Program Administrator: DialCare, LLC ("DialCare")
7400 Gaylord Parkway, Frisco, TX 75034
To add a family member to your plan or for assistance using your plan, please call Member Services at (855)335-2255.
Terms and Conditions: These Terms and Conditions are part of the membership agreement (Agreement) between you and DialCare, LLC ("DialCare"). DialCare provides administrative services to DialCare clinicians and does not provide professional medical or behavioral health services. The Terms and Conditions define the obligations of DialCare, its authorized agents and yourself, and they establish the basic rules of safe and fair use of DialCare's public website, member website, and services (Services). DialCare and its authorized agents reserve the right to immediately and without advance notice terminate the Services and deny access to individuals who do not abide by the Terms and Conditions.
Use of DialCare for Health Care Services: DialCare's telemedicine consults are provided by independent clinicians who are dedicated to the safe and effective, evidence-based practice of telemedicine. You choose to enter into a clinician-patient relationship with DialCare's physicians because your primary care physician is not available. You acknowledge that your clinician-patient relationship with a DialCare physician does not replace your relationship with your primary care physician. You agree to pay for telemedicine consults at the time you request a consultation, unless payment arrangements have been made through your employer, association, or another entity. You agree to have your medical history and other diagnostic and medical documentation reviewed by one of DialCare's clinicians.
You acknowledge that DialCare's clinicians may choose not to treat your condition or prescribe a medication for your condition. DialCare's clinicians do not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. You agree to accurately represent your location city and state when requesting a clinical consult.
Limitations, Exclusions & Exceptions: This plan is a telemedicine program offered by DialCare. DialCare is not a licensed insurer, health maintenance organization or other underwriter of health care services. This plan is not insurance. DialCare is not licensed to provide and does not provide health care services or items to individuals. Telemedicine consultations are provided by physician entities and behavioral health entities that are contracted with DialCare. Physicians and behavioral health professionals contracted by DialCare are solely responsible for the professional advice and treatment rendered to members and DialCare disclaims any liability with respect to such matters. DialCare may not be available in all states, and certain methods of telemedicine consultations (e.g., phone, video) may not be available per state law. Consultation times are not guaranteed. Telemedicine consultations are not appropriate for emergencies or other medical issues requiring in-person care. You must immediately dial "911" or seek in-person treatment in the event of a medical emergency, or if instructed to do so by a DialCare clinician. DialCare reserves the right to deny care for potential misuse of services. You are obligated to pay for all health care services resulting from consultations. Services and service providers may change or be discontinued at any time with notice as required by law.
You understand that your account may not be available at all times due to unanticipated system failures, back-up procedures, maintenance, or other causes beyond the control of DialCare or its authorized vendors and agents. Access is provided on an "as-is, as-available" basis and DialCare or its authorized vendors and agents do not guarantee that you will be able to access your account or receive Services at all times. Services are provided without representations or warranties of any kind, either express or implied. DialCare does not warrant accuracy, completeness or timeliness of the services or the content of the DialCare site. You understand that DialCare or its authorized vendors and agents take no responsibility for and disclaim any and all liability arising from any inaccuracies or defects in software, communication lines, the virtual private network, the Internet or your Internet Service Provider (ISP), access system, computer hardware or software, or any other service or device that you use to access your account.
Obligations: DialCare grants you a non-transferable license, subject to the terms of this Agreement, to use DialCare Services. In order to be valid, your account must contain certain required true, correct and verifiable information about your identity and medical history. In order to maintain access to DialCare services, and in order for DialCare to provide you important information regarding your medical or behavioral health treatment and health, it is your responsibility to update your personal account information and to notify DialCare of any changes in your home address, e-mail address, telephone number, guardian, or emergency contact. Your failure to do so may result in interruption of the Services or impairment of DialCare's ability to deliver important time-sensitive information about your medical condition, medications, and laboratory and diagnostic test results. You may update your personal information by accessing your account through the DialCare Website and logging in with your user name and password.
