User Agreement

USER AGREEMENT

Please read these terms carefully. These terms include important limitations on your legal rights, including under the headings "Important Disclaimers," "Limitation of Liability," "Indemnification" and "Dispute Resolution."

This is a binding agreement between First Stop Health, LLC ("FSH," also referred to as "we," "us" or "our") and any person who has indicated their assent hereto by clicking an "I agree" button or by accessing or establishing a connection to the Services. You agree to abide by all of the provisions of this agreement in order to remain an authorized user of the Website and Services. If you do not agree to the provisions of this agreement or are not satisfied with the Services, your sole and exclusive remedy is to discontinue your use of the Services.

The terms and conditions of our vendors with respect to use of their products and services, including all third-party providers of content on the Website, are incorporated by reference herein. Your acceptance of this agreement indicates your assent to be bound by those terms.

ACCESS TO THE WEBSITE AND SERVICES

To access any part of http://fshealth.com (the "Website"), any other software or electronic resources, or any advisory services that may be provided by independent providers who have contracted with FSH (any of the foregoing including the Website, the "Services"), you are asked to provide registration information. It is a condition of your use of the Services that all the information you provide is correct, current, and complete. If FSH believes the information you provide is inaccurate or intended for purposes other than becoming a bona fide member of FSH, FSH may terminate or suspend your access to the Services and you will not be entitled to a refund in that event. FSH has sole discretion to accept or reject the username that you select.

The Website and Services are not intended to be used for medical emergencies or urgent care needs. If you think you have an emergency, you should always call 911.

The Services do not include the provision of medical evaluation, diagnosis, treatment or care by FSH. FSH provides you with access to health information from trusted sources and human resources who help facilitate your interactions with medical caregivers. FSH may partner with and provide you with access to independent medical professionals, including doctors ("Independent Doctors") who are solely responsible for their medical services.

You agree that FSH may, without prior notice for any reason or no reason, immediately terminate your account and access to the Services. You agree that all terminations for cause shall be made in FSH's discretion and that FSH shall not be liable to you or any third-party for any termination of your account. In the event of termination other than for misuse or fraud, FSH will provide you with reasonable means to acquire the information you have stored within the Services and will provide the appropriate party with a pro rata refund of payments made by you or a third party on your behalf.

PAYMENT OF MEMBERSHIP FEES; FREE TRIALS AND OFFERS

Except for free trials or other complimentary offers we may make from time to time to allow you to evaluate the Services as a "Trial Member," access to the Services requires payment of a membership fee and any applicable taxes (the "Charges"). The price of membership is stated at the time of purchase, and is due and payable in full at the time a membership is commenced. This section sets for other terms and conditions of payment.

If you have an individual or family membership, you acknowledge that you will pay FSH the Charges where enrollment has been made using your credit card, whether by you personally or by someone else in your household or organization on your behalf. By paying for membership with a credit card, you certify to FSH that you are at least 18 years of age and that you are the cardholder of the credit card, or that you are certifiably at least 13 years of age and expressly authorized by the cardholder to enroll in the Services. You further acknowledge that your obligation to pay the Charges does not depend on use of the Services, and that you remain obligated to pay FSH for the Services regardless of whether or not the Services are used. Unless you enroll as part of a free trial or other complimentary offer, your obligation to pay the Charges begins on the date of your membership registration, not the date of your first use of the Services. Free trial or complimentary offers to use the Services also begin on the date of registration and not on the date of first use of the Services.

This agreement, other than payment obligations, applies to Trial Members during any trial or complimentary period offered by FSH.

If you obtained your membership through a promotional code, you must comply with the terms of that promotion. You agree not to disclose your promotional code to other persons. FSH reserves the right to cancel a membership redeemed through a promotional code if we determine that the user of the promotional code was not the intended recipient of that code. We also reserve the right to seek compensation from individuals who share or disseminate their promotion codes or passwords contrary to this policy.

If you obtained your membership through an organization your continued use of the Service is governed by the terms of our agreement with your organization.

