HIPAA Notice of Privacy Practices

Effective Date: April 25, 2025

Appalachian Health of Ohio
Appalachian Health and Wellness LLC

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Our Pledge Regarding Health Information

At Appalachian Health of Ohio, we understand that your health information is personal, and we are committed to protecting it. As a telehealth practice, all care is delivered through secure electronic and telecommunication platforms. We maintain encrypted electronic records of the care you receive. This Notice explains how we may use or disclose your health information and describes your rights and our obligations under the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH), and applicable telehealth privacy standards.
We are required by law to:
- Maintain the privacy of your protected health information (PHI).
- Provide you with this Notice explaining our legal duties and privacy practices.
- Follow the terms of this Notice.
- Notify you if there is a breach of unsecured PHI.

We may update this Notice, and any changes will apply to all information we maintain. The most current version is available upon request or on our website.

II. How We May Use and Disclose Your Health Information

For Treatment, Payment, and Healthcare Operations:
We may use or disclose your PHI to provide treatment, process payments, and manage healthcare operations — including coordination with pharmacies, other providers, labs, and insurance plans (if applicable). This does not require your written authorization.

Lawsuits and Legal Proceedings:
We may disclose your PHI in response to court orders, subpoenas, or other legal processes, consistent with applicable law.

III. Uses and Disclosures That Require Your Written Authorization

We will not use or disclose your PHI for the following without your written permission:
- Session notes (if applicable)
- Marketing purposes
- Sale of PHI

If you authorize use or disclosure, you may revoke it at any time in writing.

IV. Uses and Disclosures That Do Not Require Your Authorization

Subject to certain legal limitations, we may use or disclose your PHI without your written authorization for the following purposes:
1. When required by law, provided the disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including the reporting of suspected abuse, communicable diseases, or preventing/reducing serious health threats.
3. For health oversight activities, such as audits, inspections, or investigations by government agencies to monitor healthcare compliance.
4. For judicial and administrative proceedings, in response to lawful court orders or subpoenas.
5. For law enforcement purposes, when legally required or in response to valid law enforcement requests.
6. To medical examiners or coroners, to perform legally authorized duties.
7. For approved research, under strict privacy safeguards.
8. For specialized government functions, including military and national security operations.
9. To comply with workers’ compensation laws.
10. To contact you with appointment reminders or information about treatment alternatives or health-related services.
11. To support required clinical collaboration and oversight, including review of your medical records by our collaborating physician, as mandated by state law. This may include periodic chart reviews for quality assurance, supervision, and compliance with scope-of-practice regulations.

V. Uses and Disclosures Requiring an Opportunity to Object

We may disclose your PHI to a family member, friend, or caregiver involved in your care unless you object. You may notify us verbally or in writing if you do not want this disclosure.

VI. Your Rights Regarding Your Health Information

You have the right to:
1. Request limitations on how your PHI is used or disclosed (we are not required to agree).
2. Restrict disclosure to your health plan when services are paid out of pocket in full.
3. Request confidential communications (e.g., specific phone number or email).
4. Access and request a copy of your PHI (excluding certain mental health records).
5. Request an amendment to your PHI if you believe it is incorrect or incomplete.
6. Request a list of disclosures of your PHI (up to 6 years, excluding routine operations).
7. Request a copy of this Notice, in paper or electronic form.

VII. Contact Information

To request information or exercise any of your rights, please contact:
Appalachian Health of Ohio
Email: appalachianhealthandwellness@gmail.com
Website: www.appalachianhealthohio.org

Consent for Communication by Email or Text Message

We may offer email or text communication for convenience (e.g., appointment reminders, general questions). These communications are not always secure and may carry certain privacy risks.

By consenting to email/text communication, you acknowledge and accept the following risks and conditions:
- Messages can be misdirected or intercepted.
- Messages may be stored or forwarded without consent.
- Messages can be accessed by others on shared devices or email accounts.
- Employers may access work emails.
- Text messages will not contain PHI.
- You are responsible for the security of your email or device.
- You may revoke consent at any time in writing.

