WoWTM CONSENT AND END USER AGREEMENT
PLEASE READ THE CONSENT AND END USER AGREEMENT BELOW. INDICATE YOUR ACCEPTANCE, CONSENT AND AGREEMENT BY CLICKING THE "AGREE" BUTTON. IF YOU DO NOT AGREE TO THESE TERMS AND CONDITIONS, DO NOT CLICK "AGREE" AND DO NOT USE THE SERVICE.
Welcome to WoWTM (the "Service"), a service which is operated by WoW Health Solutions, LLC, a Michigan limited liability company (the "Company"). Please see the Company’s website (https://www.wowhealthsolutions.com/) for more information about the Service. To use the Service, you must agree to be bound by all of the terms of this Consent and Agreement. By clicking the "AGREE" checkbox, you are stating that you agree to be bound by all of the terms in this Consent and End-User Agreement (the "Agreement"). If you do not agree to these terms and conditions, you are not authorized to access or use this Service. The Company may, from time to time, change the terms of this Agreement. It is your responsibility to review these terms each time you use the Service.
CONSENT AND END-USER AGREEMENT
DO NOT USE THE SERVICE FOR EMERGENCY MEDICAL CONDITIONS.
If you experience a medical emergency, call 911 immediately.
LIMITATIONS OF THE SERVICE
The Service permits you to communicate with healthcare providers and service vendors who utilize the Service. The Company does not provide any physician, medical or other health care services. All physicians and other providers are independent of the Company and use the Service as a means to communicate with you. Any information or advice received from a provider comes from the provider alone, and not from the Company. Neither the Company nor any of its licensors or suppliers or any third parties who promote the Service or provide you with a link to the Service shall be liable for any professional advice you obtain from a healthcare provider via the Service nor for any information obtained via the Service. The Company does not recommend or endorse any specific tests, physicians, medications, products or procedures. You acknowledge that your reliance on any health care providers or information provided by the Service is solely at your own risk and you assume full responsibility for all risk associated therewith.
The Company does not credential or make any representations or warranties about the training or skill of any health care providers who provide services to you via the Service. You are responsible for choosing your own physician or other health care provider.
You hereby certify that you are physically located in the State you have identified as your current location. You acknowledge that your ability to access and use the Service is conditioned upon the truthfulness of this certification and that the providers you access are relying upon this certification in order to interact with you. If your certification is inaccurate, you agree to indemnify the Company and the providers you interact with from any resulting damages, costs or claims.
The Service is a software platform and related service which the Company makes available for use by you and healthcare providers and service vendors who utilize the Service. Healthcare services which you may obtain are not covered by insurance, governmental or self-funded group plans. The Company and the Service, individually and collectively, are not any one or more of the following: (i) a provider of healthcare services, (ii) a network of healthcare providers, (iii) a vendor of marketing, credentialing, billing or services, or (iv) an insurer, a health care plan, or an employee benefit plan including an ERISA plan. The Service, and use of the Service by you, healthcare providers and service vendors, is subject to all policies, rules and regulations which the Company has established or may hereafter establish.
The Company, for purposes of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations ("HIPAA"), may function as a business associate of the healthcare professionals or other providers you communicate with using the Service. Your personal information will be stored in a secure manner. The Company maintains customary physical and electronic procedural safeguards that limit access to your personal information to our employees (or people working on our behalf and under confidentiality agreements) who, through the course of standard business activities, need to access your personal information or to health providers. Access to the Service is enabled only by usernames and passwords. You are responsible for any and all use of the Service using your username and password. You should maintain your username and password in strict confidence and not share them. You are responsible to notify us if you have any reason to believe that your username or password has been lost, compromised or misused in any way.
To access the Service, you must first enroll to establish an individual user account ("Account"), by providing certain information. With the exception of sub-accounts established for minor children of whom you are a parent or legal guardian, you agree that you will not create more than one Account, or create an account for anyone other than yourself without first receiving permission from the other person. In exchange for your use of the Service and, if applicable, in order for providers to send notices to you, you agree to: (i) provide true, accurate, current and complete information about yourself as prompted by our Account enrollment form; and (ii) each time you log on, maintain and promptly update such Account information to keep it true, accurate, current and complete. You represent and warrant that you are at least 18 years of age and possess the legal right and ability, on behalf of yourself or a minor child of whom you are a parent or legal guardian, to agree to this Agreement. You consent to the disclosure of your contact information for support and follow up purposes by your agency/advocate, if applicable. You consent to receiving notifications from the Company about promotions or updates to the Service and related matters.
