Telehealth Consent and Medical Group Notice of Privacy Practices
INFORMED CONSENT REGARDING THE USE OF TELEHEALTH
Last updated: January 1, 2025
IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL OR MENTAL HEALTH EMERGENCY SEEK IN-PERSON CARE IMMEDIATELY OR CALL 911 IMMEDIATELY.
BY CLICKING “I AGREE,” CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE TO THIS CONSENT, DO NOT CREATE AN ACCOUNT OR USE THE SERVICE. YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON THE “I AGREE” BUTTON OR OTHERWISE INDICATES ACCEPTANCE TO THIS CONSENT ON YOUR BEHALF.
PURPOSE.
The purpose of this consent form (“Consent”) is to provide you with information about telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare and/or mental health services to you by physicians, physician assistants, nurse practitioners, and/or mental health professionals (“Providers”) using the online platforms owned and operated by Healthstar Technologies, Inc. and/or its subsidiaries (the “Service”). Telehealth Services (as more fully defined in the Healthstar Terms of Use found here) are offered by the Medical Group (individually, a “Medical Group,” and collectively, the “Medical Groups”), and the Medical Group’s providers ( individually, a “Provider,” and collectively, the “Providers”) may include a patient consultation, diagnosis, treatment recommendation, prescription, and/or a referral to in-person care, as determined clinically appropriate (the “Service(s)”). In this Consent, the terms “you” and “yours” refer to the person using the Service, or in the case of a use of the Service by or on behalf of an individual minor between the ages of thirteen (13) and eighteen (18) or higher age of majority under applicable state law, “you” and “yours” refer to and include (i) the parent or legal guardian who provides consent to the use of the Service by such minor or uses the Service on behalf of such minor, and (ii) the minor for whom consent is being provided or on whose behalf the Service is being utilized. Capitalized terms not otherwise defined in this Consent have the same meaning as set forth in the Healthstar Terms and Conditions ("Terms and Conditions”) found here.
USE OF TELEHEALTH.
Telehealth and this Service involves the delivery of healthcare and/or mental health services using electronic communications, information technology or other means between a healthcare or mental health provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, chronic disease management, follow-up and/or patient education, and may include, but is not limited to, one or more of the following: electronic transmission of medical records, video files, photo images, personal health information or other data between a patient and a provider; interactions between a patient and provider via audio, video and/or data communications (such as messaging or email communications); use of output data from medical devices, sound and video files. Alternative methods of care may be available to you, such as in-person services, and you may choose an alternative at any time. Always discuss alternative options with your Provider.
ANTICIPATED BENEFITS.
The use of telehealth may have the following possible benefits: making it easier and more efficient for you to access medical care or other services and treatment for the conditions treated by your Provider(s); allowing you to obtain medical care or other services and treatment by Provider(s) at times that are convenient for you; and enabling you to interact with Provider(s) without the necessity of an in-office appointment. While you may expect anticipated benefits from the use of telehealth, you understand that no specific results can be guaranteed or assured.
POTENTIAL RISKS.
While the use of telehealth in the delivery of care can provide potential benefits for you, there are also potential risks associated with the use of telehealth and other technology. These risks include, but may not be limited to the following: the quality, accuracy or effectiveness of the services you receive from your Provider could be limited; technology, including the Service, may contain bugs or other errors, including ones which may limit functionality, produce erroneous results, render part or all of such technology, including the Service, unavailable or inoperable, produce incorrect records, transmissions, data or content, or cause records, transmissions, data or content to be corrupted or lost; failures of technology may also impact your Provider(s) ability to correctly diagnose or treat your condition; the inability of your Provider(s) to conduct certain tests, assess vital signs, or conduct a physical examination in-person which may in some cases prevent the Provider(s) from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for you; your Provider(s) may not able to provide treatment for your particular condition and you may be required to seek alternative healthcare or emergency care services; delays in medical evaluation/treatment could occur due to unavailability of your Provider(s) or deficiencies or failures of the technology or electronic equipment used; the electronic systems or other security protocols or safeguards used could fail, causing a breach of privacy of your medical or other information; data stored and communicated electronically, for example, through email communications, may be more susceptible to unintended disclosure of protected health information to third parties; given regulatory requirements in certain jurisdictions, your Provider(s) diagnosis and/or treatment options, especially pertaining to certain prescriptions, may be limited; a lack of access to all of your medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
LIFE THREATENING AND OTHER EMERGENCY SITUATIONS; FOLLOW-UP CARE.
IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL OR MENTAL HEALTH EMERGENCY SEEK IN-PERSON CARE IMMEDIATELY OR CALL 911 IMMEDIATELY. If you are contemplating suicide, call 911 or the National Suicide Prevention Line at 1-800-273-TALK (8255). If the situation is an emergency, call 911. In some situations, telehealth is not an appropriate method of care. If you require immediate or urgent care, you must seek care at an emergency room facility or with another provider equipped to deliver urgent or emergent care. Providers may not respond promptly to communications you submit through the Service. If you are not experiencing an emergency or do not require immediate or urgent care, you can communicate with Providers through the secure message service in the Service. If a technical failure prevents you from communicating with your Providers through the Service, you should send an email to admin@healthstar.co.
DATA PRIVACY AND PROTECTION.
The electronic systems used in the Service will incorporate network and software security protocols to protect the privacy and security of your information and will include measures to safeguard data against intentional or unintentional corruption. Personal information that identifies you or contains protected health information will not be disclosed to any third party without your consent, except as authorized by law for the purposes of consultation, treatment, payment/billing, and certain administrative purposes, or as otherwise set forth in your Provider's Notice of Privacy Practices. Use of the Service may include email communications to and from you that may include your protected health information. You understand that Healthstar does not and cannot guarantee the security or privacy of the services you use to receive communications, including for example your email service provider. You understand your risks of a privacy violation increase substantially when you enter information on a public access computer, use a computer that is on a shared network, allow a computer to “autoremember” usernames and passwords, or use your work computer for personal communications. You also understand it is your responsibility to encrypt medical information you transmit electronically to your Provider and your failure to use technical safeguards, such as encryption, increases your risks of a privacy violation. You understand the dissemination of any personally-identifiable images or information from the Service to researchers or other healthcare providers will not occur except as required by federal or state law.
LABORATORY PRODUCTS AND SERVICES.
Certain healthcare services provided to you by Providers via the Service may require that you complete an at-home diagnostic test or complete in-person testing at a laboratory patient service center. These diagnostic tests are provided by third-party laboratories, and neither Healthstar Technologies, Inc. and its subsidiaries (collectively, “Healthstar”), nor your Provider(s) can guarantee the accuracy or reliability of these tests. These laboratory tests can provide false negative, false positive, or inconclusive results that could impact your Provider(s) ability to correctly diagnose or treat your medical conditions. A failure or defect of these tests could also impact your Provider(s) ability to correctly diagnose or treat your medical conditions.
RADIOLOGY AND IMAGING PRODUCTS AND SERVICES.
Certain healthcare services provided to you by Providers via the Service may require that you complete an in-person imaging or radiology exam at a third party imaging or radiology center. These radiology and imaging exams are provided by third-party radiology and imaging centers, and neither Healthstar Technologies, Inc. and its subsidiaries (collectively, “Healthstar”), nor your Provider(s) can guarantee the accuracy or reliability of these radiology and imaging exams. These radiology and imaging exams can provide inconclusive results that could impact your Provider(s) ability to correctly diagnose or treat your medical conditions. A failure or defect of these exams and/or imaging centers could also impact your Provider(s) ability to correctly diagnose or treat your medical conditions.