MEMBERSHIP

You are a member if you, a family member, an organization with which you are affiliated (employer, union, association, etc.,) or any third party is paying for you to use Services on the Website.

One of the memberships available from us is a family membership. A family membership may include up to a total of eight registered members all of whom must be related in one of the following ways: marriage, civil union, domestic partnership, and child or parent relationship. Siblings or friends living together do not qualify. Children up to age 26 may be covered by their parents. Any misuse of the family membership will result in immediate termination and a charge to cover repayment for all actual costs (which are substantially higher than our subscription rates) for consults made by unauthorized parties or which are outside our terms and conditions.

Some of our plans include an unlimited number of consults when an Independent Doctor determines that the call is appropriate. If an Independent Doctor believes that any member is abusing the system for any reason she will report that to us. Examples of abuse include making calls that have no medical purpose, calling repeatedly for the same ailment, and attempting to obtain inappropriate prescription medicines through fraudulent misrepresentations. In such cases we may in our sole discretion terminate your membership immediately or alternately limit the calls you may make to us. No refunds or credits will be due to you as the result of such a termination. The Independent Doctors are prohibited by state and federal laws from prescribing a variety of drugs. These include almost all pain killers, diet drugs, mood stabilizers, sleeping pills, psychoactive drugs, and stimulants. In states that require a prescription for pseudoephedrine, Independent Doctors will not provide these prescriptions. See the DEA's list of drugs that may not prescribed via telemedicine.

Additionally, Independent Doctors, as a matter of policy, will not prescribe lifestyle drugs such as Viagra (erectile dysfunction), Chantix (tobacco cessation), Propecia (hair regrowth) and certain other drugs that they believe require direct examination or supervision.

Please see our prescription policy at https://www.fshealth.com/prescription-policy/ for details. Failure to prescribe any drug shall not be grounds for termination of your agreement with us nor shall it entitle you to a refund of any kind.

If you acquired your membership through an organization, we may have a contract with that organization that includes additional or overriding terms to these conditions. Please consult with your organization for details.

AUTOMATIC RENEWAL OF MEMBERSHIP

If you have an individual or family membership, your membership will renew automatically on the last business day prior to the end of the current term (the "Renewal Date"). You must cancel membership prior to its Renewal Date to avoid incurring further charges. Membership renewal will be charged at the membership price in effect on the Renewal Date (not including any special offers that may be valid for new members or other specific groups), which may be higher than the price in effect during the previous term. Your credit card will be automatically charged unless you have notified FSH in accordance with Section 4 that you wish to cancel the membership.

If you obtained your membership through an organization your renewal and ability to use the Service following your termination will be governed by the terms of our agreement with your organization.

CANCELLATION

If you have an individual or family membership, you may cancel your membership during any free trial or complimentary offer without charge. You may also cancel a membership at any other time during its term. However, FSH does not prorate any Charges upon termination or cancellation and does not refund any such amounts for any term already charged.

You may cancel your account for the Services by completing and submitting a cancellation form at here or calling Customer Service at +1 (888) 691-7867. We strongly recommend that you use the cancellation form, as telephone calls are accepted only during business hours and may result in delays of cancellation. You may also send a certified letter, return receipt requested, to First Stop Health, Attention: Cancellation, 222 N. Columbus Drive, Suite D, Chicago, IL 60601 and your cancellation will be effective upon receipt. Communications other than the foregoing, including notifying your credit card company or bank that you no longer wish to be a member, will not serve as valid means of cancellation.

If you obtained your membership through an organization your cancellation will be governed by the terms of our agreement with your organization.

Your Electronic Health Record ("EHR") shall remain available to you notwithstanding your cancellation of a paid membership. If FSH intends to delete your EHR, it shall provide you with reasonable advance notice, at the last e-mail address provided by you, and afford you the opportunity to download its contents.

PRIVACY

FSH's Privacy Policy, located at http://www.fshealth.com/privacypolicy, describes FSH's collection and use of your personal and other information. The Privacy Policy is part of this agreement and you explicitly consent to FSH's use of your personal information as described therein.

