HIPAA Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSEDAND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY AND USKNOW IF YOU HAVE ANY QUESTIONS.

I. Our Responsibilities

Edge Health, P.C. (“Author Provider Group”, “we, and “our”) provides you technology-enabled behavioralhealth services via telehealth and in-person services provided in-home or at some other facility orcommunity location through our engaged clinicians and support staff (the “Care Team”), with non-clinicalsupport from our technology partner, Author Health, LLC (“Author”, and together with us, “Author Health”)(collectively, the “Services”). By providing the Services, we have access to “Protected Health Information”or “PHI” (defined below) and act a covered entity, as defined by the Health Insurance Portability andAccountability Act of 1996 and its implementing regulations, as amended from time to time (collectively,“HIPAA”).

We are required by HIPAA to maintain the privacy and security of your PHI and to provide you with noticeof our legal duties, privacy practices and your patient rights. This Notice of Privacy Practices (“Notice”)describes how we may use and disclose your PHI to carry out treatment, payment or health careoperations, and for other specified purposes that are permitted or required by law. The Notice appliesto your PHI that we use and disclose in our role as a covered entity.

We will not use or disclose your PHI other than as described in this Notice unless you expressly authorizeus to do so.

II. Definition of Protected Health Information

PHI is information about you, including your demographic information, that relates to your physical ormental health condition or health care provided to you. PHI can include your medical history, laboratoryresults, insurance information and other health information that is collected, generated, used, andcommunicated to or by Author in course of providing you the Services. Examples of PHI include yourname, date of birth, medical record number, social security number and insurance beneficiary number.PHI includes health information you or your other healthcare providers provide to us.

III. Uses and Disclosures of Your Protected Health Information

Your protected health information may be used and disclosed by our health care providers, our staff, andothers outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to support our business operations, to obtain payment for your care, and anyother use authorized or required by law.

We may use or disclose your PHI for the following purposes:

  • Treatment. We will use and disclose your protected health information to provide, coordinate,or manage your health care and any related services. This includes the coordination ormanagement of your health care with a third party. For example, your protected healthinformation may be provided to any other healthcare provider with whom you have an existingtreatment relationship to ensure the necessary information is accessible to diagnose or treatyou.
  • Payment. Your protected health information may be used to bill or obtain payment for yourhealth care services. For example, we may use or disclose your PHI to your health insurance planto obtain payment and in connection with processing payments for services provided to you.
  • Healthcare Operations. We may use or disclose, as needed, your protected health informationin order to support the business activities of this office. These activities include, but are notlimited to, improving quality of care, providing information about treatment alternatives or otherhealth-related benefits and services, development or maintaining and supporting computersystems, legal services, and conducting audits and compliance programs, including fraud, wasteand abuse investigations.
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    We may also de-identify and anonymize your information such that it is no longer consideredprotected health information or personally identifiable information and as such, will not containany reference to you. In that instance, we may modify or create derivative works which containthis de-identified and anonymized information and may use that information as may benecessary to enhance the services we are providing. In addition, we may use this de-identifiedinformation for non-commercial purposes including but not limited to analytics, research,preparation of case studies and other educational and research related publication and usage.Under no circumstances will we sell or commercially market your information. We may also useand disclose "partially de-identified" health information about you for research, public health orhealth care operations purposes if the person or entity who will receive the information signs anagreement to protect the privacy of the information as required by federal and state law.Partially de-identified health information will not contain any information that would directlyidentify you (such as your name, street address, social security number, phone number, faxnumber, electronic mail address, website address, or license number).

    Individuals Involved in Your Care or Payment for Your Care. We may release PHI about you to a familymember, other relative, or close personal friend who is directly involved in your medical care if the PHIreleased is relevant to such person’s involvement with your care. However, we will not share yourtreatment information to a family member, other relative, or close personal friend without your consentexcept in cases of an emergency. We also may release information to someone who helps pay for yourcare. In addition, we may disclose PHI about you to an entity assisting in a disaster relief effort so thatyour family can be notified about your location and general condition.

    Personal Representatives. We may disclose your PHI to your authorized personal representative, such asyour lawyer, administrator, executor, health care proxy or another authorized person responsible for youor your estate.

    Business Associates. We may disclose your PHI to other companies or individuals, known as “BusinessAssociates,” who provide services to us. For example, we may share your PHI with other companies thatprovide billing services to assist with your care. Our Business Associates are required to protect theprivacy and security of your PHI and notify us of any improper disclosure of PHI.

IV. Uses and Disclosures That Do Not Require Your Consent

We may use or disclose your protected health information in the following situations without your writtenconsent. These situations include the following uses and disclosures: as required by law or regulation; forpublic health purposes; for health care oversight purposes; for abuse or neglect reporting; pursuant toFood and Drug Administration requirements; in connection with legal proceedings; for law enforcementpurposes; to coroners, funeral directors and organ donation agencies; for certain research purposes; forcertain criminal activities; for reporting threats to health and safety; for certain military activity andnational security purposes; for workers’ compensation reporting; relating to certain inmate reporting; andother required uses and disclosures. Under the law, we must make certain disclosures to you upon yourrequest, and when required by the Secretary of the Department of Health and Human Services toinvestigate or determine our compliance with the requirements of HIPAA. State laws may further restrictthese disclosures.

Uses and disclosures that occur incidentally with a use or disclosure described in this Notice areacceptable provided there are reasonable safeguards in place to limit such incidental uses anddisclosures.