YOUR ACKNOWLEDGMENTS By clicking “I Agree”, checking a related box to signify your acceptance, using any other acceptance protocol presented through the Service or otherwise affirmatively accepting this consent, you are agreeing and providing your consent with respect to the following: Healthcare and mental health services provided to you by Providers via the Service will be provided by telehealth. In some cases, your treating Provider may be a nurse practitioner or physician assistant and not a physician. Certain technology, including the Service, may be used while still in a beta testing and development phase, and before such technology is a final and finished product. Technology used to deliver care, including the Service, may contain bugs or other errors, including ones which may limit functionality, produce erroneous results, render part or all of such technology unavailable or inoperable, produce incorrect records, transmissions, data or content, or cause records, transmissions, data or content to be corrupted or lost, any or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that you receive from your Provider(s). Certain diagnostic testing services, including laboratory products and services offered through the Service, as well as radiology and imaging exams offered through the Service, may contain defects or produce inconclusive results, including ones which may limit functionality or produce erroneous results, any or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that you receive from your Provider(s). The delivery of healthcare services via telehealth is an evolving field and the use of telehealth or other technology in your medical care and treatment from Provider(s) may include uses of technology different from those described in this Consent or not specifically described in this Consent. No potential benefits from the use of telehealth or other technology or specific results can be guaranteed, including any laboratory testing results, radiology and imaging exams, or related diagnosis or treatment by your Provider(s). Your condition may not be cured or improved, and in some cases, may get worse. There are limitations in the provision of medical care or other services and treatment via telehealth and technology, including the Service, and you may not be able to receive diagnosis and/or treatment through telehealth for every condition for which you seek diagnosis and/or treatment. There are potential risks to the use of telehealth and other technology, including but not limited to the risks described in this Consent. You have the opportunity to discuss the use of telehealth, including the Service, with your Provider(s), including the benefits and risks of such use and the alternatives to the use of telehealth. You have the right to withdraw your consent to the use of telehealth in the course of your care, without prejudice to any future care or treatment and without risking the loss or withdrawal of any health benefits to which your entitled, but you understand that the Providers who utilize the Service do not offer in-person treatment. Any withdrawal of your consent will be effective upon receipt of written notice to your Providers, except that such withdrawal will not have any effect on any action taken by Healthstar or your Provider(s) in reliance on this Consent before it received your written notice of withdrawal. Any withdrawal of your consent will not affect any other provision of this Consent, and you will continue to be bound by this Consent. You understand that the use of the Service involves electronic communication to and from you of your personal medical information in connection with the provision of telehealth services, including through email. You understand that it is your duty to provide Healthstar and your Provider(s) truthful, accurate and complete information, including all relevant information regarding care that you may have received or may be receiving from healthcare and/or mental health providers. You understand that each of your Provider(s) may determine in their sole discretion that your condition is not suitable for diagnosis and/or treatment using telehealth technology, including the Service, and that you may need to seek care and treatment from a specialist or other healthcare or mental health provider, outside of such telehealth technology. You understand and agree that at the beginning of each telehealth session you will help your Provider to complete a check-in to assess the suitability of using the Service by verifying your full name, your current location, your readiness to proceed, and any other information your Provider may request, and whether you are in a situation conducive to private, uninterrupted communication. You understand that the Provider will take responsibility for your care only after you have created an account, answered all the required health questions and provided a photo and/or have had a video chat and made payment, and the Provider has subsequently received your request for treatment and your responses to all the required health questions and any photos and/or information received from a video chat, reviewed all your information, and then subsequently determined that you are a good candidate for the telehealth Services. You understand that the Provider’s duty of care does not begin at the point of you answering questions or making payment or starting a video visit but at the point at which the doctor accepts the duty of care. Making a request for treatment using the Healthstar Platform (by completing a visit in the mobile app or website and making payment, including providing photos and/or initiating a video chat) or sending a message through the mobile app or website does not in and of itself create a duty of care or create a doctor-patient relationship. Your Provider reserves the right to deny care if, in the professional judgment of the Provider, the provision of the telehealth services is not medically or ethically appropriate. If you are experiencing a medical emergency, you will be directed to dial 9-1-1 immediately and you understand that your Provider is not able to connect you directly to any local emergency services. In choosing to participate in a telehealth visit and use the Service you understand that some parts of the Services involving tests (e.g., labs or bloodwork) or radiology (imaging exams), will be conducted at another location such as a testing facility or an imaging center at the direction of your Provider. Your Provider and Medical Group will take steps to make sure that your health information is not seen by anyone who should not see it. Telehealth may involve electronic communication of your personal health information to other health practitioners who may be located in other areas, including out of state. You consent to the Medical Group and Provider using and disclosing your health information for purposes of your treatment and care coordination, to receive reimbursement for the services provided to you, and for Medical Group’s health care operations. You understand that persons may be present during the telehealth visit other than your Provider in order to operate the telehealth technologies and Service. If another person is present during the telehealth visit, you will be informed of the individual’s presence and his/her role. There is no guarantee that you will be issued a prescription or an order for a test or other service, including but not limited to radiology, lab testing, or third-party medical equipment or devices, and that the decision of whether a prescription or order is appropriate will be made in the professional judgement of your Provider. If your Provider issues a prescription or order, you have the right to select the pharmacy or testing center or supply manufacturer of your choice. There is no guarantee that you will be treated by a Provider. Your Provider reserves the right to deny care for potential misuse of the Service or for any other reason if, in the professional judgment of your Provider, the provision of the Service is not medically or ethically appropriate.
