PHYSICIAN’S NOTICE OF PRIVACY PRACTICES
CONSENT AND AUTHORIZATION TO RECEIVE EMAILS, TEXT MESSAGES, AND PUSH
NOTIFICATIONS FROM YOUR PHYSICIAN AND/OR SKINCHECKONLINE (“SkinCheck”),
CONSENT AND AUTHORIZATION TO RECEIVE MEDICAL SERVICES THROUGH TELEMEDICINE
FROM A PHYSICIAN AFFILIATED WITH SKINCHECK
REGARDING TELEHEALTH SERVICES PROVIDED THROUGH E-LINK GLOBAL HEALTH
CORPORATION, DOING BUSINESS AS SKINCHECKONLINE (“SkinCheck”)
Last Revised: August 8, 2018
This Physician’s Notice of Privacy Practices (“NPP”) describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Application of the Health Insurance Portability and Accountability Act
This NPP is provided to you in accordance with the Health Insurance
Portability and Accountability Act and its implementing regulations
(“HIPAA”), and applies to all records of care generated by the physician
who will be or is providing medical care and treatment to you via
telemedicine (“your Physician,” “we,” “us,” or “our”) through the
www.skincheckonline.com portal (“Site”).
While HIPAA may not necessarily apply to us and/or SkinCheck, we know medical information is personal and private, and that you may feel uncomfortable providing fully and complete information to us without assurance that we will maintain the privacy and security of information we collect from you and the records we create and store. We need such information to provide you with quality care and to comply with certain legal requirements. To best insure this information is kept private and secure, we decided to treat all information defined under HIPAA as Protected Health Information, which includes identifiable information regarding your medical condition, care, treatment, and/or payment for medical services (“PHI”), as if it were covered by HIPAA and to otherwise follow HIPAA laws and regulations whether or not we are required by law to do so. Therefore, this NPP applies to PHI we already have about you and to PHI we receive in the future and you are subject to this NPP if you use our services.
Accordingly, we will maintain the privacy of your PHI, provide you with notice of legal duties and our privacy practices with respect to that information, notify you if you are affected by an unauthorized disclosure or breach of unsecured medical and related health information, and otherwise abide by the terms of this NPP. You have the legal right to all of these to the extent HIPAA applies.
Physician(s) Subject To This NPP
While this NPP may be adopted by multiple physicians who provide services through the Site, it is not a “Joint NPP.” Each physician who provides services through the Site may choose whether or not to adopt it. Physicians generally practice through their own professional corporations or other entities, and they will continue to do so when practicing through the Site and with regard to adopting the NPP. Your Physician has adopted this NPP unless he or she provides a different NPP to you or SkinCheck posts it separately on the Site.
NPP Effective Date
This NPP is effective as of [Expressly required by regulation: Insert the date the most current version is posted] or the date your Physician began treating patients through the Site, whichever is later. The most current NPP is posted on the Site.
If we make material changes to any of our privacy practices, we will revise the NPP and post the revised version on the Site when the changes become effective. The changes will apply to all information we have about you.
YOUR HIPAA RIGHTS UNDER THIS NPP
You have the right under HIPAA to:
- We are set up to communicate with you asynchronously, as defined in the Consent And Authorization To Receive Medical Services Through Telemedicine From A Physician Affiliated With E-Link Global Health Corporation D/B/A Skincheckonline, and primarily through the SkinCheck platform. Therefore, You Physician cannot honor requests that consultations and treatment be by phone or email.
- We can, however, send emails, text messages (SMS), or push notifications advising that a message is waiting for you on the Site, but only if you consent in writing. If you wish to receive such text messages, emails, and/or push notifications, please fill in and submit the Consent And Authorization To Receive Emails, Text Messages, And Push Notifications You’re Your Physician And/Or Skincheckonline.
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 PHI that we have about you. In your request, please include a description of what records you want to receive, whether you want them to be sent via email, and the email or other address where you want them to be sent (“Complete Request”).
- We will provide a copy or a summary of your PHI, usually within 30 days of receiving a Complete Request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
- You can ask us to correct PHI about you that you think is incorrect or incomplete. Just send a Complete Request to one of the addresses above.
