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First Stop Health Agreement

USER AGREEMENT

Please read these terms carefully. These terms include important limitations on your legal rights, including under the headings "Important Disclaimers," "Limitation of Liability," "Indemnification" and "Dispute Resolution."

This is a binding agreement between First Stop Health, LLC ("FSH," also referred to as "we," "us" or "our") and any person who has indicated their assent hereto by clicking an "I agree" button or by accessing or establishing a connection to the Services (as defined below). You agree to abide by all of the provisions of this agreement in order to remain an authorized user of the Website and Services. If you do not agree to the provisions of this agreement or are not satisfied with the Services, your sole and exclusive remedy is to discontinue your use of the Services.

The terms and conditions of our vendors with respect to use of their products and services, including all third-party providers of content on the Website, are incorporated by reference herein. Your acceptance of this agreement indicates your assent to be bound by those terms.

ACCESS TO THE WEBSITE AND SERVICES

To access any part of http://fshealth.com (the "Website"), any other software or electronic resources, or any advisory services that may be provided by independent providers who have contracted with FSH (any of the foregoing including the Website, the "Services"), you are asked to provide registration information. It is a condition of your use of the Services that all the information you provide is correct, current, and complete. If FSH believes the information you provide is inaccurate or intended for purposes other than becoming a bona fide member of FSH, FSH may terminate or suspend your access to the Services and neither you nor your employer or other third party that has paid for your access will be entitled to a refund in that event. FSH has sole discretion to accept or reject the username that you select.

The Website and Services are not, under any circumstances, intended to be used for medical emergencies or urgent care needs. If you think you have an emergency, you should always call 911.

The First Stop Health Services are not available for direct access by children under the age of 16. Use of the First Stop Health Services directly by children between the ages of 16 and 18 requires the consent of a parent or legal guardian. Parents or guardians may access the First Stop Health Services on behalf of their children under 16 through their own accounts.

The Services do not include the provision of medical evaluation, diagnosis, treatment or care by FSH. FSH provides you with access to health information from trusted sources and individuals who help facilitate your interactions with medical caregivers. FSH may partner with and provide you with access to independent medical professionals, including doctors ("Independent Doctors") who are solely responsible for their medical services.

You agree that FSH may, without prior notice for any reason or no reason, immediately terminate your account and access to the Services. You agree that all terminations for cause shall

be made in FSH's discretion and that FSH shall not be liable to you or any third-party for any termination of your account. In the event of termination other than for misuse or fraud, FSH will provide you with reasonable means to acquire the information you have stored within the Services and will provide the appropriate party with a pro rata refund of payments made by you or a third party on your behalf.

PAYMENT OF MEMBERSHIP FEES

Your continued use of the Service is governed by the terms of our agreement with the organization to which you belong (which may be your employer) that has contracted with us to provide the Services to you. Access to the Services requires payment of a membership fee and any applicable taxes by your providing organization (the "Charges"). All Charges associated with your membership must be current and fully paid in order for you to continue to access the Services. You further acknowledge that your providing organization’s obligation to pay the Charges does not depend on use of the Services, and that your providing organization remains obligated to pay FSH for the Services regardless of whether or not the Services are used.

MEMBERSHIP

You are a member of an organization with which you or a family member are affiliated (employer, union, association, etc.,). This third party is paying for you to use Services on the Website.

If an Independent Doctor believes that any member is abusing the system for any reason, he/she will report that to us. Examples of abuse include making calls that have no medical purpose, calling repeatedly for the same ailment, and attempting to obtain inappropriate prescription medicines through fraudulent misrepresentations. In such cases we may in our sole discretion terminate your membership immediately or alternately limit the calls you may make to us. No refunds or credits will be due to you or your providing organization as the result of such a termination. The Independent Doctors are prohibited by state and federal laws from prescribing a variety of drugs. These include almost all pain killers, diet drugs, mood stabilizers, sleeping pills, psychoactive drugs, and stimulants. In states that require a prescription for pseudoephedrine, Independent Doctors will not provide these prescriptions. See the DEA's list of drugs that may not be prescribed via telemedicine.

