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Notice of Privacy Practices

THERAPY NOTICE OF PRIVACY PRACTICES

Our Commitment 

First, a note about the therapist’s commitment to your privacy:

We deeply value our role as your trusted care provider. Central to that promise is safeguarding the privacy of your personal health information. Protected health information is information regarding your past, present or future health care services that can be used to identify you.

This Notice of Privacy Practices describes, in user-friendly terms, the privacy practices of the therapists who provide services to you. These privacy practices are specific to Protected Health Information (“PHI”) that we may collect in conjunction with providing you services using the Ours Wellness platform, including what information we collect in order to deliver you high-quality care, what we use your information for, how we may share your information when needed, and the rights and choices you may have with respect to your PHI. For information on Ours Wellness’s privacy practices regarding all other information, please see their Privacy Policy.

 

Notice of Privacy Practices

Effective: September 5, 2023

Last Updated: September 5, 2023

As you know, in order to provide your care, we must collect, create, and maintain information about you and your health. This Notice of Privacy Practices (this “Notice”) describes how protected health information about you may be used and disclosed. Protected Health Information (“PHI”) is information regarding your past, present or future health care services that can be used to identify you. For example, information you provide us when scheduling your service, providing your medical history or receiving care from us is considered PHI.

We are required by law, including the Health Insurance Portability and Accountability Act (“HIPAA”), to maintain the privacy of this information and are required by HIPAA to provide you with this Notice. This Notice describes how we use and disclose your health information and explains certain rights you have regarding this information. If there is a breach of your unsecured PHI, we will notify you in accordance with federal and state law. Unless otherwise defined, all capitalized terms have the same meaning as in HIPAA and its implementing regulations. 

This Notice also describes how you can access and amend your health information. Please review it carefully. If you have any questions, please contact the Privacy Officer at ciso@withours.com.

How We Use and Disclose Your Health Information

When we use the term “health information” in this Notice we are referring to PHI.  We protect your health information to the best of our ability from inappropriate use and disclosure. We will use and disclose your health information only for the purposes listed below.

  1. Uses and Disclosures for Treatment, Payment, and Health Care Operations Without Your Consent or Authorization. We may use and disclose your PHI in order to provide care or treatment to you, obtain payment for services provided to you, and conduct our Health Care Operations as detailed below. We have listed below some examples of how we may use and disclose your information.
  1. Treatment and Care Management. We may use and disclose health information about you to facilitate treatment provided to you by other health care providers and us. For example, we may discuss your health condition with other therapists involved in your care in order to obtain the information necessary to understand your past and current treatment. To the extent you receive services from multiple providers, such as behavioral and physical health providers, your information may be shared amongst your providers.
  2. Payment. We may use and disclose health information about you in order to get paid for the services we provide to you and to assist other providers in getting paid for the services they render to you.
  3. Health Care Operations. We may use and disclose health information about you to carry out Health Care Operations, which include care management, quality improvement activities, evaluating our own performance, and resolving any complaints or grievances you may have. We may also use and disclose your health information to assist other health care providers in performing Health Care Operations.
  4. Appointments or Information. We or Ours Wellness acting on our behalf may contact you to provide appointment reminders or information about treatment.
  1. Other Uses and Disclosures Without Your Consent or Authorization. We may also use and disclose your health information without your specific written authorization for the following purposes:
  1. As required by law. We may use and disclose your health information when required by state, federal, or local law.
  2. Public health activities. We may disclose your health information to public health authorities or other agencies and organizations conducting public health activities, such as organizations responding to the COVID-19 pandemic. 
  3. Victims of abuse, neglect, or domestic violence. We may disclose your health information to an appropriate government agency if we believe you are a victim of abuse, neglect, or domestic violence, and you agree to the disclosure or the disclosure is required or permitted by law. We will let you know if we disclose your health information for this purpose unless we believe that notifying you would place you or another person at risk of serious harm.
  4. Health oversight activities. We may disclose your health information to health oversight agencies, such as state departments of health, for activities authorized by law, such as audits, investigations, and inspections of us.
  5. Judicial and administrative proceedings. We may disclose your health information in the course of any judicial or administrative (legal) proceeding in response to an appropriate order of a court or other administrative body.
  6. Law enforcement purposes. We may disclose your health information to the police or law enforcement officials as required or permitted by law, as requested by a court order or a grand jury or administrative subpoena.
  7. Deceased individuals. We may disclose your health information to a coroner, medical examiner, or a funeral director as necessary if you pass away and as authorized by law.
  8. Organ, eye, or tissue donations. We may disclose your health information to organ procurement organizations and similar entities for the purpose of assisting them in organ, eye, or tissue procurement, banking, or transplantation.
  9. For research. If we perform research, we may use or disclose your health information for research purposes, such as studies comparing the benefits of alternative treatments received by our patients or investigations into how to improve our care delivery. We will use or disclose your health information for research purposes only with the required Institutional Review Board approval (if applicable to the research), which must follow a special approval process. 
  10. Health or safety. We may use or disclose your health information to prevent or lessen a threat to your health or safety or that of the general public. We may also disclose your health information to disaster relief organizations such as the Red Cross, or to other organizations participating in bioterrorism countermeasures.
  11. Specialized government functions. We may use or disclose your health information to provide assistance for certain types of government activities. If you are a member of the armed forces of the United States or a foreign country, we may disclose your health information to appropriate military authority as is deemed necessary. We may also disclose your health information to federal officials for lawful intelligence or national security activities.
  12. Workers’ compensation. We may use or disclose your health information as permitted by the laws governing the workers’ compensation program or similar programs that provide benefits for work-related injuries or illnesses.
  13. Business Associate Agreements. A Business Associate is a person or entity that performs certain functions or services that involve the use or disclosure of your PHI on behalf of a covered entity (we are a covered entity; Ours Wellness is our Business Associate). PHI may be used or disclosed to a Business Associate, such as Ours Wellness, only if we obtain satisfactory assurances from the Business Associate that the Business Associate will safeguard your health information from any misuse and will use the information only for certain limited permitted purposes. 
  14. Individuals involved in your care. Unless prohibited by state law, we may disclose your health information to a family member, relative, or close personal friend assisting you in receiving health care services. We will disclose your health information to these individuals only if you tell us to do this or if we can reasonably infer that you do not object.
  1. Uses and Disclosures With Your Authorization. We will not use or disclose your health information for any purpose not specified in this Notice unless we obtain your express written authorization or the authorization of your legally appointed representative.