- We may say “no” to your request if you ask us to amend a record that (i) we did not create; (ii) is not part of the record maintained by us; (iii) is not part of the information you are permitted to inspect and copy; or (iv) is accurate and complete.
- If we say “no,” we will tell you why in writing within 60 days. You may respond to our denial by filing a written statement of disagreement, which we can rebut. If this occurs, you may ask that your original request, our denial, your statement of disagreement, and our rebuttal be included in future disclosures of your PHI.
Ask us to limit what we use or share
- You can ask us not to use or share certain PHI for treatment, payment, or our operations and/or to someone who is involved in your care or the payment for your care, like a family member or friend. 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 may 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.
- To request restrictions, submit a Complete Request, as described above. Your request must also include a clear description of: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Get a list of those with whom we have shared information
- You can request a list (an accounting) of the times we have shared your PHI 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 will 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 NPP
- As noted above, the most current NPP is posted on the Site and you may download, print, or otherwise save it at any time.
- If you would like an electronic copy of the NPP to be sent to you by email, please submit a Complete Request as described above and specifically ask that we send it via email.
- You may also request a paper copy of the NPP at any time through SkinCheck, as described above, even if you have agreed to receive the NPP electronically. Upon Complete Request, we will promptly provide you with a paper copy.
Have someone to act on your behalf
- 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 PHI.
- We will require assurances that 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 may complain if you feel we have violated your rights by contacting us through SkinCheck at one of the addresses above.
- 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 for filing a complaint.
Request this NPP in a different language
- If you have difficulty reading or understanding English, you may request a copy of the NPP in a different language.
Instruct us to disclose PHI
- You may instruct us to share PHI with your family, close friends, or others involved in your care.
- You may tell us to disclose PHI in a disaster relief situation.
- While we do not maintain a directory, you may ask that we include your information in a directory, and if possible and appropriate, we will do so.
OUR USE AND DISCLOSURE OF YOUR PHI
We will use and disclose your PHI:
As authorized by you
- Uses and disclosures not listed above will be made only with your written authorization, in the form and containing information required by law.
- Specifically, we will never share your information for marketing or fundraising purposes and we will not sell your PHI unless you permit us to do so, in writing.
- You may revoke any consent to disclosure or authorization at any time.
- We will comply with lawful restrictions, such as those that may apply to disclosure of information regarding reproductive health, HIV and other sexually transmitted diseases, substance abuse, mental health, and genetic test results.
To treat you
- We can use your PHI and share it with other professionals who are treating you. For example, if your regular doctor asks your Physician about your condition, upon confirmation that the doctor is in fact treating you, your Physician will share the information with your doctor.
To run our practice
- We can use and share your PHI to run our practice, improve your care, and contact you when necessary. For example, we use PHI about you to manage your treatment and services.
To get paid for the services
- We can use and share your information if necessary to bill and/or receive payment. For example, when your credit card is charged, the statement will indicate the charge was from SkinCheck, which handles collections for us. While we do not consider this PHI, to the extent that it falls within the definition, we could nonetheless share it with the credit card company and other financial institutions as necessary to receive payment. If we accepted insurance, we could provide them with PHI as necessary for billing and collection purposes.
For other legitimate purposes
- We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health. For example, we may use your information for preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and/or preventing or reducing a serious threat to anyone’s health or safety.
- We are also allowed to share PHI for research purposes, but we would need to first meet many conditions required by law. For example, generally clinics may use and share PHI for research projects only if approved by a special process that evaluates a proposed research project and its use of medical information, and balances the research needs with patients’ need for privacy of their medical information.
To comply with the law and/or respond to legal process or certain government requests
- We will share information about you if state or federal laws require it, including with the Department of Health and Human Services (“HHS”) if it wants to see that we are complying with federal privacy law.
We may use or share PHI about you, if required,
- 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
- We may share PHI about you in response to a court or administrative order, or in response to a subpoena.
- We may also share your information when needed to lessen a serious and imminent threat to health or safety or seek a court order first.
- If you are not competent or able to identify family members or others with whom we may share information, for example if you are in crisis, we may go ahead and share information about you if we believe it is in your best interest.
To respond to organ and tissue donation requests
- We can share PHI about you with organ procurement organizations.
