Notice of Privacy Practices

— 1. Who This Notice Covers

This Joint Notice of Privacy Practices is issued by the independent, physician-owned medical practices that provide care under the Go Clinic brand (each, a “Practice,” and together, the “Practices”). For purposes of the Health Insurance Portability and Accountability Act (“HIPAA”), the Practices participate together in an organized health care arrangement and may share protected health information (“PHI”) with one another as needed for treatment, payment, and health care operations. Each Practice is responsible for its own compliance with this Notice and has agreed to abide by its terms with respect to PHI created or received as part of the arrangement. This Notice applies to all services the Practices deliver through the Go Clinic telehealth platform and any affiliated service locations.

Go Clinic MD, LLC provides administrative and technology services (including the Go Clinic patient portal) to the Practices as a HIPAA business associate under written agreements that require it to safeguard your PHI. Go Clinic MD, LLC is not a health care provider and does not provide medical care.

— 2. Our Duties

We are required by law to maintain the privacy and security of your PHI, to provide you this Notice of our legal duties and privacy practices, to notify you following a breach of your unsecured PHI, and to abide by the terms of the Notice currently in effect.

— 3. How We May Use and Disclose Your PHI

For Treatment

We use your PHI to provide, coordinate, and manage your care — for example, your neurologist, physiatrist, therapists, and other members of your care team share your evaluations, test results, and treatment notes with one another, and with outside providers involved in your care (such as an imaging center near you).

For Payment

We use and disclose PHI to bill and collect for services — for example, to prepare itemized bills, process payments, and to provide records and bills to the persons involved in administering your payment arrangements, as permitted by law and with your authorization where required.

For Health Care Operations

We use PHI to run the Practices — quality improvement, care coordination, licensing, credentialing, audits, and customer service.

Appointment Reminders and Care Communications

We may contact you (including by text message, if you have opted in) with appointment reminders, service notifications, and billing communications.

Other Uses and Disclosures Permitted or Required by Law Without Your Authorization

As required by federal, state, or local law; for public health activities; to report suspected abuse, neglect, or domestic violence as required by law; for health oversight activities; in judicial and administrative proceedings in response to lawful process; for law enforcement purposes as permitted by law; to coroners, medical examiners, and funeral directors; for organ and tissue donation; for research approved under applicable privacy safeguards; to avert a serious threat to health or safety; for specialized government functions; and for workers’ compensation as authorized by law.

Uses Requiring Your Written Authorization

We will not use or disclose your PHI for marketing purposes, sell your PHI, or disclose psychotherapy notes except with your written authorization (or as otherwise expressly permitted by law). Any other use or disclosure of your PHI not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time in writing, except to the extent we have already relied on it.

— 4. Your Rights

Access

You may inspect and obtain a copy of your PHI (including an electronic copy of records we hold electronically), generally within 30 days of your request; a reasonable cost-based fee may apply.

Amendment

You may request that we amend PHI you believe is incorrect or incomplete. We may deny the request in certain circumstances, and you may submit a statement of disagreement.

Accounting of Disclosures

You may request a list of certain disclosures of your PHI other than for treatment, payment, health care operations, and certain other exceptions.

Restrictions

You may request restrictions on how we use or disclose your PHI. We are not required to agree to every request, with one exception: if you pay for a service in full out of pocket and ask us not to disclose the related PHI to your health plan, we must honor that restriction unless disclosure is required by law.

Confidential Communications

You may ask us to communicate with you by specific means or at a specific location (for example, only by email, or only at a particular phone number), and we will accommodate reasonable requests.

Paper Copy

You may obtain a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Breach Notification

We will notify you promptly if a breach of your unsecured PHI may have compromised its privacy or security.

Complaints

If you believe your privacy rights have been violated, you may complain to any Practice using the contact below, or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

— 5. State Law

Where state law provides greater privacy protection than HIPAA — including, for California patients, the Confidentiality of Medical Information Act — the more protective law governs our handling of your PHI.

— 6. Changes to This Notice

We may change this Notice and make the new Notice apply to PHI we already hold. The current Notice is posted at goclinicmd.com and available in the patient portal, and you may request a copy at any time.

— 7. Contact — Privacy Officer

Privacy Officer for the Practices: Andrew J. Abraham, MD
390 NE 191st St, Suite 8578
Miami, FL 33179
[email protected]
(602) 730-6232