You agree not to access or use the Service in an unlawful way or for an unlawful or illegitimate purpose as determined by the Company or in any manner that contravenes this Agreement. For example, you shall not post, use, store or transmit (a) a message or information under a false name; (b) information that is defamatory, obscene, fraudulent, or predatory of minors; or (c) information that infringes or violates any of the intellectual property rights of others or the privacy or publicity rights of others. You shall not attempt to damage, impair or disrupt the operation of the Service by any method, including through use of viruses, Trojan horses, worms, time bombs, denial of service attacks, flooding or spamming.
OPERATION AND RECORD RETENTION
The Company reserves complete and sole discretion with respect to the operation of the Service. Subject to applicable law, the Company reserves the right to maintain, delete or destroy all communications and materials posted or uploaded to the Service pursuant to its internal record retention and/or destruction policies. Your health information (such as professional services, laboratory tests, imaging and prescriptions) will be available to you to view and download. The Company will not delete or destroy your health information without first giving you advance notice by email to the most recent email address in your account information, and a reasonable opportunity as determined by the Company to download the information. The Company may use de-identified data to the fullest extent permitted by applicable law.
All of the content available on or through the Service is the property of the Company or its licensors and is protected by copyright, trademark, patent, trade secret and other intellectual property law. All Company trade and service names, including, but not limited to "WoWTM", are trademarks of the Company or its licensors. Subject to the terms of this Agreement, the Company hereby grants you a limited, revocable, non-transferable and non-exclusive license to use the software, network facilities, content and documentation on and in the Service to the extent, and only to the extent, necessary to access and use the Service, and for no other use whatsoever. The license granted herein does not permit you, and you agree not to, modify, translate, reverse engineer, disassemble, decompile or create derivative works of the Service or allow a third party, whether directly or indirectly, to do so.
DISCLAIMERS AND LIMITATIONS OF LIABILITY
ACCESS TO THE SERVICE AND THE INFORMATION CONTAINED THEREIN IS PROVIDED "AS IS" AND "AS AVAILABLE" WITHOUT ANY WARRANTY OF ANY KIND, EXPRESS OR IMPLIED. TO THE FULLEST EXTENT PERMITTED BY LAW, ALL EXPRESS AND IMPLIED CONDITIONS, REPRESENTATIONS AND WARRANTIES, INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT OR OTHERWISE IMPOSED BY OPERATION OF LAW, ARE DISCLAIMED, VOID AND OF NO EFFECT. TO THE FULLEST EXTENT PERMITTED BY LAW, IN NO EVENT WILL WOW BE LIABLE FOR ANY LOST REVENUE, PROFIT OR DATA, OR FOR ANY SPECIAL, INDIRECT, CONSEQUENTIAL, INCIDENTAL, EXEMPLARY OR PUNITIVE DAMAGES, HOWEVER CAUSED REGARDLESS OF THE THEORY OF LIABILITY, ARISING OUT OF OR RELATED TO THE WOW PLATFORM, DATA OUTPUTS, REPORTS, THE USE OF OR INABILITY TO RECEIVE REPORTS OR OTHER SERVICES EVEN IF WOW HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES AND WHETHER OR NOT SUCH DAMAGES ARE FORESEEABLE. THE FOREGOING LIMITATIONS WILL APPLY EVEN IF THE ABOVE STATED WARRANTY FAILS OF ITS ESSENTIAL PURPOSE.
WITHOUT LIMITING THE FOREGOING, THE COMPANY DOES NOT WARRANT THAT ACCESS TO THE SERVICE WILL BE UNINTERRUPTED OR ERROR-FREE, OR THAT DEFECTS, IF ANY, WILL BE CORRECTED; NOR DOES THE COMPANY MAKE ANY REPRESENTATIONS ABOUT THE ACCURACY, RELIABILITY, CURRENCY, QUALITY, COMPLETENESS, USEFULNESS, PERFORMANCE, SECURITY, LEGALITY OR SUITABILITY OF THE SERVICE OR ANY OF THE INFORMATION CONTAINED THEREIN. YOU EXPRESSLY AGREE THAT YOUR USE OF THE SERVICE AND YOUR RELIANCE UPON ANY OF ITS CONTENTS IS AT YOUR SOLE RISK.
