Notice of Privacy Practices (NPP)

THIS NOTICE OF PRIVACY PRACTICES (“NOTICE”) DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU OR YOUR CHILD OR OTHER FAMILY MEMBER MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Specifically, this Notice describes the privacy practices of Pomelo, P.C., Pomelo CA, P.C., Pomelo KS, P.A., Pomelo NJ, P.C., and Women's and Children's Health, P.C. (collectively, “Pomelo Providers,” “We” or “Us”), the independent professional medical entity that contracts with Pomelo Care, Inc. (“Pomelo Care”), operates as a covered entity, and provides the requested medical services. Among other things, Pomelo Providers contract with Pomelo Care to license Pomelo Care’s web application to provide Pomelo Providers with the capability to receive, respond to and schedule requested professional services. Pomelo Care does not provide any professional services. All of these entities will share protected health information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law. Use or disclosure pursuant to this Notice may include electronic transmittal or disclosure of your protected health information. For purposes of this Notice, any references to “you” or “your” also include your child or other family member to the extent that your child or other family member is being treated or receiving services from Pomelo Providers.

The Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (“HIPAA”) requires us to ask each of our patients to acknowledge receipt of this Notice. The Notice is published on the Pomelo Care websites and the Pomelo Care mobile application. You acknowledge receipt of the Notice by clicking on the applicable acknowledgement button, or by indicating your acknowledgement in another written or digital manner provided.

We are required by HIPAA and certain state laws to maintain the privacy of our patients’ protected health information, to provide patients with notice of our legal duties and privacy practices with respect to protected health information, and to notify you in the event of a breach of your unsecured protected health information. We are required to abide by the terms of this Notice for as long as it remains in effect. We reserve the right to change the terms of this Notice as necessary and to make a new Notice effective for all protected health information maintained by Pomelo Providers. Should we make a change, a copy of any revised Notice of Privacy Practices may be obtained by mailing a request to Pomelo, P.C., 4701 Sangamore Road, Suite 100-N, Bethesda, MD 20816 or by email to privacy-inquiries@pomelocare.com.

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

Uses and Disclosures That May Be Made Without Your Consent

Uses and Disclosures for Treatment: We may make use and disclosures of your protected health information as necessary for your treatment. Doctors, nurses and other health care professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your course of treatment that may include procedures, medications, tests, medical history, etc. We may participate in secure health information exchanges (“HIEs”) to retrieve health information about you from other health care organizations that treat you and to share information we create about you with them, when allowed by law. This helps us and your other providers see a more complete picture of your health, such as past visits, diagnoses, medicines, lab results, and vaccines, so we can coordinate your care. In some states, we may also ask you to make a separate choice about HIE sharing in an additional HIE consent form. Whether or not you see that separate form, you can ask us to limit how we use HIEs for your care by contacting us at privacy-inquiries@pomelocare.com.

Uses and Disclosures for Payment: We may make uses and disclosures of your protected health information as necessary for payment purposes. For instance, during the normal course of business operations, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you. We may use your information to prepare a bill to send to you or to the person responsible for your payment.

Uses and Disclosures for Health Care Operations: We may use and disclose your protected health information as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your protected health information for purposes of improving clinical treatment and patient care practices.

Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations (including Pomelo Care) such as auditing, accreditation, outcomes data collection, legal services, etc. At times it may be necessary for us to provide your protected health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.

Other Uses and Disclosures: We are permitted and/or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization for the following: any purpose required by law; public health activities, such as required reporting of disease, injury, birth and death, or required public health investigations; for research and quality improvement purposes, which may include collaboration with academic or research partners; de-identified or aggregate findings may be published or shared with such partners; to prevent or mitigate a serious threat to your health and safety or the health and safety of the public or another person; if we suspect child abuse or neglect; if we believe you to be a victim of abuse, neglect, or domestic violence; to the Food and Drug Administration to report adverse events, product defects, or to participate in product recalls; to your employer when we have provided health care to you at the request of your employer; to a government oversight agency conducting audits, investigations, or civil or criminal proceedings; in response to a court or administrative ordered subpoena or discovery request; to law enforcement officials as required by law to report wounds and injuries and crimes; to coroners and/or funeral directors consistent with law; to respond to organ and tissue donation requests; if you are a member of the military we may also release your protected health information for national security or intelligence activities; to workers’ compensation agencies for workers’ compensation benefit determination or as otherwise required under workers’ compensation laws; if you are an inmate of a correctional institution or under the custody of a law enforcement official, we may also release your protected health information to the correctional institution or law enforcement official.

