Notice of Privacy Practices

Treatment

We may use or disclose your PHI to provide medical care, including:

• Comprehensive home-based medical evaluations
• Chronic disease management
• Medication management and reconciliation
• Acute illness assessments (non-emergent)
• Caregiver support and education
• Advance care planning and goals-of-care discussions
• Coordination with specialists, hospitals, home health, hospice, and community services

Payment

Doc on the Block operates as a direct-pay concierge practice.

• Membership fees are due at the beginning of each month.
• We do not bill Medicare, Medicaid, or commercial insurance.
• Membership fees cannot be submitted for insurance reimbursement.
• We do not submit claims on your behalf.

Healthcare Operations

We may use PHI for:

• Quality improvement
• Documentation
• Care coordination
• Practice administration

Uses and Disclosures Required or Permitted by Law

We may disclose PHI without your authorization when required or permitted by federal or state law, including:

• Public health reporting
• Reporting abuse, neglect, or domestic violence
• Health oversight activities
• Judicial or administrative proceedings
• Law enforcement purposes
• Organ or tissue donation
• Workers' compensation
• To avert a serious threat to health or safety
• Specialized government functions (e.g., military or national security, if applicable)

Substance Use Disorder Records (42 CFR Part 2)

If we maintain any records related to substance use disorder treatment, those records are protected by federal law (42 CFR Part 2). We will not disclose Part 2 information without your written consent except as permitted by law.

• Psychotherapy notes (if applicable)
• Marketing communications
• Sale of PHI
• Any other use or disclosure not described in this Notice

Revoking Authorization

You may revoke an authorization at any time in writing, except to the extent we have already acted on it.

• Clinical information is communicated through a secure patient portal.
• Acute concerns may be communicated via phone call or text message.
• Non-clinical matters may be communicated via email.
• Home visits occur within the practice's geographic service area and require a safe environment.
• We may leave limited voicemail or text messages when necessary for care coordination unless you request otherwise.
• We use reasonable safeguards to protect your information when communicating electronically.

• Access and obtain copies of your medical record
• Request corrections to inaccurate or incomplete information
• Request restrictions on certain uses or disclosures
• Request confidential communication methods
• Receive an accounting of disclosures
• Receive a paper copy of this Notice at any time

How to Exercise These Rights

You may submit a written request to the Privacy Officer using the contact information below.

• Maintain the privacy of your PHI
• Notify you in the event of a breach of unsecured PHI
• Follow the terms of this Notice
• Use HIPAA-compliant systems for communication and documentation

We will not use or disclose your PHI without your written authorization except as described in this Notice.

Doc on the Block – Privacy Officer

Melissa P. Broyles, D.O.

• Phone: 610-368-2987
• Email: [email protected]

You may also file a complaint with the U.S. Department of Health and Human Services (HHS):

• Office for Civil Rights
• U.S. Department of Health and Human Services
• 200 Independence Avenue, S.W.
• Washington, D.C. 20201
• Website: hhs.gov/ocr/privacy/hipaa/complaints

You will not be retaliated against for filing a complaint.