Notice of Privacy Practices

This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review It carefully.

WHO WILL FOLLOW THIS NOTICE

This Notice of Privacy Practices (this “Notice”) describes the privacy practices of Cloud Health Medical Group, P.A., Cloud Health Medical Group of California, P.C., Cloud Health Medical Group of New Jersey, P.A. Cloud Health Medical Group of Kansas, P.C., Cognitive Nutrition & Wellness LLC and Pesto Health, Inc., and our healthcare practitioners and other personnel who provide services to you (collectively, “Providers,” “we” or “us”).

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that your health information is personal and we are committed to protecting it. We create a record of the care and services you receive from Providers. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice is required by law and applies to all of the records of your care generated us.

This Notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.

We are required by law to:

• make sure that health information that identifies you is kept private (with certain exceptions);
• give you this Notice of our legal duties and privacy practices with respect to health information about you;
• follow the terms of the notice that is currently in effect; and
• promptly notify you in the event of a breach of your unsecured health information.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean, but not every use or disclosure in a category will be listed. When health information is disclosed as permitted by applicable law, the information could be redisclosed by the recipient and no longer protected by privacy law.

For Treatment

We may use health information about you to provide you with medical treatment or services, including telehealth. We may also share your health information with other healthcare providers who provide (or who have provided) treatment and/or services to you.

For Payment

We may use and disclose health information to obtain payment for the services we provided to you. For example, we may need to give your health plan information about your appointment so your health plan will pay us. Also, we may use and disclose your health information to bill you directly for services and/or items.

For Healthcare Operations

We may use and disclose health information about you for healthcare operations. These uses and disclosures are necessary to run the Providers’ practice and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine the health information we have with health information from other providers to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of health information so others may use it to study health care and health care delivery without learning who the specific patients are. Additionally, we may disclose your health information in order to resolve any complaints you may have. We may also use and disclose your health information to contact you and remind you about upcoming appointments, to notify you about services we offer, or to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Individuals Involved in Your Care

We may release health information about you to family, friends and/or other close persons you choose to involve in your care or payment for care, provided we (a) obtain your consent; (b) provide you an opportunity to object and you do not object; or (c) can make a reasonable inference that you do not object. Additionally, we may use or disclose your health information to notify or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition or death. If at all possible we will provide you with an opportunity to object to this use or disclosure.

Business Associates

We may disclose health information to our business associates who perform functions on our behalf or provide us with services, and who agree by contract to protect your health information in the same manner that we protect it.

Required by Law

We may use or disclose your health information when we are required to do so by law. For example, we may disclose your health information to the U.S. Department of Health and Human Services if it requests such information to determine that we are complying with federal privacy law.

Research

Under certain circumstances, we may use and disclose health information about you for research purposes. Before we use or disclose health information for research, the project will have been approved through a research approval process or certain other circumstances may permit disclosure, such as if we disclose health information about you to people preparing to conduct a research project to help them look for patients with specific medical needs, so long as the health information they review does not leave our possession.

To Avert a Serious Threat to Health or Safety

We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Workers’ Compensation

We may release health information about you for workers’ compensation or similar programs as required by state law. These programs provide benefits for work-related injuries or illness.

Public Health Risks

We may disclose health information about you for public health activities. These activities generally include the following:

• to prevent or control disease, injury or disability;
• to report deaths;
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using; or
• 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.

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.

Health Oversight Activities

We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes

We may use and disclose your health information in response to a court or administrative order, or in response to a subpoena, discovery request or other lawful process from another party involved in the lawsuit if we have made an effort to inform you of the request or to obtain a protective order. If we receive records from a substance use disorder treatment program subject to the federal privacy restrictions, such records or testimony about their content cannot be used or disclosed in civil, criminal, administrative, or legislative proceedings against the individual unless based on written consent or we receive a court order entered after notice or an opportunity to be heard is provided to the individual or to us, as authorized by 42 CFR Part 2.  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.

Law Enforcement

We may disclose your health information to a law enforcement official for permitted purposes, such as to report a crime that occurred on our premises.