YOU SHALL BE SOLELY AND FULLY RESPONSIBLE FOR ANY DAMAGE TO THE SERVICE OR ANY COMPUTER SYSTEM, ANY LOSS OF DATA, OR ANY IMPROPER USE OR DISCLOSURE OF INFORMATION ON THE SERVICE CAUSED BY YOU OR ANY PERSON USING YOUR USERNAME OR PASSWORD. THE COMPANY CANNOT AND DOES NOT ASSUME ANY RESPONSIBILITY FOR ANY LOSS, DAMAGES OR LIABILITIES ARISING FROM THE FAILURE OF ANY TELECOMMUNICATIONS INFRASTRUCTURE, OR THE INTERNET OR FOR YOUR MISUSE OF ANY PROTECTED HEALTH INFORMATION, ADVICE, IDEAS, INFORMATION, INSTRUCTIONS OR GUIDELINES ACCESSED THROUGH THE SERVICE.
IN THE EVENT OF ANY PROBLEM WITH THE SERVICE OR ANY OF ITS CONTENT, YOU AGREE THAT YOUR SOLE REMEDY IS TO CEASE USING THE SERVICE. UNDER NO CIRCUMSTANCES SHALL THE COMPANY, ANY OF THE COMPANY LICENSOR OR SUPPLIER, OR ANY THIRD PARTY WHO PROMOTES THE SERVICE OR PROVIDES YOU WITH A LINK TO THE SERVICE BE LIABLE IN ANY WAY FOR YOUR USE OF THE SERVICE OR ANY OF ITS CONTENT, INCLUDING, BUT NOT LIMITED TO, ANY ERRORS OR OMISSIONS IN ANY CONTENT, ANY INFRINGEMENT BY ANY CONTENT OF THE INTELLECTUAL PROPERTY RIGHTS OR OTHER RIGHTS OF THIRD PARTIES, OR FOR ANY LOSS OR DAMAGE OF ANY KIND INCURRED AS A RESULT OF THE USE OF ANY CONTENT.
UNDER NO CIRCUMSTANCES SHALL THE COMPANY, ITS LICENSORS OR SUPPLIERS OR ANY THIRD PARTY WHO PROMOTES THE SERVICE OR PROVIDES YOU WITH A LINK TO THE SERVICE, BE LIABLE FOR ANY PUNITIVE, EXEMPLARY, CONSEQUENTIAL, INCIDENTAL, INDIRECT OR SPECIAL DAMAGES (INCLUDING, WITHOUT LIMITATION, ANY PERSONAL INJURY, LOST PROFITS, BUSINESS INTERRUPTION, LOSS OF PROGRAMS OR OTHER DATA ON YOUR COMPUTER OR OTHERWISE) ARISING FROM OR IN CONNECTION WITH YOUR USE OF THE SERVICE, WHETHER UNDER A THEORY OF BREACH OF CONTRACT, NEGLIGENCE, STRICT LIABILITY, MALPRACTICE OR OTHERWISE, EVEN IF WE OR THEY HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
YOU HEREBY RELEASE AND HOLD THE COMPANY, ITS LICENSORS, SUPPLIERS AND PROVIDERS AND ANY THIRD PARTY WHO PROMOTES THE SERVICE OR PROVIDES YOU WITH A LINK TO THE SERVICE HARMLESS FROM ANY AND ALL CLAIMS, DEMANDS, AND DAMAGES OF EVERY KIND AND NATURE (INCLUDING, WITHOUT LIMITATION, ACTUAL, SPECIAL, INCIDENTAL AND CONSEQUENTIAL), KNOWN AND UNKNOWN, SUSPECTED AND UNSUSPECTED, DISCLOSED AND UNDISCLOSED, ARISING OUT OF OR IN ANY WAY CONNECTED WITH YOUR USE OF THE SERVICE. YOU WAIVE THE PROVISIONS OF ANY STATE OR LOCAL LAW LIMITING OR PROHIBITING A GENERAL RELEASE.