RESTRICTIONS ON USE

You may search, retrieve, access, display, download and print content from the Website only for your personal, non-commercial use. Use of the Services is limited to registered and authorized users. In the case of a family membership, the managing member may use the Services on behalf of other members enrolled in the family membership only. You may not use the Services for any other purpose. You may not, for example, (i) modify, publish, distribute, transmit, systematically download, use automated means (including so called "crawlers," "bots" and "spiders") to index or extract data from, participate in the transfer or sale or rental of, translate, create derivative works from, frame, co-brand, or in any way exploit any part of the Services other than for personal use or as specifically permitted in this agreement, without FSH's written consent, (ii) transfer or resell your access to the Services to any third party, or (iii) use the Services in any harmful manner or interfere with any party's use or enjoyment of the Services. You agree to cooperate with FSH in causing any unauthorized use of the Services to immediately cease.

Any party seeking permission for systematic access (automated queries, meta-search, etc.) should contact FSH using this form here.

OWNERSHIP

The material accessible within the Services, including text, data, images, interfaces and other materials or works of authorship (collectively, the "Content"), is owned or licensed by FSH. FSH and its licensors own all right, title and interest in and to the Services and Content, including all copyrights, trademarks and other intellectual property rights. Content may not be copied, distributed, republished, uploaded, posted, or transmitted in any way without the prior written consent of FSH, except that you may print out limited portions of the Content solely for your personal use. You may not remove or alter, or cause to be removed or altered, any copyright, trademark, trade name, service mark, or any other proprietary notice or legend appearing on any of the Content.

RECORDINGS

All calls to physicians for both informational and diagnostic purposes are recorded and made available to the calling member via their internal member dashboard. Calls may be reviewed for customer service, data collection, and quality control purposes. All members' information, including recordings, are considered to be Personal Health Information (PHI) and are covered by FSH's privacy policy.

CONTENT SUBMISSIONS

You retain ownership of all text, photos, graphics, or other material submitted or communicated to FSH through the Website or the Services for inclusion in your electronic health record. All information contained in your EHR will be maintained in confidence in accordance with our privacy policy. With respect to all other content you may provide on the site (e.g., blogs, comments, etc., collectively referred to as "User Generated Content"), you also retain ownership of this material. You hereby grant to FSH the royalty-free, perpetual, irrevocable, worldwide, non-exclusive right and license to use, reproduce, modify, adapt, publish, translate, create derivative works from, distribute, perform, and display, and to incorporate any User Generated Content in other works in any form, media, or technology now known or later developed. FSH will not be required to treat any User Generated Content as confidential, and may use it in its business (including without limitation, for products or advertising) without incurring any liability for royalties or other payment. FSH shall not be liable as a result of any similarities between User Generated Content and future FSH operations. You represent to FSH that you own or otherwise possess all necessary rights to use the User Generated Content for the purposes provided.

You may not post, send, submit, publish, or transmit in connection with the Services any material that (i) you do not have the right to post, including proprietary material of any third party, (ii) advocates illegal activity or discusses an intent to commit an illegal act, (ii) is vulgar, obscene or threatening, (iv) libels, defames, or invades the privacy of other users, (v) does not pertain directly to the subject matter of the Services or advertises another product or service, includes programs that contain viruses, worms, or any other malicious computer code, or (vi) contains hyperlinks to other sites that contain content that falls within the descriptions set forth above.

FSH reserves the right to monitor use of the Website to determine compliance with this agreement, as well the right to remove or refuse User Generated Content for any reason. Notwithstanding these rights, you remain solely responsible for the content of User Generated Content.

EXTERNAL LINKS

The Website may contain hyperlinks to other websites that are not owned or operated by FSH. These links are provided for your convenience, and FSH may receive commissions or other financial compensation from the owners of these websites. Hyperlinks are to be accessed at your own risk. FSH has no control over other websites and is not liable for any content, advertising, products, services or other materials on or available from those websites. Nonetheless, we wish to provide the best possible experience for our users, and we therefore invite feedback about any websites that are linked from within the Services.

