Policies

To help accommodate the needs of our patients that wish to be seen on a timely basis and ensure available appointment times, we request that our patients comply with our cancellation and no-show policies.

Due to the unique nature of Personal MD and our scheduling system, we do not double-book or overbook our schedule. When you secure an appointment time, that time is placed on hold for you and cannot be used by another patient.

We understand that circumstances can change from the time you schedule your appointment and the actual appointment. We ask that you please communicate with us as best as possible. If you must cancel an appointment, please notify us within 3 hours of your scheduled appointment. Patients who do not show for a routine scheduled appointment will be charged $50 toward their account. Patients who do not show for an extended appointment, such as a physical examination or procedure, will be billed $75 toward their
account.

Informed Consent for Telemedicine Medical Services

Introduction:

Please read this document thoroughly and completely. To better serve the needs of the community, health care services are now available using telecommunications or information technology (“Telemedicine”). Telemedicine involves the use of real-time evaluation, diagnosis, consultation, and treatment of health conditions using interactive telecommunications technology, allowing the health care provider to see and communicate with you in real-time.

Consent for Treatment:

When you schedule a “Telemedicine visit”, you are voluntarily requesting that a health care provider of Personal MD Family Healthcare P.A. participate in your medical care using Telemedicine. In doing so, you understand. Acknowledge and agree to the following:

1. The health care provider may practice in a location different from where you usually go to receive in-person medical care.
2. Unlike traditional medicine, the health care provider providing the Telemedicine services will not have the opportunity to meet with you face to face.
3. Your health care provider providing the Telemedicine services must rely on the information you provide.
4. To the best of your ability, you agree to provide complete and accurate information concerning your medical history.
5. You understand that if the health care provider that your medical needs cannot be adequately addressed using Telemedicine, you may be required to seek an in-person evaluation.
6. You understand you can stop your Telemedicine session at any time.
7. You understand you can ask questions or seek clarifications of the Telemedicine procedures and technology at any time.
8. You understand that no guarantee or any specific result or cure is made by the health care provider rendering the Telemedicine services.

If you experience an emergency after the Telemedicine session you should alert your primary treating physician and dial 911 or go to the nearest emergency department.

Risks.

You agree and acknowledge that there are potential risks associated with receiving medical care using Telemedicine:

1. The Telemedicine session may be interrupted or disconnected due to a technological problem or equipment failure.
2. There may be electronic tampering.
3. The advice provided by the health care provider may be based on factors not within his/her control, such as incomplete or inaccurate information provided by you or distortions of diagnostic images or specimens due to their electronic transmission.

NOTICE CONCERNING COMPLAINTS.

While we hope all patients are happy with the Telemedicine services, they receive, you have a right to make a verbal or written complaint. If you have comments, questions, or concerns, please contact us.

Telemedicine Consent

Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including nurse practitioners, physician assistants, acupuncturists, and surgical assistants, may be reported for investigation to the following address:

Texas Medical Board

Attn: Investigations

333 Guadalupe, Tower 3, Suite 610

P.o. Box 2018, MC-263

Austin, TX 78768-2018

Assistance in filing a complaint is available by calling the following telephone number: I 800-201-9353. For more information on filing a complaint with the Texas Medical Board, visit the Texas Medical Board website at www.tmb.tx.us

Personal MD Family Healthcare, P.A. Communication Policy

Personal MD Family Healthcare, P.A. (Personal MD) and its physicians and providers fully support an electronic patient experience through the implementation of a common electronic health record platform. Personal
MD provides a Patient Portal Secure Access for an individual seen in our practice at no charge. Through this portal, patients can send secure email communications to their provider or other Personal MD staff members.
Each secure communication is recorded and kept as part of the patient’s permanent medical record.

Attachments such as pictures, PDFs, etc. are not allowed in this secure communication system. Login credentials can be obtained directly from our office.

