whom we have shared your information:
You may request a list of disclosures (up to 6 years). One annual request is free; additional requests may incur a reasonable, cost-based fee.
Get a copy of this notice:
You may request a paper copy of this Notice of Privacy Practices at any time, even if you agreed to receive it electronically.
Choose someone to act for you:
If someone has medical power of attorney or legal guardianship, that person may act for you regarding your health information. We will verify their authority before taking action.
File a complaint:
If you believe your rights have been violated, you may contact us at info@mentalhealthtele.com or file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at www.hhs.gov. We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your preferences about how we share your data. If you have a specific request, we will follow your instructions whenever legally possible.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, friends, or others involved in your care
- Share information in a disaster relief situation
If you are unable to communicate (e.g., unconscious), we may act in your best interest to ensure your safety or continuity of care.
In these cases, we will never share your information without your written permission:
- Marketing purposes
- Sale of your information
Our Uses and Disclosures
We typically use or share your health information in the following ways:
Help manage the mental health care you receive:
We may use or share your information with mental health professionals involved in your treatment.
Run our organization:
We use your health data to operate our telehealth platform effectively and improve services.
Pay for your health services:
We use and disclose your health information to manage billing, payment, or insurance coordination.
Additional Uses and Disclosures
We are permitted or required by law to share your information in specific cases, including:
-
- Public health and safety purposes (e.g., preventing disease, reporting abuse, or adverse reactions)
- Health research
- Compliance with state or federal laws
- Organ and tissue donation requests
- Medical examiner or funeral director coordination
- Workers’ compensation or law enforcement purposes
- Special government functions (e.g., national security, presidential protection)
- Legal actions or court orders
Our Responsibilities
- We are required by law to protect the privacy and security of your protected health information.
- We will notify you promptly if a breach occurs that may compromise your privacy.
- We must follow the duties and practices described in this notice and provide you with a copy upon request.
- We will not use or share your information beyond what is outlined here unless you authorize it in writing.
Privacy Officer
Please contact our Privacy Officer for any questions or concerns:
[Name, Title]
Mental Health Tele.com
Email: info@mentalhealthtele.com
Changes to This Notice
We may change the terms of this notice at any time. The new notice will apply to all information we have about you and will be made available upon request and on our website.
For more information, visit: www.mentalhealthtele.com
