HIPAA notice of privacy practices

For purposes of this notice, “we,” “us,” and “Curadoc” refer to the following covered entities (and any successors), which provide clinical services to patients: Curadoc, P.A. (Florida); Curadoc, P.A. (Texas); Curadoc, P.C. (Arizona); Adeeb Saleh, D.O., P.C. d/b/a Curadoc (New Jersey); and Curadoc, P.C. (Utah). Curadoc Corporation (Hawaii) is pending and is not an active covered entity under this notice until formed and operational.

QPrescribe LLC is not a covered entity under this notice. It supplies technology and administrative services to support care delivered by the entities above.

We are required by law to maintain the privacy of protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI as required by law.

[TO BE COMPLETED BY COUNSEL: describe the systems and locations where patient charts / electronic health records are stored, including any business associates that host clinical data.]

We may use and disclose your PHI without your written authorization for treatment (including sharing with other providers involved in your care and transmitting prescriptions to pharmacies), for payment (including billing and collections), and for health care operations (including quality review, training, licensing, and business management).

When a prescription is transmitted, the dispensing pharmacy’s name, street address, phone, and fax are provided to you as part of that process.

We may also use or disclose PHI as permitted or required by law — for example, for public health activities, health oversight, judicial or administrative proceedings, law enforcement, serious threats to health or safety, workers’ compensation, or as otherwise authorized by HIPAA and applicable state law.

Uses and disclosures not described in this notice or otherwise permitted by law generally require your written authorization. You may revoke an authorization in writing, except to the extent we have already relied on it.

Subject to applicable law, you have the right to: request restrictions on certain uses and disclosures; request confidential communications; inspect and obtain a copy of your PHI in a designated record set; request an amendment; receive an accounting of certain disclosures; and receive a paper copy of this notice.

We may deny some requests as permitted by law. If we deny a request, we will tell you why in writing when required.

We must abide by the terms of this notice currently in effect. We may change this notice and make the revised notice effective for PHI we already have as well as PHI we create or receive in the future. The revised notice will be posted with an updated effective date.

[TO BE COMPLETED BY COUNSEL: name, title, mailing address, phone, and email of the privacy officer for the Curadoc covered entities.]

If you believe your privacy rights have been violated, you may file a complaint with us by contacting the privacy officer listed above (once designated) or by writing to the applicable Curadoc covered entity at the address provided in your patient materials.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Information is available at https://www.hhs.gov/hipaa/filing-a-complaint/ or by calling 1-800-368-1019. We will not retaliate against you for filing a complaint.

Business and partnership questions for the technology and administrative services company may be directed to QPrescribe LLC, 7901 4th Street N, Suite 300, St. Petersburg, FL 33702. Email: partners@qprescribe.com. Do not use that channel to submit patient PHI.