Uses and Disclosures That May Be Made Without Your Authorization With the Opportunity to Object

Unless you object, we may from time to time disclose your protected health information to designated family, friends, and others who are involved in your care or in the payment for your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with involved individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

Uses and Disclosures Based Upon Your Written Consent

Psychotherapy Notes: We must obtain your written authorization for most uses and disclosures of psychotherapy notes.

Marketing: We must obtain your written authorization to use and disclose your protected health information for most marketing purposes.

Sale of Protected Health Information: We must obtain your written authorization for any disclosure of your protected health information that constitutes a sale of protected health information.

Other Uses: Other uses and disclosures of your protected health information, not described above, will be made only with your written authorization. You may revoke your authorization, at any time, in writing, except to the extent that we have already taken action in reliance on such prior authorization.

Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information: Special privacy protections apply to certain types of health information that are considered sensitive under applicable law, such as HIV-related information, alcohol and substance abuse information, mental health information, genetic information, and reproductive health information. If applicable law imposes stricter requirements on any type of sensitive health information, we will comply with those requirements, including by obtaining your consent prior to use or disclosure of such information when legally required. If your treatment involves this information, you may contact the Privacy Officer for more information about applicable protections.

We will not use or disclose any substance use disorder (“SUD”) treatment records received from federally assisted SUD treatment programs (“SUD Programs”), or testimony relaying the content of those records, in civil, criminal, administrative, or legislative proceedings against you unless based on written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as required by law. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed. Further, we will not use or disclose records received from SUD Programs to fundraise without first providing you with a clear and conspicuous opportunity to elect not to receive fundraising communications.

If your health information is disclosed to a recipient pursuant to any of the applicable purposes described in this Notice, it is possible that such protected health information may be subject to further redisclosure by the recipient and no longer protected by the requirements of this Notice.

Rights You Have Regarding Your Protected Health Information

You may request to exercise any of the rights described below by contacting our Privacy Officer using the contact information at the end of this Notice.

Access to Your Protected Health Information

You have the right to a copy and/or inspect much of the protected health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your legal representative and access is usually provided within 30 days of the request. If you request a copy of your protected health information you may be charged a nominal fee for copying and postage. In certain situations, we may deny your request and will tell you why we are denying it. In some cases, you may have the right to ask for a review of our denial.

Amendments to Your Protected Health Information

You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests must be in writing, signed by you or your legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, we may notify others who work with us if we believe that such notification is necessary.

Receive Confidential Communications From Us by Alternative Means or at Alternative Locations

You have the right to request that we communicate with you in a certain way or at a certain location. Your request must be in writing and specify how and where you would like to be contacted. We will accommodate all reasonable requests.

Complaints

If you believe your privacy rights have been violated, you can file a complaint in writing with the Privacy Officer, Pomelo, P.C., 4701 Sangamore Road, Suite 100-N, Bethesda, MD 20816. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html. There will be no retaliation for filing a complaint.

Accounting for Disclosures of Your Protected Health Information

You have the right to receive an accounting of certain disclosures made by us of your protected health information. Requests must be made in writing and signed by you or your legal representative. The first accounting in any 12-month period is free. You will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified of the fee at the time of your request.

Restrictions on Use and Disclosure of Your Health Information

You have the right to request restrictions on uses and disclosures of your protected health information (1) for treatment, payment, or health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. We are not required to agree to your restriction request, but will attempt to accommodate reasonable requests when appropriate. However, we must agree not to disclose your protected health information to your health plan if the disclosure is for payment or health care operations and relates to a health care item or service which you paid for in full out of pocket. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction by sending us such termination notice.

Paper Copy

You have the right to obtain a paper copy of this notice from us.

Contact Us

If you have questions or need further assistance regarding this Notice, you may contact our Privacy Officer at Pomelo, P.C., 4701 Sangamore Road, Suite 100-N, Bethesda, MD 20816, or by email at privacy-inquiries@pomelocare.com, or by phone at 914-919-9200.