To work with a medical examiner or funeral director
- We can share PHI with a coroner, medical examiner, or funeral director when an individual dies.
Limited to the minimum necessary
- When we disclose your PHI for any of the purposes described above, we will limit the use or disclosure to the amount of PHI necessary to the legitimate purposes of the disclosure unless you instruct us otherwise.
Questions and Additional Information
If you have questions about this NPP or our privacy practices, please contact us at Info@skincheckonline.com or send a written request to SkinCheckOnline, P.O. Box 3874, Yountville, CA 94599.
For more information about your rights and our obligations, you may visit the Department of Health and Human Services website, available at: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Please acknowledge your receipt, review, and agreement to the foregoing by continuing through the consents below.
Purpose of this Consent and Authorization. As explained in the Physician’s Notice of Privacy Practices (“NPP”), SkinCheck and its affiliated physicians act in accordance with the Health Insurance Portability and Accountability Act and its implementing regulations (“HIPAA”). HIPAA requires your written consent to receive emails, text messages, and push notifications from SkinCheck or the physician who will be or is providing medical care and treatment to you via telemedicine (“your Physician”).
Your Physician is set up to communicate with you through the SkinCheckOnline.com platform, developed and operated by E-Link Global Health Corporation d/b/a SkinCheckOnline (“we,” “us,” “our,” or “SkinCheck”). Therefore, your Physician cannot honor requests that consultations and treatment be by phone or email. However, SkinCheck and/or your Physician may send emails, text messages (SMS), or push notifications advising that a message is waiting for you on the Site so long as you provide written consent as described below.
Consent Specific to Push-Notifications. If you consent to our sending you text messages, you may also receive push notifications depending on your device settings. If so, your Physician’s name or SkinCheck’s identity may be visible on your phone at rest by way of a push-notification, banner or otherwise such that third parties may be able to see or read the names and other information. These notifications may remain in your device’s memory indefinitely.
Consent and Right to Cancel. If you understand the above and still wish to receive text messages, push-notifications, and/or emails, please provide your written consent by filling in the information below and submitting it to us. You may withdraw or cancel your consent at any time by terminating your user account or notifying your Physician through SkinCheckOnline by sending an email to Info@skincheckonline.com or a written request to SkinCheckOnline, P.O. Box 3874, Yountville, CA 94599. You understand that when you cancel your consent, it is effective only from the date of cancelation forward, and not retroactively. Your cancellation will not affect your right to future care or treatment.
You may acknowledge the terms of this Consent and Authorization to Send Emails, Texts, and Push Notifications and provide your written consent to receiving all or some of these from SkinCheck after you review the telemedicine authorization below.
Purpose of this Consent and Authorization. The purpose of this form is to obtain your consent to participate in and/or receive medical care, including a consultation, evaluation, diagnosis, and/or treatment, via telemedicine rather than in-person. In some states, the medical services provided through the SkinCheck website (“the Site”) or some of them, may be considered “telehealth” or “telemedicine” under applicable laws. Some of these laws may require your written informed consent to receive medical services from a SkinCheck affiliated physician (“your Physician”) through the Site, via asynchronous, store-and-forward electronic communications such as text and photographs (“Technologies”). To ensure compliance with any such laws, and where inapplicable, that you are fully informed, Physicians and SkinCheck require that you submit this consent before your Physician will provide medical services to you through the Site.
Provider of Telemedicine Services. Your Physician is your provider of telemedicine services and will be a Medical Doctor, licensed in the state where you are located if we operate in that state, who specializes in dermatology and whose professional corporation or medical group is affiliated with SkinCheck (“your Physician”). Your Physician will provide dermatology services through the SkinCheck website (“Site”) as your Physician determines is medically appropriate. While your Physician is affiliated with SkinCheck, your Physician is not employed, owned, or controlled by SkinCheck.
Nature of the Telemedicine Encounter.
- By registering and creating an account with SkinCheck, you are asking that your Physician provide medical services to you, including the evaluation and potential treatment of your skin condition, solely through asynchronous, store-and-forward electronic communications such as text and photographs, and not through a live, synchronous, or in-person encounter (“Technologies”).
- The encounter will generally include your description of the condition, photographs submitted through the Site to your Physician, and your Physician’s response, including requests for additional information or recommendations for treatment.