Inmates

Under certain circumstances, we may disclose the health information of inmates of a correctional institution or those in police custody.

Coroners, Medical Examiners and Funeral Directors

We may release health information to a coroner, medical examiner, or funeral director as necessary for them to perform their authorized duties.

Organ or Tissue Donation

We may disclose your health information to organ procurement organizations or other entities engaged in procuring, banking, or transplanting organs for the purpose of tissue donation and transplant.

Specialized Government Functions

We may disclose health information about you to U.S. government entities with special functions, such as the military or Department of State under certain circumstances or to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities.

Uses and Disclosures of Medical Information Which Require Your Authorization

Uses and disclosures of health information that are not discussed in this Notice will only be made with your authorization. Your written authorization will typically be required for most uses and disclosures of psychotherapy notes, most uses and disclosures for marketing and most arrangements involving the sale of health information. You may revoke your authorization at any time. After you revoke your authorization, we will no longer use or disclose your health information for the reasons described in the authorization, except to the extent we have already relied on your authorization. To revoke an authorization, please contact the Privacy Officer at the contact information provided at the end of this Notice.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy

You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information. If your health information is maintained in an electronic health record, you may obtain an electronic copy of your health information and, if you choose, instruct us to transmit such copy directly to an entity or person you designate in a clear, conspicuous and specific manner.

To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to the Privacy Officer at the email address listed at the end of this Notice. In most cases, we are required to respond within 30 days of the request. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain circumstances. If you are denied access to health information, you may request that the denial be reviewed.

Right to Amend

If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, your request must be made in writing and submitted to the Privacy Officer at the email address listed at the end of this Notice. In addition, you must provide a reason that supports your request.

We will act on your request within 60 days (or 90 days if the extra time is needed), and we will inform you in writing as to whether the amendment will be made or denied.  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request, as well as in certain circumstances such as when your record is accurate and complete.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we make of your health information. We will include all disclosures except those for treatment, payment, health care operations, and certain other disclosures (such as those you asked us to make).  Your request must state a time period which may not be longer than six years. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.  To request an accounting of disclosures, your request must be made in writing and submitted to the Privacy Officer at the email address listed at the end of this Notice.

Right to Request Restrictions

You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a service you had.

We are not required to agree to your request, unless you request that we restrict disclosure to a health plan for a payment or health care operation purpose and the health information relates solely to a health care item or service for which you have (or someone one your behalf has) paid out of pocket and in full. If we honor your request, we will comply with your request unless the information is needed to provide you with emergency treatment.

To request restrictions, you must make your request in writing to the Privacy Officer at the email address listed at the end of this Notice. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request to the Privacy Officer at the email address provided at the end of this Notice. We will not ask you the reason for your request. We will accommodate reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

You may obtain a copy of this Notice at our website at https://www.betterbrain.com/privacy-practices.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by contacting the Privacy Officer at the email address listed at the end of this Notice. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, DC 20201 or online at https://ocrportal.hhs.gov/. You will not be penalized for filing a complaint.

Changes to This Notice

We reserve the right to change our privacy practices and to make any such change applicable to the health information we obtained about you before the change. If a change in our practices is material, we will revise this Notice to reflect the change. We will post a copy of the current notice at https://www.betterbrain.com/privacy-practices. You also may obtain any new notice by contacting the Privacy Officer.

Contact Information:

You may contact the Privacy Officer at:

Privacy Officer

legal@betterbrain.com

ACKNOWLEDGMENT

By signing below, you acknowledge that you have received a copy of the Notice of Privacy Practices. You consent to allow the Providers to use and disclose your health information consistent with HIPAA for purposes of treatment, payment and health care operations and any of the other purposes described in the Notice of Privacy Practices.  

You consent to and authorize the Providers to perform health care examinations, consultations, treatment, and referrals for or to you as deemed necessary in their professional judgment.

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Name

______________________________________________________

Signature

______________________________________________________

Date

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Authority to act on behalf of the patient, if applicable

48824172.2

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