YOU ACKNOWLEDGE AND AGREE THAT THE COMPANY IS NOT ENGAGED IN THE PRACTICE OF MEDICINE AND THAT THE COMPANY IS NOT DETERMINING APPROPRIATE MEDICAL USE OF THE SERVICE. THE COMPANY, ITS LICENSORS, SUPPLIER AND ALL THIRD PARTIES WHO PROMOTE THE SERVICE OR PROVIDE YOU WITH A LINK TO THE SERVICE EXPRESSLY DISCLAIMS ANY AND ALL LIABILITY RESULTING FROM THE DELIVERY OF HEALTHCARE VIA THE SERVICE, INCLUDING, BUT NOT LIMITED TO LIABILITY FOR MEDICAL MALPRACTICE.
The Company may suspend or terminate your access to the Service at any time, for any reason or for no reason at all. The Company has the right (but not the obligation) to refuse to provide access to the Service to any person, agency or organization at any time, for any reason or for no reason at all, in our sole discretion. The Company reserves the right to change, suspend, or discontinue all or part of the Service or any functionality, temporarily or permanently, without prior notice. The Company reserves the right to delete or change any username or password at any time, for any reason or for no reason at all.
Without limiting the generality or effect of other provisions of this Agreement, as a condition of use of the Service, you agree to indemnify, hold harmless, and defend the Company and its parents, subsidiaries, affiliates, licensors, suppliers and their officers, directors, affiliates, subcontractors, agents and employees (collectively, "Indemnified Parties" and each, individually, an "Indemnified Party") against all costs, expenses, liabilities and damages (including reasonable attorney's fees) incurred by any Indemnified Party in connection with any third party claims arising out of: (i) your failure to comply with any applicable laws and regulations; (ii) your breach of any of its obligations set forth in this Agreement; and/or (iii) your use of the Service.
ELECTRONIC CONTRACTING AND NOTICES
You agree to the terms of this Agreement by clicking the "AGREE" checkbox. You agree that we may send to you in electronic form any privacy or other notices, disclosures, reports, documents, communications or other records regarding the services (collectively, "Notices"). The Company can send you electronic Notices (1) to the e-mail address that you provided during registration, or (2) by posting the Notice on the Service or otherwise through our site. The delivery of any Notice from the Company is effective when sent by us, regardless of whether you read the Notice when you receive it or whether you actually receive the delivery. You can withdraw your consent to receive Notices electronically by canceling or discontinuing your use of the Service.
NOTICE OF PRIVACY PRACTICES
The HIPAA Notice of Privacy Practices is available below. The Notice of Privacy Practices applies to physicians and other healthcare professionals you choose to communicate with using the Service, unless a healthcare provider and service vendor has adopted and/or furnished you with its own Notice of Privacy Practices. By clicking "AGREE", you acknowledge receipt of the applicable Notice of Privacy Practices and agree to its terms and conditions. In addition, by clicking the "AGREE" button, you are authorizing to release your contact information to the Company in order for the Company to provide you with marketing materials promoting the Service. You may opt out of receiving such marketing materials by contacting us at email@example.com.
By clicking the "AGREE" button you acknowledge that you are consenting to receiving care via the Service from the healthcare providers and service vendors you have chosen to communicate with using the Service. The scope of care will be at the sole discretion of the healthcare providers and service vendors who are treating you, with no guarantee of diagnosis, treatment, or prescription. The healthcare provider will determine whether or not the condition being diagnosed and/or treated is appropriate for a telehealth encounter via the Service.
INFORMED CONSENT FOR SERVICES PERFORMED BY PHYSICIANS AND OTHER HEALTH CARE PROVIDERS VIA THE SERVICE
The Company is providing this information on behalf of the healthcare providers and service vendors whom you choose to communicate with using the Service:
Telemedicine involves the use of electronic communications to enable healthcare providers and service vendors at sites remote from patients to provide consultative services. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include live two-way audio and/or video and other materials (e.g. medical records, data from medical devices). The communications systems used will incorporate network and software security protocols to protect the confidentiality of patient information and will include reasonable measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption. An encounter summary may be provided to the patient at the end of each encounter which may be kept for the patient's records and may be shared with the patient's local primary care or other provider, as appropriate.