Additionally, Independent Doctors, as a matter of policy, will not prescribe lifestyle drugs such as Viagra (erectile dysfunction), Propecia (hair regrowth), and certain other drugs that they believe require direct examination or supervision.

Please see our prescription policy at https://www.fshealth.com/prescription-policy/ for details. Failure to prescribe any drug shall not be grounds for termination of your agreement with us nor shall it entitle you or your providing organization to a refund of any kind.

We have a contract with your providing organization that may include additional or overriding terms to these conditions. Please consult with your organization for details.

RENEWAL OF MEMBERSHIP

Your renewal and ability to use the Service following your termination will be governed by the terms of our agreement with your providing organization. Please consult with your providing organization for details.

CANCELLATION

Cancellation of your membership will be governed by the terms of our agreement with your providing organization as well as this User Agreement. Please consult with your providing organization for details.

Your Electronic Health Record ("EHR") shall remain available to you notwithstanding your cancellation of a membership. If FSH intends to delete your EHR, it shall provide you with reasonable advance notice, at the last e-mail address provided by you, and afford you the opportunity to download its contents.

CANCELLING MONTH TO MONTH SUBSCRIPTIONS

By signing up for a month to month subscription, you are agreeing to a six month long commitment. You can cancel your monthly subscription any time after your six month long commitment has ended. You may notify us of your intent to cancel at any time. If your cancellation request comes before the completion of your six month commitment, your payment method will automatically be processed until the end of the six month term from the beginning of your subscription and you will not receive a refund for the first six months of payment. If your cancellation request comes after the six month commitment has concluded, your cancellation will become effective at the end of your current monthly billing period. You will not receive a refund for that month; however your subscription access and/or delivery and accompanying subscriber benefits will continue for the remainder of the current monthly billing period.

CANCELLING SIX MONTH SUBSCRIPTIONS

When cancelling a six month subscription, all future charges associated with future months of your subscription will be cancelled. You may notify us of your intent to cancel at any time; your cancellation will become effective at the end of your current monthly billing period. You will not receive a refund; however your subscription access and/or delivery and accompanying subscriber benefits will continue for the remainder of the current monthly billing period.

CANCELLING YEARLY SUBSCRIPTIONS

When cancelling a yearly subscription, all future charges associated with future years of your subscription will be cancelled. You may notify us of your intent to cancel at any time; your cancellation will become effective at the end of your current annual billing period. You will not receive a refund, prorated or otherwise, for the remainder of the annual term. However, your subscription access and/or delivery and accompanying subscriber benefits will continue for the remainder of the current annual billing period. In order to change or cancel your subscription please contact info@uncoveredhc.com

SUBSCRIPTION TERMS

Your subscription begins as soon as your initial payment is processed. Your account access to First Stop Health telemedicine services will be granted two business days after your payment has been processed. Your subscription will automatically renew, based on the terms of your subscription, without notice until you cancel. You authorize us to store your payment method(s) and to automatically charge your payment method(s) every month until you cancel. We will automatically charge you the then-current rate for your plan, plus applicable taxes, every month upon renewal until you cancel.

 

PRIVACY

FSH's Privacy Policy, located at http://www.fshealth.com/privacypolicy, describes FSH's collection and use of your personal and other information. The Privacy Policy is part of this agreement and you explicitly consent to FSH's use of your personal information as described therein.