We will need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy Notes” are notes we may have made about your conversation during a private, group, joint, or family counseling session, which have been kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.  

If you give us your authorization to share either PHI or your Psychotherapy Notes, you may revoke it at any time by providing us with a written notice stating that you wish to revoke your authorization, in which case we will no longer use or disclose your health information for the purpose you authorized, except to the extent that we have relied on your prior authorization to provide your care.

  1. Special Treatment of Alcohol and Drug Abuse Records. Health information we may receive about you from federally assisted alcohol or drug treatment programs may be subject to special protection under state or federal law. If your health information is protected by a federal or state law, we will not disclose this information except where required by, and in full compliance with, federal or state law.
  2. Other State Laws. To the extent that you reside in a state that provides additional protections for medical information or a subset of treatment information, we will protect your information in accordance with state law. 

Your Rights Regarding Your Health Information

You have the following rights regarding your health information:

  1. Right to Inspect and Copy. You have the right to inspect or request a copy of health information about you that we maintain. Your request should describe the information you want to review and the format in which you wish to review it, which we will reasonably request. We may refuse to allow you to inspect or obtain copies of this information in certain limited cases. If permitted by federal and state law, we may charge you a fee for copies of your record.
  2. Right to Request Amendments. You have the right to request changes to any health information we maintain about you if you state a reason why this information is incorrect or incomplete. But, we do not have to agree to make the changes you request. If we do not agree with the requested changes, we will notify you in writing and inform you how to have your objection included in our records. If changes are made to your record, it does not mean that we will destroy or rewrite your previous records, but we will add an addendum to your current records to reflect your changes.
  3. Right to an Accounting of Disclosures. You have the right to receive a list of the disclosures of your health information by us. The list will not include disclosures made for certain purposes, including disclosures for treatment, payment, or health care operations, or disclosures you authorized in writing. Your request should specify the period covered by your request, which cannot exceed six years. The first time you request a list of disclosures in any 12-month period, it will be provided at no cost. If you request additional lists within the 12-month period, we may charge you a nominal fee.
  4. Right to Request Restrictions. You have the right to request restrictions on the ways in which we use and disclose your health information for treatment, payment, and health care operations, or disclose this information to disaster relief organizations or individuals who are involved in your care. But we do not have to agree to the restrictions you request; we would be bound by any restrictions to which we both agree.
  5. Right to Request Confidential Communications. You have the right to ask us to send health information to you in a different way or at a different location if the request is reasonable and you believe that you may be endangered by our ordinary form of communication. For example, if you are afraid that someone living with you may open your mail, resulting in harm, you may ask us to mail to an alternate address. Your request for an alternate form of communication should also specify where and/or how we should contact you.
  6. Right to Paper Copy of Notice. You have the right to receive a paper copy of this Notice at any time. You may obtain a paper copy of this Notice by writing to our Privacy Official at ciso@withours.com. You may also print out a copy of this Notice by going to our website at www.withours.com.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by writing to our Privacy Official at ciso@withours.com. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. We will not penalize or retaliate against you for filing a complaint.

Changes to This Notice

We may change the terms of this Notice at any time. If the terms of the Notice are changed, the new terms will apply to all of your health information, whether created or received by us before or after the date on which the Notice is changed. Any updates to the Notice will be emailed to you and prominently displayed at www.withours.com within 60 days of the date on which they become effective.