DIGITAL MILLENNIUM COPYRIGHT ACT ("DMCA") NOTICE TO COPYRIGHT OWNERS

FSH owns, protects and enforces copyrights in its own creative material and respects the copyrights of others. Materials may be made available on the Services, or via the Services, by third parties not within the control of FSH. It is our policy not to permit materials known by us to be infringing to remain on this Website.

In accordance with the Digital Millennium Copyright Act, or "DMCA" (summary here), you should notify us promptly if you believe any materials displayed within the Services infringe your copyright. Regardless of whether we are liable for such infringement, our response may include removing or disabling access to material claimed to be infringing activity and/or terminating the alleged infringer's access to the Website. If we remove or disable access in response to your notice, we will make a good-faith attempt to contact the person who submitted the material so that they may have the opportunity to submit a counter notification.

Please send all notices to FSH at 222 N. Columbus Dr., Suite D, Chicago, Il 60601. Your notice of alleged copyright infringement should include:

  • A description of how your copyrighted work or other intellectual property has been infringed;
  • A description of where the infringing material is located on the Website;
  • Where we can contact you and, if different, where the allegedly infringing party can contact you;
  • A statement that you believe that the use of the material is not authorized by the copyright or other intellectual property rights owner, by its agent, or by law;
  • A statement, under penalty of perjury, that the information in the notification is correct and that you are authorized to act on behalf of the owner of the exclusive right that is alleged to be infringed; and
  • Your electronic or physical signature.

Please note that under the DMCA, misrepresentations made in your notices or counter notices can expose you to liability for substantial damages. If you are not sure whether material available on the Website infringes your copyright, or whether material posted by you is infringing, you should seek legal advice.

SECURITY AND SECURITY VIOLATIONS

Passwords used to access the Services are for individual use only. Distribution of your user name or password to others for access to the Services is prohibited and may result in termination of your account or other liability. You are responsible for the security of your own password and for all activities that occur through the use of your account if accessed with your password, including liability for damages resulting from misuse. If you use a password that FSH considers insecure, FSH may require you to change the password or terminate your account. If you have reason to believe that your account with FSH is no longer secure, you must immediately notify FSH using this form here and request that your password be changed.

You may not attempt to violate the security of the Services, or use the Services to violate the security of other persons or websites or to violate the law, including by: (i) accessing data not intended for you or logging into an account that you are not authorized to access, (ii) attempting to probe, scan or test the vulnerability of the Services or to breach security or authentication measures, (iii) attempting to interfere with service to any user, host or network, including without limitation, by submitting a virus to the Services, overloading, conducting "denial of service attacks," "flooding," "spamming," "mail bombing" or "crashing," (iv) sending unsolicited e-mail, including promotions and/or advertising of products or services, (v) forging any TCP/IP packet header or any part of the header information in any e-mail, or (vi) attempting to decipher, decompile, disassemble or reverse engineer any of the software making up any part of the Services.

FSH will take all reasonably necessary steps to investigate suspected violations of this agreement. FSH reserves the right to involve and fully cooperate with any law enforcement authorities and comply with court orders requesting or directing FSH to disclose the identity of anyone engaging in conduct that is believed to violate the law. FSH further reserves the right, in its discretion, to release your details to system administrators at other sites in order to assist them in resolving security incidents.

You release and hold harmless FSH from and against any claims resulting from any action taken by FSH during or as a result of its investigations and from any actions taken as a consequence of investigations by either FSH or law enforcement authorities.

Please review the following section with particular care, as they significantly affect your legal rights.

IMPORTANT DISCLAIMERS

You acknowledge that your use of the site and the services is at your sole risk. The services are provided on an "as is" and "as available" basis. FSH is not responsible for the acts or omissions of any medical providers or for the content that you access through the Services. FSH disclaims any warranties, express or implied, including any implied warranties of merchantability, fitness for a particular purpose, title, or non-infringement.