Healthstar has commercial relationship with Laboratory Corporation of America Holdings, Quest Diagnostics, Inc., and Google, Inc. Healthstar has financial relationship with the entity that employs or contracts with your Provider or Medical Group. You are free to obtain your medical examination from another healthcare provider that is not associated with Healthstar. Healthstar will use its laboratory partners to fulfill your lab orders for any laboratory testing services. You are free to obtain your laboratory test(s) or laboratory testing services from any laboratory of your choice by contacting our support team. You must pay the full amount of the costs associated with use of the Service, including any lab tests or other Services you may receive, and you will not attempt to submit a claim to Medicare, any other federal payor, or any state or private insurer. If you have a concern about a medical professional, you may contact the Medical Board, in the state you were located in at the time you received your telehealth services from your Provider, regarding your concerns.
MEDICAL GROUP NOTICE OF PRIVACY PRACTICES
Last updated: Janurary 1, 2025
IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL OR MENTAL HEALTH EMERGENCY SEEK IN-PERSON CARE IMMEDIATELY OR CALL 911 IMMEDIATELY.
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 Notice of Privacy Practices (the “Notice”) tells you about the ways we may use and disclose your protected health information (“medical information”) and your rights and our obligations regarding the use and disclosure of your medical information. “We” refers to, and this Notice applies to: Sean Penwell, M.D., including their providers and employees (individually, a “Medical Group,” and collectively, the “Medical Groups”) who are independently contracted with, employed by, and/or sole proprietors of the Medical Group(s). Capitalized terms not otherwise defined in this Notice have the same meaning as set forth in the Healthstar Terms and Conditions ("Terms and Conditions”) found here.
OUR OBLIGATIONS.
We maintain the privacy of your medical information and notify affected individuals following a breach of unsecured medical information, in each case to the extent required by state and federal law. We provide you this Notice explaining our legal duties and privacy practices with respect to medical information about you.
To provide services, We may provide medical information to other vendors and entities, including Healthstar Technologies, Inc. and its affiliates (“Healthstar”), in accordance with the Health Insurance Portability and Accountability Act (“HIPAA”). By using our services, you authorize the Medical Groups to transmit your medical information to Healthstar Technologies, Inc., including Healthstar’s subsidiaries, affiliated third parties and business associates.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The Medical Group(s) collect medical and related identifiable patient information (such as billing information, claims information, referral and health plan information) and stores it in an electronic chart and in electronic administrative or billing files. The medical record is the property of the Medical Group(s), but the medical information in the medical record is accessible to the patient. The following categories describe the different ways that we typically use and disclose medical information, the purposes for such uses and disclosures, and the reasons for such uses and disclosures. As noted below, we may contact you via different methods that you may approve, such as via text message, email, mail, telephone, or through your Healthstar account and/or other Healthstar affiliated accounts. In most instances, your initial communication with the applicable Medical Group will be through an interaction with the Medical Group through the Healthstar website, Healthstar app, the Healthstar Platform or other Healthstar affiliated accounts.
Specifically speaking, the applicable Medical Group may communicate with you in the following specific ways and for the following specific purposes:
Type & Purpose
Email communications: To obtain information from you necessary to provide services to you, communicate with you about your diagnosis and treatment and provide you with information on special offers and deals.
Texts: To obtain information from you necessary to provide services to you and communicate with you about your diagnosis and treatment.
Customer Service Emails, Texts, or App Notifications: To provide you with updates on problems with orders, late shipments, and other questions applicable to your provider visit(s).
Tracking emails: To notify you when laboratory orders and prescriptions have been ordered, will be available, and other confirmations.
Order information: To provide information on content of orders (additional products or samples).
For Treatment: We may use and disclose medical information about you to provide you with health care treatment and related services, including coordinating and managing your health care. We may disclose medical information about you to physicians, nurses, other health care providers and personnel who are providing or involved in providing health care to you (both within and outside of the applicable Medical Group(s)). For example, should your care require referral to a pharmacy or for the provision of prescription drugs or for laboratory services, we may provide that pharmacy or laboratory with your medical information in order to aid the pharmacist or laboratory patient service center personnel in his or her treatment of you. In addition, should your care require referral to a physician or healthcare specialist for the provision of ongoing care or transfer of care, we may provide that physician or healthcare specialist with your medical information in order to aid the physician or healthcare specialist in his or her treatment of you.
