Legal
HIPAA Notice of Privacy Practices
Effective date: [ATTORNEY: Insert effective date]
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.
[ATTORNEY: ...]
require your input. This page structure is provided as a framework only —
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Our Responsibilities
[ATTORNEY: Determine and document whether Pattern Health is a Covered Entity, Business Associate, or both under HIPAA. This determination fundamentally shapes the entire NPP. If Pattern Health operates through affiliated medical groups or independent practice associations, clarify the entity structure here. Include required language about duty to protect PHI, follow NPP terms, notify of breaches, and right to revise practices.]
How We May Use and Disclose Your Health Information
For Treatment
[ATTORNEY: Describe how PHI is used for treatment purposes — including sharing with affiliated clinicians, specialists, pharmacies, and labs. Include telehealth-specific examples.]
For Payment
[ATTORNEY: Describe how PHI is used for billing, insurance, and payment processing purposes.]
For Healthcare Operations
[ATTORNEY: Describe healthcare operations uses including quality review, training, compliance, and business management.]
Other Permitted Uses and Disclosures
[ATTORNEY: List all other permitted/required disclosures under HIPAA — including public health, law enforcement, legal proceedings, research, and national security. Include applicable limitations.]
Uses Requiring Your Written Authorization
[ATTORNEY: List uses requiring patient authorization under HIPAA, including: most marketing uses, sale of PHI, psychotherapy notes, and uses of specially protected categories (substance use, mental health, HIV, genetic information, reproductive health). Confirm which categories apply to this practice.]
Your Rights Regarding Your Health Information
You have the following rights with respect to your protected health information:
Right to Inspect and Copy
[ATTORNEY: Describe right to access medical records, timeline, format options, and any applicable fees. Address electronic access requirements under 21st Century Cures Act.]
Right to Amend
[ATTORNEY: Describe amendment request process, timeline, and grounds for denial.]
Right to an Accounting of Disclosures
[ATTORNEY: Describe accounting of disclosures right and limitations.]
Right to Request Restrictions
[ATTORNEY: Describe restriction request process. Note required restriction for out-of-pocket paid services.]
Right to Confidential Communications
[ATTORNEY: Describe right to receive communications by alternative means or at alternative locations.]
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice upon request. Contact us using the information below.
How to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Contact our Privacy Officer:
[ATTORNEY / EDIT: Insert Privacy Officer name, title, address]
Email: privacy@patternhealthrx.com
Phone: [EDIT: Insert phone number]
U.S. Department of Health and Human Services:
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
hhs.gov/hipaa/filing-a-complaint
Changes to This Notice
We reserve the right to change the terms of this Notice at any time. Any revised Notice will apply to all health information we maintain. The current Notice will always be available on our website.
[ATTORNEY: Confirm change notification requirements under 45 CFR § 164.520(b)(1)(v).]
State Law
[ATTORNEY: This section is critical for a multi-state telehealth platform. Identify all states where services are offered and document any state privacy laws that are more protective than HIPAA (e.g., California CMIA, New York SHIELD, state mental health/substance use/HIV confidentiality laws). Where state law is more protective, it prevails over HIPAA.]