RESTRICTIONS ON USE

You may search, retrieve, access, display, download and print content from the Website only for your personal, non-commercial use. Use of the Services is limited to registered and authorized users. You may not use the Services for any other purpose. You may not, for example, (i) modify, publish, distribute, transmit, systematically download, use automated means (including so called "crawlers," "bots" and "spiders") to index or extract data from, participate in the transfer or sale or rental of, translate, create derivative works from, frame, co-brand, or in any way exploit any part of the Services other than for personal use or as specifically permitted in this agreement, without FSH's written consent; (ii) reverse engineer, disassemble or decompile any section or technology on the Website or used in providing the Services; (iii) transfer or resell your access to the Services to any third party; or (iv) use the Services in any harmful manner or interfere with any party's use or enjoyment of the Services. You agree to cooperate with FSH in causing any unauthorized use of the Services to immediately cease.

Any party seeking permission for systematic access (automated queries, meta-search, etc.) should contact FSH using this form here.

OWNERSHIP

The material accessible within the Services, including text, data, images, interfaces and other materials or works of authorship (collectively, the "Content"), is owned or licensed by FSH. FSH

and its licensors own all right, title and interest in and to the Services and Content, including all copyrights, trademarks and other intellectual property rights. Content may not be copied, distributed, republished, uploaded, posted, or transmitted in any way without the prior written consent of FSH, except that you may print out limited portions of the Content solely for your personal use. You may not remove or alter, or cause to be removed or altered, any copyright, trademark, trade name, service mark, or any other proprietary notice or legend appearing on any of the Content.

RECORDINGS

All consultations with physicians for diagnostic purposes are recorded and made available to the calling member via their internal member dashboard. Calls may be reviewed for customer service, data collection, and quality control purposes. All members' information, including recordings, are considered to be Personal Health Information (PHI) and are covered by FSH's privacy policy.

CONTENT SUBMISSIONS

You retain ownership of all text, photos, graphics, or other material submitted or communicated to FSH through the Website or the Services for inclusion in your electronic health record. All information contained in your EHR will be maintained in confidence in accordance with our privacy policy. With respect to all other content you may provide on the site (e.g., blogs, comments, etc., collectively referred to as "User Generated Content"), you also retain ownership of this material. You hereby grant to FSH the royalty-free, perpetual, irrevocable, worldwide, non-exclusive right and license to use, reproduce, modify, adapt, publish, translate, create derivative works from, distribute, perform, and display, and to incorporate any User Generated Content in other works in any form, media, or technology now known or later developed. FSH will not be required to treat any User Generated Content as confidential, and may use it in its business (including without limitation, for products or advertising) without incurring any liability for royalties or other payment. FSH shall not be liable as a result of any similarities between User Generated Content and future FSH operations. You represent to FSH that you own or otherwise possess all necessary rights to use the User Generated Content for the purposes provided.

You may not post, send, submit, publish, or transmit in connection with the Services any material that (i) you do not have the right to post, including proprietary material of any third party, (ii) advocates illegal activity or discusses an intent to commit an illegal act, (ii) is vulgar, obscene or threatening, (iv) libels, defames, or invades the privacy of other users, (v) does not pertain directly to the subject matter of the Services or advertises another product or service, includes programs that contain viruses, worms, or any other malicious computer code, or includes any spamming or phishing messages; (vi) alters or modifies any of the Content or the Services; or (vii) contains hyperlinks to other sites that contain content that falls within the descriptions set forth above.

FSH reserves the right to monitor use of the Website to determine compliance with this agreement, as well the right to remove or refuse User Generated Content for any reason.

Notwithstanding these rights, you remain solely responsible for the content of User Generated Content.

EXTERNAL LINKS

The Website may contain hyperlinks to other websites that are not owned or operated by FSH. These links are provided for your convenience, and FSH may receive commissions or other financial compensation from the owners of these websites. Hyperlinks are to be accessed at your own risk. FSH has no control over other websites and is not liable for any content, advertising, products, services or other materials on or available from those websites. Nonetheless, we wish to provide the best possible experience for our users, and we therefore invite feedback about any websites that are linked from within the Services.

DIGITAL MILLENNIUM COPYRIGHT ACT ("DMCA") NOTICE TO COPYRIGHT OWNERS

FSH owns, protects and enforces copyrights in its own creative material and respects the copyrights of others. Materials may be made available on the Services, or via the Services, by third parties not within the control of FSH. It is our policy not to permit materials known by us to be infringing to remain on this Website.

