Privacy

HealthRight LLC

HIPAA BUSINESS ASSOCIATE PRIVACY STATEMENT

HealthRight LLC takes privacy very seriously. HealthRight is a Business Associate, which provides services, such as maintenance of medical records, customer-intake, billing and technical services to the physicians, known as Covered Entities, who provide telehealth services to our customers (“Physicians”). As a Business Associate, we share a commitment with the Physicians to protect the privacy and confidentiality of health information that we obtain about you subject to the terms of our Business Associate Agreements with Physicians and in compliance with the Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act, and the HIPAA Privacy and Security Rules (collectively “HIPAA”).

This Privacy Statement is provided to help you better understand how we at HealthRight use, disclose, and protect your health information in accordance with the terms of Business Associate Agreements between HealthRight and Covered Entities such as Physicians and as required by HIPAA.

Definitions

Business Associate Agreement. The Business Associate Agreement is a formal written contract between HealthRight and a Covered Entity that requires HealthRight to comply with specific requirements related to the use and disclosure of your health information.

Covered Entity. A Covered Entity is a health plan, health care provider (e.g., physician, physician group practice, hospital), or healthcare clearinghouse that must comply with HIPAA.

Use and Disclosure of Your Health Information

The following is a description of how HealthRight may use and disclose your health information:

Use and Disclosure of De-Identified Health Information

For various reasons, HealthRight may use de-identified health information, and the de-identified health information of other HealthRight users. In this situation, all identifiers are removed from your health information in accordance with HIPAA requirements, so there is no reasonable basis to believe that the information can be used to identify you.

Safeguards

We use appropriate safeguards to prevent the use or disclosure of your health information. We have implemented administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of your electronic health information that we create, receive, maintain, or transmit on behalf of Physicians. By way of example, such safeguards include:

Mitigation of Harm

In the event of a use or disclosure of your health information that is in violation of the requirements of the Business Associate Agreements, we will mitigate, to the extent practicable, any harmful effect resulting from the violation. Such mitigation will include:

Access to Your Health Information

We will make your health information available to Physicians, or as directed by them, to you, in accordance with your right of access under HIPAA. HealthRight will comply with your health information amendment and accounting obligations set forth in HIPAA. If you wish to access your health information, please send a written/email request to:

Regular mail:

Chief Administrative OfficerHealthRight, LLC
181 Washington StreetConshohocken PA   19428

Or via email to: 
privacy@healthright.com

Upon request, we will make available our internal practices, books, and records relating to the use and disclosure of your health information received from, or created or received by HealthRight on behalf of a Physician to the Secretary of the U.S. Department of Health and Human Services for the purpose of determining compliance with HIPAA.

INFORMED CONSENT FOR SERVICES PROVIDED BY HEALTHRIGHT LLC

Telehealth is the use of electronic communications to enable physicians at different locations to share individual customer health information for the purpose of improving customer/patient care. Customer health information may be used for diagnosis, treatment, follow-up and/or education, and may include any combination of the following: (1) medical records; (2) medical images; (3) live two-way audio or video; and (4) output data from medical devices and sound and video files. Telehealth services include remote monitoring, consultations, and prescription orders and refills, among other things. The Physicians who will provide telehealth services to you are U.S. based, state licensed physician and are licensed in the state where you reside. HealthRight provides administrative services, such as handling intake and maintaining electronic medical records, to these physicians. This Consent is provided to help you better understand how HealthRight supplies you access to telehealth consultation services, the role of the physicians, and your responsibility for your decision to seek telehealth services. HealthRight will document your verbal consent as part of your electronic medical record.

HealthRight’s electronic systems incorporate network and software security protocols (e.g., encrypting data) to protect the confidentiality of your health information, identifying information, and imaging data, as well as measures to safeguard the data and to ensure its integrity against corruption.

Primary responsibility for your medical care and medical record should remain with your primary care doctor, if you have one. HealthRight will provide information about your telehealth consultation(s) to your personal doctor or other healthcare providers upon your written authorization.

As explained in this Consent, there are both benefits and risks in receiving telehealth services or taking any prescribed medications.


Expected Benefits

Potential Risks

Acknowledgements
I represent that the following has been explained to me:

Additional State-Specific Consents.
The following apply to residents of certain states:

Texas: I may file a complaint with the Texas Board of Medicine regarding the telehealth services that I receive from the physician(s). I can submit the complaint electronically (Online Complaint Form), by mail (Complaint Form), or by phone (1-800-201-9353), in accordance with the Texas Board of Medicine’s instructions available on the Texas Board of Medicine’s website: http://www.tmb.state.tx.us/page/place-a-complaint.


Nevada (DOs only). The HealthRight physician(s) who provide telehealth services to me do not have a financial interest in HealthRight or HealthRight’s website/portal


I understand the information provided above, have discussed it with the HealthRight nurse advocate, and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telehealth in my medical care.

March 2016 LEGAL\25864563\7