It is your duty to be truthful and accurate with all the information you enter into or upload to the system. You understand that any misstatements or misrepresentations about a patient's condition may result in serious harm to that patient. The documentation of consultations will be maintained in your account. You may also use your account to upload relevant medical information pertaining to your current health, medical condition and health history. While your account with DialCare is active and in good standing, you will have unlimited access to the information stored in your account. You are advised to immediately contact DialCare if you disagree with or do not understand the contents of the consultation report or the instructions issued by the treating DialCare clinician.
You understand that it is extremely important that you keep your password to access DialCare completely confidential. If at any time you feel that the confidentiality of your password has been compromised, you will change it by going to the Password link on the DialCare website. You understand that DialCare and their authorized vendors and agents take no responsibility for and disclaim any and all liability or consequential damages arising from a breach of your account or health information resulting from your sharing or losing your password. You also agree not to attempt or facilitate an attempt to attack or undermine the security or the integrity of the systems or networks of DialCare, the software provider or any of its authorized agents or affiliates. If DialCare, or their authorized vendors and agents, discovers that you have inappropriately shared your password with another person, or that you have misused or abused your online access privileges in any way, your use of the Services may be discontinued without prior notice.
When receiving a consultation, your environment should ensure privacy. You should be easily heard and visible (for video consultations). Your camera must be placed on a secure, stable platform to avoid wobbling and shaking during the videoconferencing session. Any device you use for a consultation shall have up-to-date antivirus software and shall have the latest security patches and updates applied to the operating system and any 3rd party applications.
If you are a legal guardian or a parent of a child under age 18, you accept this Agreement on their behalf. You agree not to falsify or misrepresent your identity or your authority to act on behalf of another person. Patients under the age of 18 may only use DialCare medical services at the discretion of their parent or guardian. Behavioral health services are provided on a case-by-case basis in compliance with state parental consent laws.
You understand that DialCare clinicians or staff may send you messages. These messages may contain information that is important to your health and medical care. It is your responsibility to monitor these messages. By entering your valid and functional email address and mobile phone number, you authorize DialCare to notify you of messages sent to your DialCare Inbox. You understand that contents of any message may be stored in your account. You agree that all communication will be in regard to your own health condition(s). You understand that asking for advice on behalf of another person violates the Terms and Conditions. DialCare and its clinicians do not assume any responsibility for health information or services used by persons other than you.
Indemnification: You agree not to hold DialCare or its authorized vendors and agents liable for any loss, injury or claims of any kind resulting from your violation of the Terms and Conditions or your failure to read DialCare messages in a timely manner, provide complete and accurate information, follow any treatment recommendations, or follow-up with additional medical care as recommended by your treating clinician. DialCare does not make any guarantees about the results of a consult or any representations or warranties about the training or skill of any clinicians who provide consultations via the Services.
You agree to defend, indemnify and hold harmless DialCare and its affiliates and each of their officers, directors, employees, agents, and representatives, from and against any and all claims and demands of every kind and nature asserted by a third party, whether groundless or otherwise, including, but not limited to, any and all actions, causes of action, suits, judgments, controversies, losses, damages, costs, liens, charges, court costs, reasonable attorney's fees, payments, penalties, liabilities and expenses, occasioned by, resulting from, arising out of, related to, or in connection with any act or omission by you, including, but not limited to, your failure to comply with these Terms and Conditions.
Limitation of Liability: EXCEPT AS PROHIBITED BY LAW, AND WITHOUT LIMITATION:
DIALCARE SHALL NOT BE LIABLE FOR THE ACTS OR OMISSIONS OF ANY OF THE CLINICIANS.
YOU SHALL BE SOLELY AND FULLY RESPONSIBLE FOR ANY DAMAGE TO THE PARTIES AND THEIR SERVICES OR ANY COMPUTER SYSTEM, ANY LOSS OF DATA, OR ANY IMPROPER USE OR DISCLOSURE OF INFORMATION ON THE SERVICES CAUSED BY YOU OR ANY PERSON USING YOUR USER NAME OR PASSWORD. DIALCARE DOES NOT ASSUME ANY LIABILITY ARISING FROM THE FAILURE OF ANY TELECOMMUNICATIONS INFRASTRUCTURE, OR THE INTERNET OR FOR MISUSE OF ANY OF THE ADVICE, IDEAS, INFORMATION, INSTRUCTIONS, OR GUIDELINES ACCESSED THROUGH THE SERVICES.