Each Personal MD staff member also has a non-secure traditional email. Communications sent via a company or personal email are not considered secure and are not recorded in your medical record and are not kept for
later reference.

Text communication between you and your provider is not considered a secure form of communication, and the details of your exchange with your provider or staff member are not always recorded in your medical record or kept for later reference.

PERSONAL MD FAMILY HEALTHCARE, P.A.
Patient Portal Policy

OUR COMPANY AND ITS AFFILIATES, SUPPLIERS, AND OTHER THIRD PARTIES MENTIONED ON THIS SITE ARE NEITHER RESPONSIBLE NOR LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, PUNITIVE, OR OTHER DAMAGES (INCLUDING, WITHOUT LIMITATION, THOSE RESULTING FROM LOST PROFITS, LOST DATA, OR BUSINESS INTERRUPTION) ARISING OUT OF OR RELATING IN ANY WAY TO THE SITE, SITE-RELATED SERVICES AND PRODUCTS, CONTENT OR INFORMATION CONTAINED WITHIN THE “SITE,” and ANY HYPERLINKED WEB SITE, WHETHER BASED ON WARRANTY, CONTRACT, TORT, OR ANY OTHER LEGAL THEORY AND WHETHER OR NOT ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. YOUR SOLE REMEDY FOR DISSATISFACTION WITH THE SITE, SITE-RELATED SERVICES, and HYPERLINKED WEBSITES IS TO STOP USING THE SITE and THOSE SERVICES. APPLICABLE LAW MAY NOT ALLOW THE EXCLUSION OR LIMITATION OF INCIDENTAL OR CONSEQUENTIAL DAMAGES, SO THE ABOVE LIMITATION OR EXCLUSION MAY NOT APPLY TO YOU. ACCEPTANCE OF THIS POLICY INDICATE THAT YOU HAVE READ AND UNDERSTAND OUR WEBSITE

TERMS OF USE POLICIES AVAILABLE ON OUR WEBSITE.

• PERSONAL MD may forward patient emails to other staff within our clinic. We will not send emails to other third parties without your prior written consent, except as authorized or required by law.
• PERSONAL MD uses encryption technology that is HIPAA compliant to keep your information secure.
• PERSONAL MD will not disclose your email address to any third party without prior written consent.
• PERSONAL MD will never sell your email address.
• PERSONAL MD is not liable for breaches of confidentiality caused by you or any third party.
• Response Time – PERSONAL MD will respond to the email message, usually within one to two business days.
• PERSONAL MD reserves the right to remove you from our email database and may notify you if such action is taken.
• The email address you enter is where message notifications will be sent.
• These notifications DO NOT contain personal or medical information. They simply state you have received a secure message from PERSONAL MD that is available to you by logging into the website.
• PERSONAL MD will not disclose your email address to other parties.

Controlled Substance Prescription Philosophy

PERSONAL MD POLICY REGARDING PROLONGED USE OF CONTROLLED SUBSTANCES
Chronic pain is a common condition that afflicts many patients seeking and getting care at Personal MD. It is the role of the primary care clinician to diagnose the cause and lead in efforts to decrease the impact of chronic pain on the life of our patients. We take the responsibility to review all previous attempts at diagnosis and, when appropriate, suggest alternative studies and therapeutic modalities that have proven efficacy in enhancing function and diminishing the pain associated with the conditions responsible for the pain. At times, it is reasonable to use narcotics for long-term pain relief. This is especially true when the cause is due to untreatable cancer or when there is unremitting nerve pain. Fortunately, these are the rare causes of chronic pain.

Even with these conditions, there is a well-documented benefit to techniques that involve training in relaxation, movement, and meditation. The chronic use of narcotics without other efforts to relieve pain and improve function
frequently result in the development of tolerance to the drug (the decreasing effectiveness of any given dosage), addiction (dependence on the drug to avoid a withdrawal reaction), habituation (the use of the drug when inappropriate), and increasing pain sensitivity. These are results of the use of long-term narcotics and depend on the medication, its dosage, and the length of time used. While there are individual variations to these responses, they are the expected consequences of their use unless carefully monitored, adjusted, and restricted.