For Payment: We may use and disclose medical information about you so that we may bill and collect from you, an insurance company, or a third party for the health care services we provide. This may also include the disclosure of medical information to obtain prior authorization for treatment and procedures from your insurance plan. For example, we may send a claim for payment to your insurance company, and that claim may have a code on it that describes the services that have been rendered to you. If, however, you pay for an item or service in full, out of pocket and request that we not disclose to your health plan the medical information solely relating to that item or service, as described more fully in Section title “YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU” of this Notice, we will follow that restriction on disclosure unless otherwise required by law.
For Health Care Operations: We may use and disclose medical information about you for our health care operations. These uses and disclosures are necessary to operate and manage our practice and to promote quality care. For example, we may need to use or disclose your medical information in order to assess the quality of care you receive or to conduct certain cost management, business management, administrative, or quality improvement activities or to provide information to our insurance carriers.
Quality Assurance and Utilization Review: We may need to use or disclose your medical information for our internal processes to assess and facilitate the provision of quality care to our patients. We may need to use or disclose your medical information to perform a review of the services we provide in order to evaluate whether that the appropriate level of services is received, depending on condition and diagnosis.
Credentialing and Peer Review: We may need to use or disclose your medical information in order for us to review the credentials, qualifications and actions of our health care providers.
Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that we believe may be of interest to you.
Appointment Reminders and Information about Health Related Benefits and Services: We may use and disclose medical information, in order to contact you (including, for example, contacting you by phone and leaving a message on an answering machine) to provide appointment reminders and other information. We may use and disclose medical information to tell you about health-related benefits or services that we believe may be of interest to you. See also the specific types of communications noted above.
Vendors and Business Associates: There are some services (such as billing or legal services) that may be provided to or on behalf of the Medical Group through contracts with third parties, such as Healthstar Technologies, Inc. (including Healthstar’s subsidiaries and affiliated third parties), vendors, and business associates. When these services are contracted, we may disclose your medical information to our vendors, third parties, and business associates so that they can perform the job we have asked them to do. To protect your medical information, however, we require the third parties, business associates, and vendors to appropriately safeguard your information. Our business associates and vendors are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Individuals Involved in Your Care or Payment for Your Care: We may disclose medical information about you to a friend or family member who is involved in your health care, as well as to someone who helps pay for your care, but we will do so only as allowed by state or federal law (with an opportunity for you to agree or object when required under the law), or in accordance with your prior authorization.
As Required by Law: We will disclose medical information about you when required to do so by federal, state, or local law or regulations.
Other: Subject to applicable legal requirements, and where appropriate for your medical care or required by law, we may also use your medical information (i) to avert an imminent threat of injury to health or safety, (ii) for organ donation purposes, (iii) to appropriate military authorities if you are in the armed forces, (iv) for workers’ compensation programs, (v) for public health activities, (vi) for health oversight activities, (vii) for other legal matters, (viii) for law enforcement purposes, (ix) to coroners and medical examiners, (x) for marketing or fundraising purposes, (xi) for research purposes if the research study meets privacy law requirements, or (xii) for data breach notification purposes.
Change of Ownership: In the event that the Medical Group(s) is sold or merged with another organization patients' medical information will become the property of the new owner, although patients will maintain the right to request that copies of their medical information be transferred to another physician, provider, or medical group.
Electronic Disclosures of Medical Information: Under the law of certain states, we are required to provide notice to you if your medical information is subject to electronic disclosure. This Notice serves as general notice that we may disclose your medical information electronically for treatment, payment, or health care operations or as otherwise authorized or required by state or federal law.
OTHER USES OF MEDICAL INFORMATION.
Authorizations. There are times we may need or want to use or disclose your medical information for reasons other than those listed above, but to do so we will need your prior authorization. Other than expressly provided herein, any other uses or disclosures of your medical information will require your specific written authorization.
Psychotherapy Notes, Marketing and Sale of Medical Information. Most uses and disclosures of “psychotherapy notes,” uses and disclosures of medical information for marketing purposes, and disclosures that constitute a “sale of medical information” under applicable state and federal law require your authorization. The Medical Groups do not anticipate that they will use or sell medical information or use or disclose any psychotherapy notes created by a provider in the course of providing you mental health therapy except by your provider to provide you with ongoing mental health care.
Right to Revoke Authorization. If you provide us with written authorization to use or disclose your medical information for such other purposes, you may revoke that authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your medical information for the reasons covered by your written authorization. You understand that we are unable to take back any uses or disclosures we have already made in reliance upon your authorization, and that we are required to retain our records of the care that we provided to you.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
Certain laws and regulations provide you with certain rights regarding the medical information we have about you. The following is a summary of those rights.
