‍Your Rights and Acknowledgements:

• You have the same privacy rights via telemedicine that you would have during an in-person visit. Dissemination of any identifiable images or information from the telemedicine visit to researchers or other entities will not occur without your written consent. For more information about how we protect your privacy, please read the Columbia Medical, Llc, HIPAA Privacy Statement at the bottom of this document.
• Telemedicine may involve electronic communication of your personal medical information to healthcare practitioners who may be located in other areas, including out of state.
• You understand that you may expect the anticipated benefits from the use of telemedicine, but that no results can be guaranteed or assured.
• You understand that all information submitted to Columbia Medical IDTF, LLC via text message/e-mail and entered by your healthcare practitioner in the will be part of your medical record
• This information will have the same restrictions on dissemination without your consent.
• You understand that your healthcare practitioner’s initial contact to you will include his/her name and credentials, and this will be recorded in the TelMDCare platform as part of your medical record.
• You understand you may withdraw your consent and delete your patient profile at any time by emailing ainfo@cmwellcare.com.
• You understand that your healthcare information may be shared with other individuals in accordance with the Columbia Med Privacy Policy and regulations or laws in state or territory in which you are located.
• You further understand that your healthcare information may be shared in the following circumstances:
• When a valid court order is issued for medical records.
• Reporting suspected abuse, neglect, or domestic violence.
• Preventing or reducing a serious threat to anyone's health or safety

Call/Email/Text Messaging Consent: You expressly consent to allow ColumbiaMedical or its healthcare practitioners to call, email, or text you (via SMSand/or MMS) with or regarding Personal Data (as defined in the Columbia Medical PrivacyPolicy), appointments, or similar matters related to your telemedicine encounters using the contact information you have provided. Your phone carrier’s normal rates may apply.This is consent, not a condition of purchase. You may revoke this consent at any time by emailing admin@Columbiamed.com.

 

Columbia Medical. Llc

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HIPPA Privacy Statement:

Notice of Privacy Practices for ProtectedHealth Information (PHI)

Effective Date: 4/16/2024

This Notice of Privacy Practices("Notice") describes how Columbia Medical and its affiliated licensed medical groups and healthcare providers providing medical weight loss services ("we", "us", or "our") may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding your PHI. We are required by law to maintain the privacy of your PHI, provide you with thisNotice of our legal duties and privacy practices, and to abide by the terms of this Notice.

Uses and Disclosures of PHI

We may use and disclose your PHI for the following purposes:

1. Treatment: We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This may include communication with other healthcare providers about your treatment and coordinating your care with other providers.
2. Payment: We may use and disclose your PHI to obtain payment for healthcare services provided to you. This may include sharing PHI with other healthcare providers, pharmacies, or collection agencies.
3. Healthcare Operations: We may use and disclose your PHI for healthcare operations, including quality assessment, improvement activities, case management, accreditation, licensing, credentialing, and conducting or arranging for medical reviews, audits, or legal services.
4. As Required by Law: We may use and disclose your PHI when required to do so by federal, state, or local law.
5. Public Health and Safety: We may use and disclose your PHI to prevent or control disease, injury, or disability, to report child abuse or neglect, to report reactions to medications or problems with products, and to notify persons who may have been exposed to a communicable disease or may be at risk of spreading a disease or condition.
6. Health Oversight Activities: We may disclose your PHI to health oversight agencies for activities authorized by law, such as audits, investigations, inspections, and icensure.
7. Judicial and Administrative Proceedings: We may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process.
8. Law Enforcement: We may disclose your PHI for law enforcement purposes, such as to report certain types of wounds or injuries, or to comply with a court order, warrant, or other legal process.
9. Research: We may use and disclose your PHI for research purposes when the research has been approved by an institutional review board and privacy protections are in place.
10. Workers' Compensation: We may disclose your PHI for workers' compensation or similar programs that provide benefits for work-related injuries or illnesses.
11. Military and Veterans: If you are a member of the armed forces, we may disclose your PHI as required by military authorities.
12. Inmates: If you are an inmate, we may disclose your PHI to the correctional institution or law enforcement official having custody of you.

Your Rights Regarding PHI

You have the following rights with respect to your PHI:

1. Right to Inspect and Copy: You have the right to inspect and copy your PHI that we maintain, with certain exceptions. To request access, submit a written request to our Privacy Officer at info@cmwellcare.com.
2. Right to Amend: You have the right to request an amendment to your PHI if you believe it is incorrect or incomplete. To request an amendment, submit a written request to our Privacy Officer, specifying the information you believe is incorrect and why. We may deny your request if we believe the information is accurate and complete, or if we did not create the information.
3. Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures of your PHI made by us in the past six years, except for disclosures made for treatment, payment, or healthcare operations, and certain other disclosures. To request an accounting, submit a written request to our Privacy Officer at info@cmwellcare.com.
4. Right to Request Restrictions: You have the right to request a restriction on our use or disclosure of your PHI for treatment, payment, or healthcare operations. We are not required to agree to your request but will consider it. To request a restriction, submit a written request to our Privacy Officer at info@cmwellcare.com, specifying the restriction you are requesting and to whom it applies.
5. Right to Request Confidential ommunications: You have the right to request that we communicate with you about your PHI in a certain way or at a certain location. To request confidential communications, submit a written request to our Privacy Officer, specifying how or where you wish to be contacted.
6. Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice, even if you have agreed to receive it electronically. To obtain a paper copy of this Notice, contact our Privacy Officer.
7. Right to be Notified of a Breach: You have the right to be notified in the event that we discover a breach of your PHI.

Transmission of PHI

We are committed to protecting the privacy of your PHI and will ensure that any electronic transmission of PHI complies with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule(45 CFR 164). This includes the use of Secure-Socket Layer (SSL) or equivalent technology for the transmission of PHI, as well as adherence to all applicable security standards for online transmissions of PHI.

Changes to This Notice

We reserve the right to change this Notice and the revised Notice will be effective for PHI we already have about you, as well as any information we receive in the future. We will post a copy of the currentNotice in our office and on our website. The Notice will contain the effective date on the first page.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer at admin@Columbiamed.com or with the Secretary of the Department ofHealth and Human Services. You will not be retaliated against for filing a complaint.

Contact Information

To exercise any of your rights, or if you have any questions about this Notice or our privacy practices, please contact thePrivacy Officer at admin@Columbiamed.com

This Notice is provided in accordance with theNotice of Privacy Practices for Protected Health Information from theDepartment of Health and Human Services' Model and is applicable across all US states. Rights of Specific Jurisdictions within the US Certain states may have additional privacy protections that apply to your PHI. The following is an example of specific rights in the state of California. If you reside in a state with additional privacy protections, you may have additional rights related to your PHI.

Notice of Privacy Practices for ProtectedHealth Information (PHI) - State-Specific Provisions

In addition to the privacy practices described in our Notice of Privacy Practices for Protected Health Information, we comply with applicable state-specific privacy laws related to PHI.

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