In accordance with the Digital Millennium Copyright Act, or "DMCA" (summary here), you should notify us promptly if you believe any materials displayed within the Services infringe your copyright. Regardless of whether we are liable for such infringement, our response may include removing or disabling access to material claimed to be infringing activity and/or terminating the alleged infringer's access to the Website. If we remove or disable access in response to your notice, we will make a good-faith attempt to contact the person who submitted the material so that they may have the opportunity to submit a counter notification.

Please send all notices to FSH at 233 N. Michigan Ave., Suite 1400, Chicago, IL 60601. Your notice of alleged copyright infringement should include:

A description of how your copyrighted work or other intellectual property has been infringed;

A description of where the infringing material is located on the Website;

Where we can contact you and, if different, where the allegedly infringing party can contact you;

A statement that you believe that the use of the material is not authorized by the copyright or other intellectual property rights owner, by its agent, or by law;

A statement, under penalty of perjury, that the information in the notification is correct and that you are authorized to act on behalf of the owner of the exclusive right that is alleged to be infringed; and

Your electronic or physical signature.

Please note that under the DMCA, misrepresentations made in your notices or counter notices can expose you to liability for substantial damages. If you are not sure whether material available

on the Website infringes your copyright, or whether material posted by you is infringing, you should seek legal advice.

SECURITY AND SECURITY VIOLATIONS

Passwords used to access the Services are for individual use only. Distribution of your user name or password to others for access to the Services is prohibited and may result in termination of your account or other liability. You are responsible for the security of your own password and for all activities that occur through the use of your account if accessed with your password, including liability for damages resulting from misuse. If you use a password that FSH considers insecure, FSH may require you to change the password or terminate your account. If you have reason to believe that your account with FSH is no longer secure, you must immediately notify FSH using this form here and request that your password be changed.

You may not attempt to violate the security of the Services, or use the Services to violate the security of other persons or websites or to violate the law, including by: (i) accessing data not intended for you or logging into an account that you are not authorized to access, (ii) attempting to probe, scan or test the vulnerability of the Services or to breach security or authentication measures, (iii) attempting to interfere with service to any user, host or network, including without limitation, by submitting a virus to the Services, overloading, conducting "denial of service attacks," "flooding," "spamming," "mail bombing" or "crashing," (iv) sending unsolicited e-mail, including promotions and/or advertising of products or services, spam or phishing messages, (v) forging any TCP/IP packet header or any part of the header information in any e-mail, (vi) attempting to alter or modify any of the Content or Services, or (vii) attempting to decipher, decompile, disassemble or reverse engineer any of the software making up any part of the Services.

FSH will take all reasonably necessary steps to investigate suspected violations of this agreement. FSH reserves the right to involve and fully cooperate with any law enforcement authorities and comply with court orders requesting or directing FSH to disclose the identity of anyone engaging in conduct that is believed to violate the law. FSH further reserves the right, in its discretion, to release your details to system administrators at other sites in order to assist them in resolving security incidents.

You release and hold harmless FSH from and against any claims resulting from any action taken by FSH during or as a result of its investigations and from any actions taken as a consequence of investigations by either FSH or law enforcement authorities.

Please review the following section with particular care, as they significantly affect your legal rights.

IMPORTANT DISCLAIMERS

You acknowledge that your use of the site and the services is at your sole risk. The services are provided on an "as is" and "as available" basis. FSH is not responsible for the acts or omissions of any medical or other health care providers or for the content that you access through the

Services. FSH disclaims any warranties, express or implied, including any implied warranties of merchantability, fitness for a particular purpose, title, or non-infringement.

Without limiting the generality of the above, FSH makes no warranties:

Regarding the accuracy, suitability, completeness or timeliness of the information, products or services you receive on or through the Services;

That the Services will be uninterrupted or error-free, or that defects will be corrected; or

That the Website or the server that makes it available are free of viruses or other harmful components.