YOU ACKNOWLEDGE THAT IN CONNECTION WITH THE SERVICES, INFORMATION WILL BE TRANSMITTED OVER LOCAL EXCHANGE, INTEREXCHANGE AND INTERNET BACKBONE CARRIER LINES AND THROUGH ROUTERS, SWITCHES AND OTHER DEVICES OWNED, MAINTAINED AND SERVICED BY THIRD PARTY LOCAL EXCHANGE AND LONG-DISTANCE CARRIERS, UTILITIES, INTERNET SERVICE PROVIDERS AND OTHERS, ALL OF WHICH ARE BEYOND THE CONTROL AND JURISDICTION OF THE PARTIES AND THEIR SUPPLIERS. ACCORDINGLY, DIALCARE ASSUMES NO LIABILITY FOR OR RELATING TO THE DELAY, FAILURE, INTERRUPTION OR CORRUPTION OF ANY DATA OR OTHER INFORMATION TRANSMITTED IN CONNECTION WITH USE OF THE SERVICES.
IN NO EVENT SHALL DIALCARE NOR ANY OF ITS AFFILIATES BE LIABLE FOR ANY DIRECT DAMAGES IN EXCESS OF (i) THE MONTHLY OR ANNUAL SUBSCRIPTION RATE PAID UNDER YOUR PLAN, OR (ii) IN THE EVENT NO PURCHASE PRICE WAS PAID OR REQUIRED, THE LIQUIDATED SUM OF $50.00. IN ADDITION, TO THE MAXIMUM EXTENT PERMITTED BY LAW, IN NO EVENT SHALL DIALCARE OR ANY OF ITS AFFILIATES BE LIABLE FOR ANY SPECIAL, PUNITIVE, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES, THAT RESULT FROM (i) PERSONAL INJURY, WRONGFUL DEATH, LOSS OF USE, LOSS OF PROFITS, INTERRUPTION OF SERVICE OR LOSS OF DATA, OR (ii) MISTAKES, OMISSIONS, INTERRUPTIONS, DELETION OF FILES, ERRORS, DEFECTS, DELAYS IN OPERATION OR TRANSMISSION OR ANY FAILURE OF PERFORMANCE, WHETHER OR NOT LIMITED TO ACTS OF GOD, COMMUNICATION FAILURE, THEFT, DESTRUCTION OR UNAUTHORIZED ACCESS TO RECORDS, PROGRAMS OR SERVICES, AND WHETHER IN ANY ACTION IN WARRANTY, CONTRACT, TORT (INCLUDING, BUT NOT LIMITED TO NEGLIGENCE OR FUNDAMENTAL BREACH), OR OTHERWISE ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE USE OF, OR THE INABILITY TO USE, THIS SITE OR ANY SERVICE OFFERED THROUGH THIS SITE OR ANY MATERIAL OR INFORMATION CONTAINED IN, ACCESSED THROUGH, OR PRODUCTS PURCHASED ON THIS WEB SITE, EVEN IF AN AUTHORIZED REPRESENTATIVE OF A PARTY IS ADVISED OF THE LIKELIHOOD OR POSSIBILITY OF THE SAME. TO THE EXTENT CERTAIN JURISDICTIONS RESTRICT ANY OF THE ABOVE LIMITATIONS OF LIABILITY; SUCH LIMITATIONS SHALL NOT APPLY IN SUCH JURISDICTIONS TO THE EXTENT OF SUCH RESTRICTIONS. YOU ACKNOWLEDGE AND AGREE THAT DIALCARE'S AGGREGATE LIABILITY TO YOU FOR ANY DAMAGES, LOSSES, FEES, CHARGES, EXPENSES OR LIABILITIES, AND IN CIRCUMSTANCES WHERE THE FOREGOING LIMITATION IS FINALLY DETERMINED TO BE UNAVAILABLE SHALL NOT EXCEED THE SUBSCRIPTION PRICE PAID BY YOU PRIOR TO THE FIRST OCCURRENCE OF THE SUBJECT DAMAGES, LOSSES, FEES, CHARGES, EXPENSES OR LIABILITIES.