The anticipated benefits of telemedicine may include improved access to medical care by enabling a patient to remain at his or her home or office while consulting a healthcare provider and service vendor, and more efficient medical evaluation and management. The possible risks of telemedicine may include delays in medical evaluation and consultation or treatment may occur due to deficiencies or failures of the equipment; failures in security protocols, causing a breach of privacy of personal medical information; and lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other negative outcomes.
By clicking "AGREE," you acknowledge that you understand and agree with the following:
- I understand that telemedicine may involve electronic communication of my personal medical information to healthcare providers and service vendors who may be located in other areas, including out of state.
- I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.
- I understand that I am not guaranteed that a healthcare provider and service vendor will write a prescription or furnish treatment to me using the Service.
- I understand that my healthcare information may be shared with other individuals for treatment, payment and healthcare operations purposes and/or as otherwise specified in the Notice of Privacy Practices.
- I understand that I may give additional express or implied consent while communicating with a healthcare provider and service vendor while using the Service.
- I agree to the terms and conditions of Payment Authorization and Responsibility below.
Patient Consent to the Use of Telemedicine
I have read and understand the information provided above, and understand the risks and benefits of telemedicine, and by clicking "AGREE" I hereby give my informed consent to participate in a telemedicine visit under the terms described herein.
PAYMENT RESPONSIBILITY AND CREDIT CARD AUTHORIZATION
GOVERNING LAW; VENUE; WAIVER OF JURY TRIAL
This Agreement shall be governed by the laws of the State of Michigan without regard to its rules on conflicts or choice of law. You and the Company each agree that to bring any action or proceeding in respect of any claim arising out of or related to this Agreement or the transactions contemplated hereby exclusively in any state court sitting in Oakland County or any federal court in the Eastern District of Michigan (the "Michigan Courts"), and, solely in connection with claims arising under this Agreement or the transactions contemplated hereby that are the subject of this Agreement, (i) irrevocably submits to the exclusive jurisdiction of the Michigan Courts, (ii) waives any objection to laying venue in any such action or proceeding in the Michigan Courts, (iii) waives any objection that the Michigan Courts are an inconvenient forum or do not have jurisdiction over any party. YOU AND THE COMPANY EACH ACKNOWLEDGE AND AGREE THAT ANY CONTROVERSY WHICH MAY ARISE UNDER THIS AGREEMENT IS LIKELY TO INVOLVE COMPLICATED AND DIFFICULT ISSUES, AND THEREFORE EACH SUCH PARTY HEREBY IRREVOCABLY AND UNCONDITIONALLY WAIVES, TO THE EXTENT PERMITTED BY LAW AT THE TIME OF INSTITUTION OF THE APPLICABLE LITIGATION, ANY RIGHT SUCH PARTY MAY HAVE TO A TRIAL BY JURY IN RESPECT OF ANY LITIGATION DIRECTLY OR INDIRECTLY ARISING OUT OF OR RELATING TO THIS AGREEMENT OR THE TRANSACTIONS CONTEMPLATED BY THIS AGREEMENT.
This Agreement constitutes the sole Agreement between you and the Company relating to your use and our provision of the Service and the subject matter hereof, and no representations, statements or inducements, oral or written, not contained in this Agreement shall bind either you or the Company. Any of the terms of this Agreement which are determined to be invalid or unenforceable shall be ineffective to the extent of such invalidity or unenforceability, without rendering invalid or unenforceable any of the remaining terms of this Agreement or affecting the validity or enforceability of the Agreement as a whole. Failure to insist on performance of any of the terms of the Agreement will not operate as a waiver of any subsequent default. No waiver by the Company of any right under this Agreement will be deemed to be either a waiver of any other right or provision or a waiver of that same right or provision at any other time. You may not assign, transfer or delegate your rights or obligations hereunder, in whole or in part. This Agreement shall be binding upon and inure to the benefit of each of the parties and the parties' respective successors and permitted assigns. This Agreement may be modified, supplemented, or superseded by the Company at any time without advance notice.