- The Physician’s response will not be immediate, but should reach you within 48 hours as described …
- Your Physician may ask you, through the Technologies, to share details of your medical history, symptoms, current medications, better quality photographs, and other health information.
- Your Physician will review the information you provide and may discuss it with other health professionals, in accordance with the NPP.
- If your Physician concludes that you have a condition that may be appropriately and effectively treated through telemedicine, your Physician may make treatment recommendations and may prescribe medication. If your Physician determines that appropriate evaluation and treatment cannot be provided using Technologies, you may be advised to seek in-person care from a qualified health care provider.
Risks, Benefits and Alternatives. The benefits of telemedicine include convenient and improved access to care without having to leave your home or travel outside of your local health care community. However, limitations inherent in the use of Technologies may affect your Physician’s ability to provide medical services to you, and in some cases, an in-person physical examination, test, or other procedure not available through your Physician might provide information important or relevant to your health and treatment. In some cases, quantity, of the information you provide to us (including photographs and other data you upload) may affect the quality of the diagnosis, treatment, and/or advice that your Physician provides. Additionally, failures of equipment or Technologies or scheduling issues may cause delays in evaluation or treatment. Further, while you will be asked to provide pertinent information, including for example your medical history, your Physician will not have access to your medical records and may be unable to identify potential adverse drug interactions, allergic reactions, or other errors.
You understand the risks presented by the above issues, circumstances, and disadvantages and that the alternative to a telemedicine consultation is a face-to-face visit with a physician of your choice, which may in some cases be better for you.
Unauthorized Access. While we have safeguards in place to protect our digital medical records, in rare circumstances, security protocols could fail, causing a breach of patient privacy. We are not responsible for loss of protected health information (“PHI”) or other data due to technical failures and other circumstances that are beyond our control, and we are not responsible for unauthorized access of PHI while in transmission to you or for safeguarding information once delivered to you.
Rights. You may withhold or cancel your consent to receiving telemedicine services at any time before and/or during your consultation by terminating your user account or notifying your Physician through SkinCheckOnline by sending an email to Info@skincheckonline.com or a written request to SkinCheckOnline, P.O. Box 3874, Yountville, CA 94599. You understand that when you cancel your consent, it is effective only from the date of cancelation forward, and not retroactively. However, if you cancel your consent to communicating using Technologies, your Physician will not have the ability to communicate with you. Otherwise, your cancellation will not affect your right to future care or treatment.
Electronic Prescriptions. Your Physician may prescribe medications electronically as part of your telemedicine consultation, and you consent to our use of e-prescribing. The e-prescription service is included in the list of persons with whom we may share information about you. Your Physician may request, consider, and use your prescription medication history as available electronically from other health care providers and/or third party pharmacy benefit payors for treatment purposes, as described in your Physician’s Notice of Privacy Practices.
Response Time. You understand that your communications to us may not be read or answered within a consistent timeframe and if you have an urgent or serious condition requiring immediate medical attention, CALL 9-1-1, GO TO YOUR NEAREST EMERGENCY OR URGENT CARE CENTER, AND/OR CONTACT YOUR PERSONAL PHYSICIAN, AS APPROPRIATE.
Communications. In general, your Physician will communicate with you only through the Site, via secure asynchronous transmission. Communications with you via e-mail, text message, and/or video-chat regarding your medical care, treatment, and services may be governed by your Physician’s Notice of Privacy Practices.
Consent and Authorization. You acknowledge the following:
- That you are physically located in the state(s) where your Physician is licensed to practice;
- That you accept your Physician as your telemedicine provider based on what you consider sufficient information about the identity and credentials of your Physician;
- That you understand your Physician will not provide medical services to you in-person or face-to-face, for example in a live, synchronous chat;
- That any diagnosis, treatment recommendations, and/or prescription will be based on your written and/or pictorial communications submitted through the Site to your Physician, and your Physician’s responsive questions, if any, which you may receive up to 48 hours after your submission;
- That you have read and understood the above risks, benefits, and alternatives of telemedicine.
- That these understandings provide you with adequate information to make a decision about whether you wish to consult with and receive telemedicine services from your Physician in accordance with this Consent and Authorization.
- That you wish to proceed with the telemedicine encounter.