The Services include content, technology and other features provided by third parties, including the opportunity for users of the Services to purchase goods or services from third parties. FSH makes no warranties with regard to, nor does it endorse, the content, technology, goods or services provided by the third parties. Your recourse for dissatisfaction or problems with the foregoing must be pursued exclusively through the third party, and you agree not to make any claim against FSH with respect to those third party goods or services. Should you make any such claim against FSH, you will be responsible for all legal fees and expenses incurred by FSH, regardless of whether you prevail in the matter.

LIMITATION OF LIABILITY

IN NO EVENT SHALL FSH, ITS SUBSIDIARIES, AFFILIATES, LICENSORS, SERVICE PROVIDERS, CONTENT PROVIDERS, EMPLOYEES, AGENTS, OFFICERS, AND DIRECTORS (COLLECTIVELY THE "FSH PARTIES") BE LIABLE FOR ANY INCIDENTAL, DIRECT, INDIRECT, PUNITIVE, ACTUAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR OTHER DAMAGES, INCLUDING PERSONAL INJURY, WRONGFUL DEATH, PRODUCTS LIABILITY, TORT, LOSS OF REVENUE OR INCOME, PAIN AND SUFFERING, EMOTIONAL DISTRESS, OR SIMILAR DAMAGES, EVEN IF THE FSH PARTIES HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

In no event will the collective liability of FSH Parties to you (regardless of the form of action, whether in contract, tort, or otherwise) exceed the greater of $500 or the amount that has been paid to FSH for the services provided to you individually during the most recent 12-month period.

You agree that your providing organization will be responsible by reason of such payment for the Services provided to you by FSH or its contractors and you may not bring any claim against your providing organization with respect thereto. Your providing organization is an intended beneficiary of this agreement for the purpose of defending any claim you bring in violation of your agreements contained in this paragraph.

You agree to waive, to the fullest extent permitted by law, all laws that may limit the efficacy of indemnifications or releases, specifically including California Civil Code Section 1542, which provides:

A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.

INDEMNIFICATION

To the maximum extent permitted by law, you shall indemnify the FSH Parties for and defend the FSH Parties against all third-party claims, liabilities and expenses, including legal fees and costs, arising out of your use of the Services or your breach of any representation contained in or other provision of this agreement. FSH reserves the right, in its sole discretion and at its own expense, to assume the exclusive defense and control of any claim for which you are obligated to provide indemnification under this section. You will cooperate as fully as reasonably required in the defense of any claim.

DISPUTE RESOLUTION

If you have a membership, the parties agree that any dispute relating to this agreement shall be finally resolved by binding arbitration administered by JAMS in accordance with its Arbitration Rules, and judgment on the arbitration award may be entered in any court of appropriate jurisdiction in accordance with the Federal Arbitration Act. The place of the arbitration shall be in Chicago, Illinois.

If you obtained your membership through an organization, disputes will be resolved in accordance with the terms of our agreement with your organization.

AMENDMENT

FSH may modify this agreement at any time by posting the revised terms on the Website. Use of the Services after the effective date of any modifications posted on the Website will be deemed to be your acceptance of the changes. If you do not accept the agreement, you must discontinue use of the Services. Certain categories of users may be required to accept or reject modifications to this agreement during their next sign-on to the Services. Failure to accept the modifications may result in interruption of access to the Services.

The date of last revision to this agreement is indicated at the bottom of this page.

MISCELLANEOUS

This agreement shall be governed and interpreted pursuant to the laws of the State of Illinois (United States of America), without regard to its choice of law rules. If any part of this agreement is unlawful, void, or unenforceable, that part will be deemed severable and will not affect the validity and enforceability of any remaining provisions. FSH may provide notice to you by e-mail (effective upon transmission) or by written communication delivered by express courier (effective upon confirmed delivery), to the e-mail or street address you provided during registration. You may give legal notice to FSH by express courier (effective upon confirmed delivery) at 233 N. Michigan Ave., Suite 1400, Chicago, IL 60601 and, Attention: General Counsel.