V. Uses and Disclosures That Require Your Consent:

Uses and disclosures of PHI for purposes other than those described above (or as otherwise permittedor required by law) will not be made without a written authorization signed by you or your personalrepresentative. Once you sign an authorization, you may revoke it at any time by contacting us, unlesswe have already relied upon it to use or disclose PHI. A revocation of authorization must be submittedto 754 202 2655 at the address provided at the end of this Notice.

We never share your information in the following cases, unless you give us written permission: marketingpurposes; most use and disclosure of psychotherapy notes; and sale of your information.

VI. Your Rights

You have the following rights with respect to your PHI. To exercise any of these rights, please contact ususing the contact information provided at the end of this Notice.

  • Access to PHI. You, or your authorized representative, have the right to access and copy yourPHI maintained by us. You may get your PHI by requesting a copy of your information, in whichcase we may charge you a reasonable fee for the costs of copying, mailing or other supplies thatare necessary to fulfill your request. If we maintain an electronic health record containing yourinformation, you have the right to request that we send a copy of your PHI in electronic formatto you or a third party that you identify. We may deny access to certain information for specificreasons, for example, if the access requested is reasonably likely to endanger the life or safetyof you or another person. If your request for information is denied, you may request that thedenial be reviewed by filing a request at 754 202 2655.
  • Restrictions on Uses and Disclosures. You have the right to request restrictions on our usesand disclosures of your PHI. While we will consider all requests for additional restrictionscarefully, we are not required to agree to a requested restriction except for restrictions on usesor disclosures for the purpose of carrying out payment or health care operations, where youhave made payment to us "out-of-pocket" and in full. If we do agree to a requested restriction,we will not disclose your PHI in accordance with the agreed-upon restriction.
  • Alternative Confidential Communications. You may request that we communicate with youabout your PHI in a specific means or to an alternative postal mail or email address. Your requestmust be in writing and must specify the alternative means or location. We will accommodatereasonable requests for confidential communications. We reserve the right to verify youridentity to confirm the alternative contact and address information.
  • Correct or Update Your Information. If you believe the PHI we maintain about you contains anerror, you may request that we correct or update your information. Your request must be inwriting and must explain why the information should be corrected or updated. We may denyyour request under certain circumstances and provide a written explanation.
  • Accounting of Disclosures. You have the right to receive an accounting of certain disclosuresof your PHI that we have made, paper or electronic, except for certain disclosures which werepursuant to an authorization, for purposes of treatment, payment, healthcare operations (unlessthe information is maintained in an electronic health record), or for certain other purposes. Therequest must be in writing, and the accounting will include disclosures made within the prior six(6) years. The first accounting you request within a twelve (12) month period will be providedfree of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved, and you may choose to withdraw or modify your request at thattime.
  • Copy of Notice. You have the right to obtain a paper or electronic copy of this Notice uponrequest.
  • Choose Someone to Act for You. If you have given someone medical power of attorney or ifsomeone is your legal guardian, that person can exercise your rights and make choices aboutyour PHI. We will make sure that person has this authority and can act for you before we takeany action.
  • File a Complaint. If you believe your privacy rights have been violated or if you disagree with adecision we make about your rights, such as accessing or amending your records, you may filea complaint with us at 754 202 2655 or the Contact information below. If you are not satisfiedwith the manner in which a complaint is handled by us, you may submit a formal complaint tothe Department of Health and Human Services, Office for Civil Rights by sending a letter to 200Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing acomplaint.

VII. Breach Notification

We will notify you if a reportable breach of your unsecured protected health information is discovered.Notification will be made to you no later than 60 days from the breach discovery and will include a briefdescription of how the breach occurred, the protected health information involved and contactinformation for you to ask questions.

VIII. Changes to Our Notice of Privacy Practices

We reserve the right to amend our privacy practices and the terms of this Notice from time to time,provided such changes are permitted by applicable law. When changes are made, we will promptlypost the updated Notice on the Author website at __________ , 2023 or otherwise provided an updatedcopy directly to you.

IX. Questions

If you have any questions or comments about our privacy practices or this Notice, or if you would like amore detailed explanation about your privacy rights, please contact us using the contact informationprovided at the end of this Notice.

X. Contact Information

When communicating with us regarding this Notice, our privacy practices or your privacy rights, pleasecontact us using the following contact information:

  • Call us at: 754 202 2655
  • Mail completed request form to:

    Attn: Author Health
    47 HIGH STREET, #7
    MEDFORD, MA 02155-3808

By signing below, you indicate that you have read and understood this Notice of Privacy Practices, andthat you agree to abide by its terms. Further, you certify that if you are signing as a personalrepresentative of the patient, you have legal authority to provide consent for the treatment of thepatient*

PATIENT NAME: ___________________
NAME OF PERSONAL REPRESENTATIVE (IF ANY): ___________________
RELATIONSHIP TO MEMBER (IF ANY): ___________________
SIGNATURE: ___________________
PATIENT: ☐
PERSONAL REPRESENTATIVE: ☐

DATE:___________________

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*If you are signing this Notice of Privacy Practices on behalf of a patient who is a family member orotherwise under your legal guardianship, you agree to provide, if we make a request, a copy of the mostrecent power of attorney that demonstrates that you have the right to authorize care and treatment forthe patient. If there are any changes in your legal status with respect to the patient, you understand thatit is your responsibility to promptly notify us of any such changes.

*If you wish to report a complaint or grievance, you may contact us at:

Attn: Author Health
47 High Street, #7
Medford, MA 02155-3808
754-202-2655
Compliance@authorhealth.com

You may also contact:

The Florida Department of Health: 850-245-4444
The United States Department of Health and Human Services, Office for Civil Rights
(OCR): OCRComplaint@hhs.gov; 800-537-7697‍