A printed version of this Agreement and of any related notice given in electronic form shall be admissible in judicial or administrative proceedings based upon or relating to this Agreement to the same extent and subject to the same conditions as other business documents and records originally generated and maintained in printed form.
Personal information or protected health information is information that includes, but is not limited to, identifying data such as name, social security number, address, contact information, as well as information about personal health issues submitted through the Services and credit card or other financial account information. This is the information we aim to protect. The Company will only collect information that you voluntarily submit. The Company intends to keep confidential personally identifiable information that identifies an individual whether or not it relates to an individual's past, present, or future physical or mental health condition. The Company collects information solely for the purposes of providing the Services, marketing and promoting our Services to you and for market research data. The Company gives you the opportunity to "opt out" of receiving direct marketing or market research information by emailing us at firstname.lastname@example.org.
The Company may maintain web logs to record data about all visitors who use this site and interact with the Services and we will store this information. These logs may contain IP address information, types of operating system you use, the date and time you visited the site, and information about the type of device you use to connect to the Services. All Web logs are stored securely and are accessible to a limited number of employees and contractors, who have to adhere to strict guidelines regarding user data security and privacy.
The Company may use technology in the aggregate as opposed to using any personally identifiable information, to understand how our users collectively use the Service. The Company may also use non-personal information to analyze data into useful information. This process of data mining is done in the aggregate, is non-personal, and allows Company to find correlations and patterns in the data.
SECURITY OF INFORMATION COLLECTED
The Company may use account information in a password-protected environment as a security measure to protect your data. The Company uses administrative, physical and technical safeguards to protect data. The Company maintains a data protection via safeguards such as data backup, audit controls, access controls, and some data encryption. The Company’s Site and the Services use industry standard SSL encryption to enhance security of electronic data transmissions. In addition, we urge you to take precautionary measures in maintaining the integrity of your data. Please be responsible in making sure no one can see or has access to your personal account and login/password information. If you use a public computer, e.g., at a library or a university, always remember to log out of the Site or Services. If you use Service through your employer's computer network or through an internet café, library or other potentially non-secure internet connection, such use is at your own risk. It is your responsibility to check beforehand on your employer's or such other site's privacy and security policy with respect to Internet use. The Company is not responsible for your handling, sharing, re-sharing and/or distribution of your personal health information. Moreover, if you forward personal health information electronically to another person on or off the Service, we are not responsible for any harm or other consequences from third party use or re-sharing of your information.
SELF REVIEW OF DATA AND ABILITY TO DELETE YOUR ACCOUNT INFORMATION
You may request to delete any personal information and to de-authorize the collection of personal information in the future by sending us an email at email@example.com.
THIRD PARTY SITES
As noted above, the Company may be a business associate of healthcare providers and service vendors under HIPAA and we share information with healthcare providers and service vendors who provide services to individuals, and they share information with us, for purposes related to treatment, payment and health care operations, and otherwise as agreed or authorized by you. Additionally, the Service may contain links to other sites which are not affiliated with the Company or the healthcare providers and service vendors you choose to communicate with using the Service. The Company does not share your personally identifiable information with those sites (unless you specifically authorize such sharing or it is permitted by the HIPAA Notice of Privacy Practices) and are not responsible for their privacy procedures. The Company seeks to work with trusted partners and organizations that will adhere to similar privacy and ethical standards. However, we encourage you to learn their particular privacy policies.
The Company discloses personally identifiable information about you as required or permitted by law, including complying with legal process (for example, we may disclose your information as necessary to comply with an authorized civil, criminal or regulatory investigation).
The Company does not knowingly permit individuals under the age 18 to create accounts that allow access to the Service.
Copyright © 2021 WoW Health Solutions, LLC. All rights reserved.
HIPAA NOTICE OF PRIVACY PRACTICES
FURNISHED ON BEHALF OF YOUR HEALTHCARE PROVIDERS UTILIZING WoWTM
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.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE,
PLEASE CONTACT THE HIPAA PRIVACY OFFICER IDENTIFIED BELOW.