CONTACT AND FEEDBACK

We welcome and encourage feedback, comments and suggestions for improvements to the Services ("Feedback"). You may submit Feedback here. You agree that all Feedback will become the sole and exclusive property of FSH and you hereby irrevocably assign to FSH all of your right, title, and interest in and to all Feedback.

 

 

 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 THIS NOTICE CAREFULLY. 

Your online health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information ("PHI"). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act ("HIPAA"), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules. It also describes your rights regarding how you may gain access to and control your PHI. 

We are required by law to maintain the privacy of PHI. We are providing you with this Notice of Privacy Practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website or by sending a copy to you upon request. 

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU 

For Treatment. 

Your PHI may be used and disclosed without authorization by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with other treatment team members. 

For Payment 

We may use and disclose PHI without authorization so that we can receive payment for the treatment services provided to you. Examples of payment-related activities are: making a determination of eligibility or coverage, processing claims, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection. 

For Health Care Operations 

We may use or disclose without authorization, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., scheduling or data entry services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. 

Required by Law 

Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the HIPAA Privacy Rule. 

Without Authorization. Following is a list of the other categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law permits us to disclose information about you without your authorization only in a limited number of situations. 

Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect if we believe a case has occurred. 

Judicial and Administrative Proceedings. We may disclose your PHI pursuant to a subpoena (with your written consent or protective order), court order, administrative order or similar process. 

Deceased Patients. We may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person' s estate or the person identified as next-of-kin. PHI of persons that have been deceased for more than fifty (50) years is not protected under HIPAA. 

Medical Emergencies. We may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. 

Family Involvement in Care. We may disclose information to close family members or friends directly involved in your treatment. 

Health Oversight. If required, we may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance and peer review organizations performing utilization and quality control. 

Workers Compensation. We may disclose your health information as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs. 

Law Enforcement. We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent or protective order), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises. 

Specialized Government Functions. We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI. 

Public Health. If required, we may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority. 

Public Safety. We may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat. 

Research. PHI may only be disclosed after a special approval process or with your authorization. 

With Authorization. Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that we have already made a use or disclosure based upon your authorization. The following uses and disclosures will be made only with your written authorization: (i) most uses and disclosures of psychotherapy notes which are separated from the rest of your medical record; (ii) most uses and disclosures of PHI for marketing purposes, including subsidized treatment communications; (iii) disclosures that constitute a sale of PHI; and (iv) other uses and disclosures not described in this Notice of Privacy Practices. 

YOUR RIGHTS REGARDING YOUR PHI 

You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Privacy Officer at Attention: 

Privacy Issues 

233 N. Michigan Ave., Suite 1400 

Chicago, IL 60601 

Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a "designated record set". A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is held or maintained by another party or contained in separately maintained psychotherapy notes. We may charge a reasonable, cost-based fee for copies. You may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person. 

Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy. Please contact the Privacy Officer if you have any questions. 

Right to an Accounting of Disclosures. You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period. 

Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, we are required to honor your request for a restriction. 

Right to Request Confidential Communication. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. We will accommodate reasonable requests. We may require information regarding how payment will be handled or specification of an alternative address or other method of contact as a condition for accommodating your request. We will not ask you for an explanation of why you are making the request. 

Breach Notification. If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself. 

Right to Have Someone 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 health information. We will confirm that such person has the authority and can act on your behalf before we take action. 

Right to a Copy of this Notice. You have the right to a copy of this notice. 

COMPLAINTS 

If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Privacy Officer at Attention: 

Privacy Issues 

233 N. Michigan Ave., Suite 1400 

Chicago, IL 60601 

 

or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling (202) 619-0257. We will not retaliate against you for filing a complaint.