In addition to traditional email and text messaging risks, please be aware that use of telehealth services may carry additional risks, including:
- Potential electronic interception of communications during video sessions despite encryption safeguards.
- Temporary service disruptions due to internet outages beyond the control of Appalachian Health of Ohio.
- Possible unauthorized access if your device, internet network, or communication channels are not secure.
We use reasonable safeguards, including end-to-end encrypted telehealth platforms, to protect your information. However, no system is completely secure.
By consenting to email, text, and telehealth communication, you acknowledge understanding these risks.

Terms of Service

Effective: April 25, 2025

Appalachian Health of Ohio

Appalachian Health and Wellness LLC

These Terms of Service (“Terms”) govern your access to and use of services provided by Appalachian Health of Ohio, including telehealth visits, online communications, and related offerings. By scheduling or receiving services, you agree to these Terms. Please read them carefully.

1. Eligibility

You must be at least 18 years of age or the legal guardian of a minor patient to receive services from Appalachian Health of Ohio. By using our services, you represent that the information you provide is accurate, complete, and that you meet eligibility requirements.

2. Services Provided

Appalachian Health of Ohio provides primary and urgent care through telehealth. These services are not intended for use in medical emergencies. We do not prescribe controlled substances and do not manage emergency psychiatric conditions. If you experience a medical emergency, call 911 or go to the nearest emergency department.

3. Payment and Billing

You are responsible for payment of all services rendered. Appalachian Health of Ohio does not accept insurance at this time. Payment is due at the time of service. Accepted payment methods include major credit or debit cards. Receipts will be provided upon request.

4. Communication and Technology Use

We use secure platforms for telehealth and electronic communication, but you acknowledge that no system is completely secure. By using email, text, or online messaging to communicate with our clinic, you accept any associated privacy risks. You are responsible for ensuring your contact information is accurate and current.

5. Patient Responsibilities

You agree to provide accurate medical and personal information, participate actively in your care, and follow treatment recommendations. You agree not to misuse or abuse the telehealth services provided. We reserve the right to discontinue services for non-compliance, inappropriate behavior, or misuse.

6. Changes to Terms

We may update these Terms at any time. Changes will be posted on our website with an updated effective date. Your continued use of services after changes are made constitutes your acceptance of the updated Terms.

7. Contact Information

If you have questions or concerns about these Terms, please contact us:

Appalachian Health of Ohio

Appalachian Health and Wellness LLC
Email: info@appalachianhealthohio.org
Website: www.appalachianhealthohio.org

Privacy Policy Statement

Effective: April 25, 2025

Appalachian Health of Ohio

Appalachian Health and Wellness LLC

Appalachian Health of Ohio is committed to protecting your privacy and the confidentiality of your health and personal information. This Privacy Policy outlines how we collect, use, and protect your data in accordance with federal and state laws, including the Health Insurance Portability and Accountability Act (HIPAA).

Information We Collect

We collect personal, health, and payment-related information when you:
- Schedule or participate in a telehealth visit
- Complete intake, consent, or billing forms
- Communicate with us by phone, email, text message, or secure messaging platform
- Submit payments or provide billing information

This may include your name, contact information, date of birth, medical history, medications, appointment details, and payment details (e.g., credit card or debit card information for billing purposes).

How Your Information Is Used

We use the information we collect to:
- Provide medical care and follow-up services
- Process payments and issue receipts for services rendered
- Communicate with you about appointments or care
- Coordinate with pharmacies, labs, and collaborating healthcare providers
- Maintain medical and financial records as required by law
- Improve the quality and delivery of telehealth services

Billing and payment information is used solely for collecting payment, managing invoices, and fulfilling regulatory documentation requirements. Payment processing may be handled by third-party vendors under strict confidentiality agreements and HIPAA-compliant Business Associate Agreements (BAAs).