Without limiting the generality of the above, FSH makes no warranties:

  • Regarding the accuracy, suitability, completeness or timeliness of the information, products or services you receive on or through the Services;
  • That the Services will be uninterrupted or error-free, or that defects will be corrected; or
  • That the Website or the server that makes it available are free of viruses or other harmful components.

The Services include content, technology and other features provided by third parties, including the opportunity for users of the Services to purchase goods or services from third parties. FSH makes no warranties with regard to, nor does it endorse, the content, technology, goods or services provided by the third parties. Your recourse for dissatisfaction or problems with the foregoing must be pursued exclusively through the third party, and you agree not to make any claim against FSH with respect to those. Should you make any such claim against FSH, you will be responsible for all legal fees and expenses incurred by FSH, regardless of whether you prevail in the matter.

LIMITATION OF LIABILITY

FSH, its subsidiaries, affiliates, licensors, service providers, content providers, employees, agents, officers, and directors (collectively the "FSH Parties") shall not be liable for any incidental, direct, indirect, punitive, actual, consequential, special, exemplary, or other damages, including personal injury, wrongful death, loss of revenue or income, pain and suffering, emotional distress, or similar damages, even if the FSH Parties have been advised of the possibility of such damages.

In no event will the collective liability of FSH Parties to you (regardless of the form of action, whether in contract, tort, or otherwise) exceed the greater of $500 or the amount that you have paid to FSH for the services during the most recent 12-month period.

If a third party such as an employer or membership organization is paying for the Services as a benefit to you, you agree that no such third party will be responsible by reason of such payment for the Services provided to you by FSH or its contractors and you may not bring any claim against a third party with respect thereto. Any such third party is an intended beneficiary of this agreement for the purpose of defending any claim you bring in violation of your agreements contained in this paragraph.

You agree to waive, to the fullest extent permitted by law, all laws that may limit the efficacy of indemnifications or releases, specifically including California Civil Code Section 1542, which provides:

A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.

INDEMNIFICATION

To the maximum extent permitted by law, you shall indemnify the FSH Parties for and defend the FSH Parties against all third-party claims, liabilities and expenses, including legal fees and costs, arising out of your use of the Services or your breach of any representation contained in or other provision of this agreement. FSH reserves the right, in its sole discretion and at its own expense, to assume the exclusive defense and control of any claim for which you are obligated to provide indemnification under this section. You will cooperate as fully as reasonably required in the defense of any claim.

DISPUTE RESOLUTION

If you have an individual or family membership, the parties agree that any dispute relating to this agreement shall be finally resolved by binding arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration Rules, and judgment on the arbitration award may be entered in any court of appropriate jurisdiction in accordance with the Federal Arbitration Act. The place of the arbitration shall be in Chicago, Illinois.

If you obtained your membership through an organization, disputes will be resolved in accordance with the terms of our agreement with your organization.

AMENDMENT

FSH may modify this agreement at any time by posting the revised terms on the Website. Use of the Services after the effective date of any modifications posted on the Website will be deemed your acceptance of the changes. If you do not accept the agreement, you must discontinue use of the Services. Certain categories of users may be required to accept or reject modifications to this agreement during their next sign-on to the Services. Failure to accept the modifications may result in interruption of access to the Services.

The date of last revision to this agreement is indicated at the bottom of this page.

MISCELLANEOUS

This agreement shall be governed and interpreted pursuant to the laws of the State of Illinois (United States of America), without regard to its choice of law rules. If any part of this agreement is unlawful, void, or unenforceable, that part will be deemed severable and will not affect the validity and enforceability of any remaining provisions. FSH may provide notice to you by e-mail (effective upon transmission) or by written communication delivered by express courier (effective upon confirmed delivery), to the e-mail or street address you provided during registration. You may give legal notice to FSH by express courier (effective upon confirmed delivery) at 222 N. Columbus Drive, Suite D, Chicago, IL 60601and, Attention: General Counsel.

CONTACT AND FEEDBACK

We welcome and encourage feedback, comments and suggestions for improvements to the Services ("Feedback"). You may submit Feedback here. You agree that all Feedback will become the sole and exclusive property of FSH and you hereby irrevocably assign to FSH all of your right, title, and interest in and to all Feedback.