Your medical information is personal. Your health care provider is committed to protecting your medical information. Your health care provider creates a record of the care and services you receive from us. Your health care provider needs this record to provide you with care and to comply with certain legal requirements. This Notice applies to all of the records of your care created and maintained by your health care provider who utilizes WoW’s service.
This Notice will tell you about the ways in which your healthcare providers may use and disclose your medical information. This Notice will also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.
Your healthcare provider is required by law to: (1) make sure that medical information that identifies you is kept private; (2) give you this Notice of your health care provider’s legal duties and privacy practices with respect to medical information about you; and (3) follow the terms of the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION:
The following describes the different ways that your medical information may be used or disclosed. For clarification, some examples are included. Not every possible use or disclosure is specifically mentioned. However, all of the ways your health care provider is permitted to use and disclose your medical information will fit within one of these general categories:
. Your healthcare provider will use medical information about you to provide you with medical treatment and services. Your health care provider may disclose medical information about you to doctors, nurses, technicians and other personnel who are involved in providing you medical treatment.
. Your healthcare provider may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or a third party. For example, your health care provider will need to disclose information to WoW and others about treatment you will receive or have received in order to pay your health care provider for the treatment.
For Health Care Operations
. Your healthcare provider may use and disclose medical information about you for health care operations. For example, your healthcare providers may use medical information to review its treatment and services and to evaluate the performance of its staff in caring for you. Your healthcare providers may also combine medical information about many of its patients to decide what additional services it should offer, what services are not needed, and whether certain new treatments are effective. Your healthcare providers may also disclose information to doctors, nurses, technicians, and other personnel for review and learning purposes. Your healthcare providers may remove information that identifies you from this set of medical information so others may use it to study healthcare and healthcare delivery without learning the identity of the specific patients.
. Your healthcare providers may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.
. Your healthcare providers may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services
. Your healthcare providers may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
. Under certain circumstances, your healthcare providers may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition.
As Required By Law
. Your healthcare providers will disclose medical information about you when required to do so by federal, state or local law. For example, disclosure may be required by Workers’ Compensation statutes and various public health statutes in connection with required reporting of certain diseases, child abuse and neglect, domestic violence, adverse drug reactions, etc.
To Avert a Serious Threat to Health or Safety
. Your healthcare providers may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Health Oversight Activities
. Your healthcare providers may disclose medical information to a governmental or other oversight agency for activities authorized by law. For example, disclosures of your medical information may be made in connection with audits, investigations, inspections, and licensure renewals, etc.
Lawsuits and Disputes
. If you are involved in a lawsuit or a dispute, Your healthcare providers may use your medical information to defend themselves or to respond to a court order.
. Your healthcare providers may release medical information about you if required by law when asked to do so by a law enforcement official.
Coroners and Medical Examiners
. Your healthcare providers may release medical information to a coroner or medical examiner to identify a deceased person or determine the cause of death.
Uses and Disclosures Requiring an Authorization
Other uses and disclosures of your medical information not covered by this Notice of Privacy Practices will be made only with your written authorization. If you provide your healthcare providers such an authorization in writing to use or disclose medical information about you, you may revoke that authorization, in writing, at any time, except to the extent that we have acted in reliance of it. If you revoke your authorization, Your healthcare providers will no longer use or disclose medical information about you for the reasons covered by your written authorization. The following are examples of uses and disclosures requiring an authorization:
Psychotherapy Notes. If your healthcare provider maintains information which qualifies as "psychotherapy notes" as defined below, your health care provider must obtain an authorization for any use or disclosure of psychotherapy notes, except: (i) To carry out the following treatment, payment, or health care operations: (A) Use by the originator of the psychotherapy notes for treatment; (B) Use or disclosure by the covered entity for its own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family, or individual counseling; or (C) Use or disclosure by the covered entity to defend itself in a legal action or other proceeding brought by the individual; and (ii) A use or disclosure that is required by the Secretary of HHS to investigate or determine our compliance or permitted by law; uses and disclosures for health oversight activities with respect to the oversight of the originator of the psychotherapy notes; uses and disclosures about decedents; or uses and disclosures to avert a serious threat to health or safety of a person or the public. Psychotherapy notes means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.