YOU AGREE TO WAIVE, TO THE FULLEST EXTENT PERMITTED BY LAW, ALL LAWS THAT LIMIT THE EFFICACY OF SUCH LIMITATIONS, INDEMNIFICATIONS OR RELEASES.
Dispute Resolution: DialCare customer service will work diligently to resolve all issues with the Services. You agree that all disputes related to the Services and use of or access to the platform will be governed by the laws of the state of Texas, without regard to its conflicts of laws rules and all claims shall be brought exclusively in the state or federal courts in Collin County, Texas. You waive any objections to jurisdiction or venue.
Complaint Procedure: If you would like to file a complaint, you must submit your complaint in writing to: DialCare, P.O. Box 2568, Frisco, TX 75034. Complaints about physicians, counselors or therapists should be directed to the state regulatory body where that individual is licensed. A list of all state medical boards is included here: https://www.fsmb.org/contact-a-state-medical-board/. A list of state counselor licensure boards is located here: https://www.counseling.org/knowledge-center/licensure-requirements/state-professional-counselor-licensure-boards/.
NOTICE CONCERNING COMPLAINTS, Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit our website at www.tmb.state.tx.us. AVISO SOBRE LAS QUEJAS, Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.
General: You understand that from time to time you may be asked to complete subscriber satisfaction surveys. DialCare or its software provider, vendors and agents may analyze information submitted via these surveys as part of descriptive (demographic) studies and reports. In such cases all of your personal identifying information will be removed.
If any provision or provisions of this Agreement shall be held to be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not be affected thereby.
You understand that no delay or omission in exercising any right or remedy identified herein shall constitute a waiver of such right or remedy, and shall not be construed as a bar to or a waiver of any such right or remedy on any other occasion.
DialCare and its authorized agents and you agree to comply with all applicable laws and regulations of governmental bodies or agencies in performance of our respective obligations under this Agreement.
HIPAA PRIVACY NOTICE
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.
This Privacy Notice is being provided to you by DialCare as that entity may be formed and incorporated in your state, and the employees and practitioners that work at such practice (collectively referred to herein as "We" or "Our"). We understand that your medical information is private and confidential. Further, we are required by law to maintain the privacy of "protected health information." "Protected health information" or "PHI" includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. We will share protected health information with one another, as necessary, to carry out treatment, payment or health care operations relating to the services to be rendered.
As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of PHI. This notice also discusses the uses and disclosures we will make of your PHI. We must comply with the provisions of this notice as currently in effect, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all PHI we maintain. You can always request a written copy of our most current privacy notice from [email protected] or you can access it on our website at www.dialcare.com.
PERMITTED USES AND DISCLOSURES
We can use or disclose your PHI for purposes of treatment, payment and health care operations. For each of these categories of uses and disclosures, we have provided a description and an example below. However, not every particular use or disclosure in every category will be listed.
Treatment means the provision, coordination or management of your health care, including consultations between health care providers relating to your care and referrals for health care from one health care provider to another. For example, a doctor treating you for a potential fracture may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to recommend a physical therapist to create the exercise regimen appropriate for your treatment.
Payment means the activities we undertake to obtain reimbursement for the health care provided to you, including billing, collections, claims management, determinations of eligibility and coverage and other utilization review activities. For example, we may need to provide PHI to your Third Party Payor, if applicable, to determine whether the proposed course of treatment will be covered or if necessary to obtain payment. Federal or state law may require us to obtain a written release from you prior to disclosing certain specially protected PHI for payment purposes, and we will ask you to sign a release when necessary under applicable law.
Health care operations means the support functions of the Providers, related to treatment and payment, such as quality assurance activities, case management, receiving and responding to patient comments and complaints, clinician reviews, compliance programs, audits, business planning, development, management and administrative activities. For example, we may use your PHI to evaluate the performance of our staff when caring for you. We may also combine PHI about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose PHI for review and learning purposes. In addition, we may remove information that identifies you so that others can use the de-identified information to study health care and health care delivery without learning who you are.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
We may also use your PHI in the following ways:
 Medical Services are provided, where applicable, by DialCare Group, PLLC, a Texas professional limited liability company, DialCare Group Alaska, P.C., an Alaskan professional corporation, DialCare Group California, P.C., a California professional corporation, DialCare Group Massachusetts, PLLC, a Massachusetts professional limited liability company, DialCare Group Michigan, PLLC, a Michigan professional limited liability company, DialCare Physician New York, PLLC, a New York professional limited liability company, DialCare Group North Carolina, PLLC, a North Carolina professional limited liability company, DialCare Group West Virginia, PLLC, a West Virginia professional limited liability company, and DialCare Group New Jersey, P.C., a New Jersey professional corporation. Behavioral Health Services are provided, where applicable, by DialCare Mental Wellness, PLLC, a Texas professional limited liability company, DialCare Group California, P.C., a California professional corporation, and DialCare Mental Wellness, P.C., an Alaska professional corporation.