Rev. 2014-01-06 13:24:51

First Stop Health Privacy Policy

First Stop Health recognizes the importance of protecting your personal information, and we are committed to safeguarding your privacy online. We appreciate your interest regarding the use we make of the personal information that you supply or which may be collected while you utilize this site. However, this policy does not apply to health information and we may only utilize your individually identifiable health information in accordance with HIPAA and other applicable state and federal law.

This privacy policy ("Privacy Policy"), as amended from time to time, sets out the type of information collected and the potential use of that information ("Non-Health Information"). By visiting this site, you are accepting and agreeing to the practices described in this Privacy Policy, and you consent to the use of your Non-Health Information in accordance with this Privacy Policy. First Stop Health may change its practices at any time. We therefore encourage you to refer to this Privacy Policy on an ongoing basis so that you understand our current Privacy Policy.

Information We Collect

You provide us with Non-Health Information when you fill out a form, contact us via e-mail or telephone, complete an online application, or otherwise submit Non-Health Information from us. The Non-Health Information typically includes, but is not limited to, your name, title, organization name, physical address, email address, and telephone number, as well as Non-Health Information regarding certain First Stop Health services used by you or your employer. While you may visit our Web site anonymously, your submission of Non-Health Information in an online document, telephone call, or e-mail constitutes your consent to the use of the Non-Health Information as described in the Privacy Policy in effect at the time submission. You may refuse to provide certain Non-Health Information; however the failure to provide requested Non-Health Information may result in your inability to use certain features of this Web site.

Cookies

We may occasionally uses alphanumeric identifiers ("cookies") which would be transferred to your computer's hard drive through your Web browser to enable our system to recognize your browser when you return to this Web site and to monitor traffic patterns. You may modify your Web browser to prevent it from accepting new cookies, to notify you when a cookie is received, or to disable cookies entirely. Doing so, however, may prevent you from utilizing certain features of this Web site.

How We Use And Share Non-Health Information

Service Processing

The Non-Health Information is used to process requests, to provide services, and to develop new services.

Marketing, Promotion, and Market Research

The Non-Health Information may be used by First Stop Health or its agents to personalize your experience, improve our Web site (we continually strive to improve our Web site offerings based on Non-Health Information and feedback from you), or improve customer service. The Non-Health Information may also be used to market and promote the services of First Stop Health and its affiliated companies, and to conduct market research. This means you may be contacted by telephone, direct mail or e-mail regarding products and services offered by First Stop Health, its affiliated companies or third parties.

Third Parties

First Stop Health does not sell your Non-Health Information to third parties except as noted under "Transfer and Sale" below. However, First Stop Health may selectively provide certain Non-Health Information to other companies or organizations that have products or services we think may interest you. If you do not want the Non-Health Information you provide to First Stop Health to be shared with other companies, and you indicate this preference in the manner indicated below under "Contact Us" or when you provide the Non-Health Information to First Stop Health. First Stop Health may also disclose Non-Health Information to third party agents we contract with to perform various tasks on our behalf and to affiliated companies and to third parties with whom we have a business relationship. These third parties may have Web sites that have separate and independent privacy policies. We therefore have no responsibility or liability for the content and activities of these linked sites. Nonetheless, we seek to protect the integrity of our site and welcome any feedback about these sites.

Transfer and Sale

We will not sell your personal Non-Health Information, except in conjunction with a corporate sale, merger, dissolution, or acquisition.

Other Purposes

We may also release your Non-Health Information when we believe release is appropriate to comply with the law, enforce our site policies, or protect ours or others' rights, property or safety. As such, First Stop Health may disclose any Non-Health Information received or collected to a law enforcement agency, a government or regulatory entity, or as determined by First Stop Health to protect its rights and the rights of its affiliated companies, including without limitation, participating or conducting investigations of fraud, harassment or other types of unauthorized activities.