How We Protect Your Information

We use administrative, technical, and physical safeguards to protect your information, including:
- Encrypted telehealth platforms and secure electronic health records
- Secure payment processing through authorized vendors
- Limited access to your information by authorized staff only
- Signed BAAs with all third-party partners handling health or financial data

Your Rights

You have the right to:
- Request access to or copies of your health information
- Request corrections to your medical record
- Limit how certain information is shared or used
- Receive a copy of our full HIPAA Notice of Privacy Practices

Use of Email or Text Communication

If you choose to communicate via email or text message, please note that these methods may not be secure. We will avoid sending sensitive health or financial information through these channels. You may revoke consent to receive messages via these methods at any time.

Questions or Concerns?

To learn more about how we protect your privacy or to exercise your rights, please contact:

Appalachian Health of Ohio

Appalachian Health and Wellness LLC
Email: info@appalachianhealthohio.org
Website: www.appalachianhealthohio.org

Patient Bill of Rights and Responsibilities

Effective Date: April 25, 2025

Appalachian Health of Ohio
Appalachian Health and Wellness LLC

Patient Rights

As a patient of Appalachian Health of Ohio, you are entitled to the following rights:

1. Respectful Care
   You have the right to receive considerate, respectful, and dignified care, free from discrimination based on race, ethnicity, gender, sexual orientation, age, religion, disability, or ability to pay.
   
   

2. Privacy and Confidentiality
   You have the right to personal privacy and to have your health information kept confidential in accordance with applicable state and federal laws, including the Health Insurance Portability and Accountability Act (HIPAA).
   
   

3. Informed Participation
   You have the right to receive accurate, clear, and understandable information about your diagnosis, treatment options, and prognosis to make informed decisions about your care.
   
   

4. Consent and Refusal
   You have the right to consent to or refuse any care, treatment, or services, within the limits of the law, and to be informed of the potential medical consequences of your decisions.
   
   

5. Access to Records
   You have the right to review and request copies of your medical records and to request amendments to those records when appropriate.
   
   

6. Continuity of Care
   You have the right to coordinated care, including appropriate referrals when necessary, and to know the identity and professional credentials of your treating clinician.
   
   

7. Communication
   You have the right to ask questions and receive understandable answers about your care and the services provided.
   
   

8. Non-Retaliation
   You have the right to express concerns or complaints about your care without fear of reprisal, and to receive a timely response.

Patient Responsibilities

As a patient of Appalachian Health of Ohio, you are expected to:

1. Provide Accurate Information
   You are responsible for providing complete and accurate information about your health history, current condition, medications, allergies, and other relevant information.
   
   

2. Follow the Treatment Plan
   You are responsible for following the treatment plan agreed upon with your clinician and for asking questions when you do not understand your care or instructions.
   
   

3. Respect Clinic Policies
   You are responsible for respecting Appalachian Health of Ohio’s policies and procedures, including those regarding appointments, cancellations, and telehealth participation.
   
   

4. Be Considerate of Staff
   You are expected to treat clinic personnel with courtesy and respect.
   
   

5. Fulfill Financial Obligations
   You are responsible for timely payment of any charges for services rendered that are your financial responsibility, including those not covered by insurance.
   
   

6. Participate in Your Care
   You are encouraged to participate actively in your care and decision-making, to the extent possible.

7. Use Services Appropriately: Understand the appropriate use and limitations of telehealth services.
   
   

8. Maintain Up-to-Date Contact Information: Keep your contact details current.
   
   

9. Communicate Changes in Condition: Notify your clinician promptly of any significant changes in your health.
   
   

10. Attend Scheduled Appointments: Attend appointments on time or provide timely notice of cancellations or rescheduling needs.
    
    

11. Acknowledge Clinic’s Right to Discontinue Care: Understand that Appalachian Health of Ohio reserves the right to discontinue care if clinic policies are not followed, including repeated missed appointments, non-compliance with treatment plans, or inappropriate behavior toward staff.