To provide appointment reminders for treatment or medical care.
To tell you about or recommend possible treatment alternatives or other health-related benefits and services that may be of interest to you.
To your family or friends or any other individual identified by you to the extent directly related to such person's involvement in your care or the payment for your care. We may use or disclose your PHI to notify, or assist in the notification of, a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, taking into account the circumstances and based upon our professional judgment.
When permitted by law, we may coordinate our uses and disclosures of PHI with public or private entities authorized by law or by charter to assist in disaster relief efforts.
We will allow your family and friends to act on your behalf to pick-up filled prescriptions, medical supplies, X-rays, and similar forms of PHI, when we determine, in our professional judgment, that it is in your best interest to make such disclosures.
We may use or disclose your PHI for research purposes, subject to the requirements of applicable law. For example, a research project may involve comparisons of the health and recovery of all patients who received a particular medication. All research projects are subject to a special approval process which balances research needs with a patient's need for privacy. When required, we will obtain a written authorization from you prior to using your health information for research.
In certain cases, we will provide your information to contractors, agents and other parties who need the information in order to perform a service for us, including, without limitation, DialCare, LLC, such as obtaining payment for health care services or carrying out business operations. Another example is that we may share your information with an insurance company, law firm or risk management organization in order to maintain professional advice about how to manage risk and legal liability, including insurance or legal claims. However, you should know that in these situations, we require third parties to provide us with assurances that they will safeguard your information.
We will use or disclose PHI about you when required to do so by applicable law.
In accordance with applicable law, we may disclose your PHI to your employer if we are retained to conduct an evaluation relating to medical surveillance of your workplace or to evaluate whether you have a work-related illness or injury. You will be notified of these disclosures by your employer or the Provider as required by applicable law.
Note: incidental uses and disclosures of PHI sometimes occur and are not considered to be a violation of your rights. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.
Subject to the requirements of applicable law, we will make the following uses and disclosures of your PHI:
Organ and Tissue Donation. If you are an organ donor, we may release PHI to organizations that handle organ procurement or transplantation as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the Armed Forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
Worker's Compensation. We may release PHI about you for programs that provide benefits for work-related injuries or illnesses.
Public Health Activities. We may disclose PHI about you for public health activities, including disclosures:
to prevent or control disease, injury or disability;
to report births and deaths;
to report child abuse or neglect;
to persons subject to the jurisdiction of the Food and Drug Administration (FDA) for activities related to the quality, safety, or effectiveness of FDA-regulated products or services and to report reactions to medications or problems with products;
to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
to notify the appropriate government authority if we believe that an adult patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if the patient agrees or when required or authorized by law.
Health Oversight Activities. We may disclose PHI to federal or state agencies that oversee our activities (e.g., providing health care, seeking payment, and civil rights).
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose PHI subject to certain limitations.
Law Enforcement. We may release PHI if asked to do so by a law enforcement official:
In response to a court order, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness, or missing person;
About the victim of a crime under certain limited circumstances;
About a death we believe may be the result of criminal conduct;
About criminal conduct on our premises; or
In emergency circumstances, to report a crime, the location of the crime or the victims, or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release PHI to a coroner or medical examiner. We may also release PHI about patients to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may release PHI about you to authorized federal officials for intelligence, counterintelligence, other national security activities authorized by law or to authorized federal officials so they may provide protection to the President or foreign heads of state.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release PHI about you to the correctional institution or law enforcement official. This release would be necessary (1) to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Serious Threats. As permitted by applicable law and standards of ethical conduct, we may use and disclose PHI if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or is necessary for law enforcement authorities to identify or apprehend an individual.