Access From Non-U.S. Locations

If you are accessing this site from a country other than the United States, your Non-Health Information may be transferred outside of the country in which you reside or work for use by First Stop Health or third parties as described in this Privacy Policy. Your submission of the Non-Health Information constitutes your consent to such transfer of your Non-Health Information and to the application of the laws of the United States, rather than those of your geographical location.

Your Consent

By using our site, you consent to our Privacy Policy.

Changes to Our Privacy Policy

If we decide to change our Privacy Policy, we will update the Privacy Policy modification date below. Policy changes will apply only to Non-Health Information collected after the date of the change.

Contact Us

If you have any questions regarding this Privacy Policy, you may contact us using the information below:

First Stop Health
Attention: Privacy Issues
222 N. Columbus Drive, Suite D
Chicago, IL 60601

Email: privacy@fshealth.com

Rev. 2015-11-23 15:47:57

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW
MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION.

 

PLEASE REVIEW THIS NOTICE CAREFULLY.

 

Your online health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information ("PHI"). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act ("HIPAA"), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules. It also describes your rights regarding how you may gain access to and control your PHI.

 

We are required by law to maintain the privacy of PHI. We are providing you with this Notice of Privacy Practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website or by sending a copy to you upon request.

 

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

 

For Treatment.

Your PHI may be used and disclosed without authorization by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with other treatment team members.

 

For Payment

We may use and disclose PHI without authorization so that we can receive payment for the treatment services provided to you. Examples of payment-related activities are: making a determination of eligibility or coverage, processing claims, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.

 

For Health Care Operations

We may use or disclose without authorization, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., scheduling or data entry services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI.

 

 

Required by Law

Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

 

Without Authorization. Following is a list of the other categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law permits us to disclose information about you without your authorization only in a limited number of situations.

 

Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect.

 

Judicial and Administrative Proceedings. We may disclose your PHI pursuant to a subpoena (with your written consent or protective order), court order, administrative order or similar process.

 

Deceased Patients. We may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person' s estate or the person identified as next-of-kin. PHI of persons that have been deceased for more than fifty (50) years is not protected under HIPAA.

 

Medical Emergencies. We may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm.

 

Family Involvement in Care. We may disclose information to close family members or friends directly involved in your treatment.

 

Health Oversight. If required, we may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance and peer review organizations performing utilization and quality control.

Law Enforcement. We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent or protective order), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.

Specialized Government Functions. We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI.

Public Health. If required, we may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.

Public Safety. We may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

 

Research. PHI may only be disclosed after a special approval process or with your authorization.

 

With Authorization. Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that we have already made a use or disclosure based upon your authorization. The following uses and disclosures will be made only with your written authorization: (i) most uses and disclosures of psychotherapy notes which are separated from the rest of your medical record; (ii) most uses and disclosures of PHI for marketing purposes, including subsidized treatment communications; (iii) disclosures that constitute a sale of PHI; and (iv) other uses and disclosures not described in this Notice of Privacy Practices.

 

YOUR RIGHTS REGARDING YOUR PHI

 

You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Privacy Officer at Attention:

Privacy Issues
222 N. Columbus Drive, Suite D
Chicago, IL 60601

 

Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a "designated record set". A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is held or maintained by another party or contained in separately maintained psychotherapy notes. We may charge a reasonable, cost-based fee for copies. You may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person.

 

Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy. Please contact the Privacy Officer if you have any questions.

 

Right to an Accounting of Disclosures. You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.

 

Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, we are required to honor your request for a restriction.

 

Right to Request Confidential Communication. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. We will accommodate reasonable requests. We may require information regarding how payment will be handled or specification of an alternative address or other method of contact as a condition for accommodating your request. We will not ask you for an explanation of why you are making the request.

 

Breach Notification. If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.

 

Right to a Copy of this Notice. You have the right to a copy of this notice.

 

COMPLAINTS

 

If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Privacy Officer at Attention:

Privacy Issues
222 N. Columbus Drive, Suite D
Chicago, IL 60601

or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling (202) 619-0257. We will not retaliate against you for filing a complaint.

Rev. 2015-11-23 15:48:03