Right to Inspect and Copy. Under most circumstances, you have the right to inspect and/or copy your medical information that we maintain in our possession in a designated record set, which generally includes your medical and billing records. To inspect or copy your medical information, you must submit your request to do so in writing to the applicable Medical Group at admin@healthstar.co. If you request a copy of your information, we may charge a fee for the costs of copying, mailing, or certain supplies associated with your request. The fee we may charge will be the amount allowed by state law. If your requested medical information is maintained in an electronic format (e.g., as part of an electronic medical record, electronic billing record, or other group of records maintained by the applicable Medical Group that is used to make decisions about you) and you request an electronic copy of this information, then we will provide you with the requested medical information in the electronic form and format requested, if it is readily producible in that form and format. If it is not readily producible in the requested electronic form and format, we will provide access in a readable electronic form and format as agreed to by the applicable Medical Group and you. In certain very limited circumstances allowed by law, we may deny your request to review or copy your medical information. We will give you any such denial in writing. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the applicable Medical Group will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.
Right to Amend. If you feel the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by the applicable Medical Group. To request an amendment, your request must be in writing and submitted to admin@healthstar.co. In your request, you must provide a reason as to why you want this amendment. If we accept your request, we will notify you of that in writing. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that (i) was not created by us (unless you provide a reasonable basis for asserting that the person or organization that created the information is no longer available to act on the requested amendment), (ii) is not part of the information kept by the applicable Medical Group, (iii) is not part of the information which you would be permitted to inspect and copy, or (iv) is accurate and complete. If we deny your request, we will notify you of that denial in writing.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures" of your medical information. This is a list of the disclosures we have made for up to six years prior to the date of your request of your medical information, but may not include disclosures for Treatment, Payment, or Health Care Operations (as described in this Notice) or disclosures made pursuant to your specific authorization (as described in this Notice), or certain other disclosures. To request a list of accounting, you must submit your request in writing to admin@healthstar.co. Your request must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve-month period will be free. For additional lists, we may charge you a reasonable fee for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for Treatment, Payment, or Health Care Operations. You also have the right to request a restriction or limitation on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. Except as specifically described below in this Notice, we are not required to agree to your request for a restriction or limitation. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. In addition, there are certain situations where we won’t be able to agree to your request, such as when we are required by law to use or disclose your medical information. To request restrictions, you must make your request in writing to admin@healthstar.co. In your request, you must specifically tell us what information you want to limit, whether you want us to limit our use, disclosure, or both, and to whom you want the limits to apply. As stated above, in most instances we do not have to agree to your request for restrictions on disclosures that are otherwise allowed. However, if you pay or another person (other than a health plan) pays on your behalf for an item or service in full, out of pocket, and you request that we not disclose the medical information relating solely to that item or service to a health plan for the purposes of payment or health care operations, then we will be obligated to abide by that request for restriction unless the disclosure is otherwise required by law. You should be aware that such restrictions may have unintended consequences, particularly if other providers need to know that information (such as a pharmacy filling a prescription). It will be your obligation to notify any such other providers of this restriction. Additionally, such a restriction may impact whether an insurance company will pay for related care that you may not want to pay for out of pocket (and which would not be subject to the restriction).
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you through a personal email address and not at work or, conversely, only at work and not a personal email address. To request such confidential communications, you must make your request in writing to admin@healthstar.co. We will not ask the reason for your request, and we will use our best efforts to accommodate all reasonable requests, but there are some requests with which we will not be able to comply with. Your request must specify how and where you wish to be contacted.
Right to an Email or Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. To obtain a copy of this Notice, you must make your request in writing to admin@healthstar.co.
Right to Breach Notification. In certain instances, we may be obligated to notify you (and potentially other parties) if we become aware that your medical information has been improperly disclosed or otherwise subject to a “breach” as defined in and/or required by applicable law.
CHANGES TO THIS NOTICE.
We reserve the right to change this Notice at any time, along with our privacy policies and practices. We reserve the right to make the revised or changed Notice effective for 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, along with an announcement that changes have been made, as applicable, on our website and in any physical office in which the Medical Groups practice medicine. When changes have been made to the Notice, you may obtain a revised copy by writing to admin@healthstar.co.
COMPLAINTS.
If you believe that your privacy rights as described in this Notice have been violated, you may file a complaint with the applicable Medical Group at admin@healthstar.co. The Medical Groups will not retaliate against any individual who files a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services. In addition, if you have any questions about this Notice, please contact admin@healthstar.co.