Note: HIV-related information, genetic information, alcohol and/or substance abuse records, mental health records and other specially protected health information may enjoy certain special confidentiality protections under applicable state and federal law. Any disclosures of these types of records will be subject to these special protections.
OTHER USES OF YOUR HEALTH INFORMATION
Certain uses and disclosures of PHI will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing purposes; and (c) that constitute a sale of PHI under the Privacy Rule. Other uses and disclosures of PHI not covered by this notice or the laws that apply to us will be made only with your written authorization. You have the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we already have taken action in reliance on your authorization.
You have the right to request restrictions on our uses and disclosures of PHI for treatment, payment and health care operations. However, we are not required to agree to your request unless the disclosure is to a health plan in order to receive payment, the PHI pertains solely to your health care items or services for which you have paid the bill in full, and the disclosure is not otherwise required by law. To request a restriction, you may make your request in writing to the Privacy Officer.
You have the right to reasonably request to receive confidential communications of your PHI by alternative means or at alternative locations. To make such a request, you may submit your request in writing to the Privacy Officer.
You have the right to inspect and copy the PHI contained in our Provider records, except:
for psychotherapy notes, (e.g, notes that have been recorded by a mental health professional documenting counseling sessions and have been separated from the rest of your medical record);
for information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding;
for PHI involving laboratory tests when your access is restricted by law;
if you are a prison inmate, and access would jeopardize your health, safety, security, custody, or rehabilitation or that of other inmates, any officer, employee, or other person at the correctional institution or person responsible for transporting you;
if we obtained or created PHI as part of a research study, your access to the PHI may be restricted for as long as the research is in progress, provided that you agreed to the temporary denial of access when consenting to participate in the research;
for PHI contained in records kept by a federal agency or contractor when your access is restricted by law; and
for PHI obtained from someone other than us under a promise of confidentiality when the access requested would be reasonably likely to reveal the source of the information.
In order to inspect or obtain a copy your PHI, you may submit your request in writing to the Medical Records Custodian. If you request a copy, we may charge you a fee for the costs of copying and mailing your records, as well as other costs associated with your request.
We may also deny a request for access to PHI under certain circumstances if there is a potential for harm to yourself or others. If we deny a request for access for this purpose, you have the right to have our denial reviewed in accordance with the requirements of applicable law.
You have the right to request an amendment to your PHI but we may deny your request for amendment, if we determine that the PHI or record that is the subject of the request:
was not created by us, unless you provide a reasonable basis to believe that the originator of PHI is no longer available to act on the requested amendment;
is not part of your medical or billing records or other records used to make decisions about you;
is not available for inspection as set forth above; or
is accurate and complete.
In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records. In order to request an amendment to your PHI, you must submit your request in writing to Medical Record Custodian, along with a description of the reason for your request.
You have the right to receive an accounting of disclosures of PHI made by us to individuals or entities other than to you for the six years prior to your request, except for disclosures:
to carry out treatment, payment and health care operations as provided above;
incidental to a use or disclosure otherwise permitted or required by applicable law;
pursuant to your written authorization;
to persons involved in your care or for other notification purposes as provided by law;
for national security or intelligence purposes as provided by law;
to correctional institutions or law enforcement officials as provided by law;
as part of a limited data set as provided by law.
To request an accounting of disclosures of your PHI, you must submit your request in writing to the Privacy Officer. Your request must state a specific time period for the accounting (e.g., the past three months). The first accounting you request within a twelve (12) month period will be free. For additional accountings, we may charge you for the costs of providing the list. We will notify you of the costs involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
You have the right to receive a notification, in the event that there is a breach of your unsecured PHI, which requires notification under the Privacy Rule.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at www.dialcare.com. The notice will contain the effective date on the last page.
If you believe that your privacy rights have been violated, you should immediately contact the Privacy Officer at [email protected] We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of the U. S. Department of Health and Human Services.
If you have any questions or would like further information about this notice, please contact the Privacy Officer at [email protected] or at Privacy Officer, DialCare, 7400 Gaylord Parkway, Frisco, TX 75034, (833) 640-3425.
This notice is effective as of July 1, 2020.