Marketing. Your healthcare provider is required by law to receive your written authorization before we use or disclose your health information for marketing purposes, except if the communication is in the form of: (A) a face-to-face communication made by it to you; or (B) a promotional gift of nominal value we provide. If the marketing involves direct or indirect remuneration to your healthcare provider from a third party, the authorization must state that such remuneration is involved. If the marketing involves financial remuneration to your healthcare provider from a third party, the authorization must state that such remuneration is involved.
Sale of PHI. Under no circumstances will your healthcare providers sell patient lists or your health information to a third party without your written authorization. Such authorization must state that the disclosure will result in remuneration to the covered entity.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:
You have the following rights regarding the medical information your health care provider maintains about you:
Right to Inspect and Copy
. You have the right to inspect and copy your medical information with the exception of any psychotherapy notes. To inspect and copy your medical information, you must submit your request in writing to the HIPAA Privacy Officer. If you request a copy of the information, Your healthcare provider may charge a fee for the costs of copying, mailing or other supplies associated with your request. Your healthcare provider may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed. For information regarding such a review, please contact the HIPAA Privacy Officer.
If your medical information is maintained in an electronic health record, you also have the right to request that an electronic copy of your record be sent to you or to another individual or entity. Your health care provider may charge you a reasonable cost-based fee limited to the labor costs associated with transmitting the electronic health record.
Right to Amend
. If you feel that medical information your healthcare provider has about you is incorrect or incomplete, you may ask your health care provider to amend the information. You have the right to request an amendment for as long as the information is kept by your healthcare provider. To request an amendment, your request must be made in writing and submitted to the HIPAA Privacy Officer. In addition, you must provide a reason that supports your request. Your health care provider may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, your health care provider may deny your request if you ask it to amend information that: (a) was not created by your healthcare provider; (b) is not part of the medical information kept by your healthcare provider; (c) is not part of the information which you would be permitted to inspect and copy; or (d) is accurate and complete.
Right to an Accounting of Disclosures
. You have the right to request an “accounting of disclosures.” This is a list of the disclosures your healthcare provider has made of your medical information. Your healthcare provider is not required to list certain disclosures, including disclosures made for treatment, payment, and health care operations purposes or disclosures made incidental to treatment, payment, and health care operations; however, if these disclosures were made through an electronic health record, you have the right to request, beginning on dates established by law or regulation, an accounting for such disclosures that were made during the previous 3 years. To request this accounting of disclosures, you must submit your request in writing to the HIPAA Privacy Officer. Your request must state a time period which may not be longer than six years.
Right to Request Restrictions
. You have the right to request a restriction or limitation on the use or disclosure your healthcare provider makes of your medical information. Your health care provider is not required to agree to your request for a restriction, except as noted below. If your healthcare provider does agree, your healthcare provider will comply with your request unless the information is needed to provide you emergency treatment.
Your healthcare provider is required to agree to your request for a restriction if, except as otherwise required by law, the disclosure is to a health plan for purpose of carrying out payment or health care operations (and is not for purposes of carrying out treatment) and the medical information pertains solely to a health care item or service for which we have been paid out of pocket in full. To request restrictions, you must make your request in writing to the HIPAA Privacy Officer.
Right to Request Confidential Communications
. You have the right to request that your healthcare provider communicate with you only in a certain manner. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the HIPAA Privacy Officer. Your health care provider will accommodate all reasonable requests.
Right to a Paper Copy of This Notice
. You have the right to a paper copy of this Notice. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice at our website at the address listed below. To obtain a paper copy of this Notice, contact the HIPAA Privacy Officer.
Right to Receive Notice of Discovery of a Breach of Unsecured Protected Health Information
. Your health care provider is required to notify you of any breach of unsecured protected health information concerning you following the discovery of the breach when required by regulation.
REVISIONS TO THIS NOTICE:
Your healthcare provider reserves the right to revise this Notice. Any revised Notice will be effective for medical information your health care provider already has about you as well as any information we receive in the future. Your health care provider will post a copy of any revised Notice on its website. Any revised Notice will contain on the first page, in the top right-hand corner, the effective date.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with your healthcare provider, contact:
[Insert Your Health Care Provider’s Name]
HIPAA Privacy Officer
Care of WoW
All complaints must be submitted in writing.