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 it carefully.

We are committed to your privacy

We understand that information about you and your health is very personal. We strive to protect your privacy. We are required by law to maintain the privacy of your protected health information (“PHI”). We are also required to provide notice of our legal duties and privacy practices with respect to PHI and to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this Notice and to make a new Notice effective for all PHI we maintain.

You have the right to:

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those whom we’ve shared your information
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
• Request a Change in Your Health Information
• Be Notified Following a Breach of Unsecured Protected Health Information

We may use and share your information as we:

• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

When it comes to your health information, you have certain rights.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us at:
• Virta Health
  Attn: HIPAA Privacy Officer
  440 Barranca Ave #5386, Covina, CA 91723
• Email: privacy@virtahealth.com
• Example: A doctor treating you for an injury or illness asks another doctor about your overall health condition or accesses your lab results from a health information exchange or other electronic health database.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
• We will not retaliate against you if you choose to file a complaint with us or the U.S. Department of Health and Human Services.

For certain health information, you can tell us your choices about what we share.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care, share information in a disaster relief situation, include your information in a hospital directory.

In these cases we never share your information unless you give us written permission:

• Marketing purposes, sale of your information, most sharing of psychotherapy notes.

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

How do we typically use or share your health information?

To treat you:

• We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury or illness asks another doctor about your overall health condition or accesses your lab results from a health information exchange or other electronic health database.

Run our organization:

• We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

Bill for your services:

• We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.

Help with public health and safety issues:

• We can share health information about you for certain situations such as:
  
  °  Preventing disease
  
  °  Helping with product recalls
  
  °  Reporting adverse reactions to medications
  
  °  Reporting suspected abuse, neglect, or domestic violence
  
  °  Preventing or reducing a serious threat to anyone’s health or safety

Do research:

• We can use or share your information for health research.

Comply with the law:

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests:

• We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director:

• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests:

• We can use or share health information about you:
  
  °  For workers’ compensation claims
  
  °  For law enforcement purposes or with a law enforcement official
  
  °  With health oversight agencies for activities authorized by law
  
  °  For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions:

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities:

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in the notice currently in effect and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
• For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, and on our website.

Jamie Anderson, Privacy Officer
440 Barranca Ave #5386, Covina, CA 91723
privacy@virtahealth.com, 1-844-VIRTA16

Hanna Sicker, Security Officer
440 Barranca Ave #5386, Covina, CA 91723
security@virtahealth.com, 1-844-VIRTA16