HIPAA Compliance Privacy Summary

HIPAA COMPLIANCE PRIVACY SUMMARY

The Health Information & Accountability Act of 1996 (also known as HIPAA) was enacted to standardize electronic data exchange, patient privacy and security.

Summary of our Notice of Privacy Practices

This Summary of our Notice of Private Practice, which describes how we may use and disclose your medical and personal information and how you can access this information.

Our Pledge to Protect Your Privacy

At E-telmed, we are committed to protect your privacy of medical and personal information. We will share your information only to the extent necessary to collect payment for the service we provide, conduct our business operations, and to comply with the laws. We will not use or disclosure your information for any other purpose without your permission.

Your Rights Regarding Medical Information about you:

To inspect and obtain a copy of your medical records with certain limitations.
To request an amendment or addendum to your medical record.
To an accounting of E-telmed disclosures of your medical information.
To request restrictions on certain uses and disclosures of your medical information.
To request a copy of the full version of this Notice of Privacy Practices.

We may use and disclose your personal and health information without your authorization for the following purposes:

To provide you with medical treatment.
To bill and receive payment for the treatment received.
As required and permitted by law.
For functions necessary to run E-telmed and assure that our patients receive quality care.
For public health activities (e.g., reporting abuse).
For research purposes in limited circumstances.
To a coroner, medical examiner, funeral director, or organ procurement organization for certain purposes.
To a court or administration order, subpoena, discovery request or other lawful purposes.
To a health oversight agency.

By my signature below, I certify that I have read, understand, and have an opportunity to ask questions about the contents of all medical documents provided by E-telmed Privacy Standards.

Patient's Signature

Date

mm/dd/yyyy