It is our responsibility as primary care clinicians to guard our patients against these expected complications of narcotic use. To do this, we ask that our patients who require the use of narcotics for more than three months adhere to a contract that outlines the responsibilities expected of patients with regards to efforts towards rehabilitation, as well as to the maintenance, safeguards, and refills of narcotic prescriptions. The patient’s primary clinician will set out a plan with the patient regarding the efforts deemed necessary to arrive at a proper diagnosis along with therapeutic efforts geared toward the improvement of the condition. Noncompliance with the contract or therapy and inappropriate reliance on narcotics go beyond the expertise of the primary clinician and will result in a referral to a pain specialist. The safe maintenance of narcotic therapy is dependent on the close working relationship between the patient and the clinician. Dosage adjustment, compliance with contract restrictions, and monitoring of side effects all require examination by the clinician. For these reasons, refills are managed by the primary clinician and not the physician on-call. It is the responsibility of the patient to arrange for timely refills when their clinician is available.

New Personal MD patients should expect to request their medical records from all prior clinicians and pharmacies before decisions are made regarding the prescription of narcotics. There is no guarantee that the Personal MD
clinician will continue narcotics previously prescribed, and it is the responsibility of new patients to have sufficient supplies of any controlled substance to last until their Personal MD clinician has had the opportunity to review all old records and perform a physical examination. Like pain, chronic anxiety is a complex problem stemming from a variety of causes, and for which there are several practical approaches. Unfortunately, anxiety is often oversimplified and treated long term with benzodiazepines. But, like narcotics, these drugs carry significant risks when used chronically. They are reliably addictive and dangerous in withdrawal. They interact with many other medicines and, in combination with narcotics, are a frequent cause of death.

For these reasons, benzodiazepines are not considered the first choice in the treatment of anxiety disorders. It is the responsibility of the Personal MD clinician to clarify the cause of the problem, review prior treatment efforts for their adequacy and appropriateness, and offer a range of effective alternatives. Medication alone will rarely be sufficient for the control of symptoms and maintenance of function. Sole reliance on benzodiazepines in anxiety often leads to excessive dosage and greater danger of addiction. As with narcotics, we treat benzodiazepines as a controlled substance requiring contractual adherence and close monitoring. New Personal MD patients who are already taking benzodiazepines have similar responsibilities as those on chronic narcotics regarding records from prior physicians. There are no guarantees that Personal MD clinicians will agree with previous physicians that benzodiazepines are appropriate, and new patients should not expect refills of prior prescriptions at first visits.

Hypnotics are medications used to treat insomnia. Benzodiazepines and non-benzodiazepine hypnotics can be helpful in the short term to treat sleep disorders, particularly when behavioral approaches fail. However, long term use of hypnotics may lead to dependence. Consequently, Personal MD clinicians will work with members to eliminate secondary causes of sleep disturbance and to correct behavioral causes of insomnia. Referrals to a Sleep Specialist can be arranged and may predate the use of chronic hypnotic therapy if your clinician feels that is appropriate.

Finally, stimulants have become popular in the treatment of Attention Deficit Disorder for both children and adults. As with the above classes of controlled substances, stimulants carry risks in both long term and short term use. Since
we take responsibility for the safe prescription of these drugs, we feel it is our responsibility to ensure that the diagnosis of ADD has been professionally verified and that the less risky options have been tried before refilling
medications started by outside clinicians. Personal MD clinicians may decide that Psychiatric consultation is warranted to justify the risks in the use of stimulant medications

PERSONAL MD FAMILY HEALTHCARE, P.A.
Website and Patient Portal Terms of Use

Our online services are available only for active patients of Personal MD. Please read through the conditions below before proceeding.

PERSONAL MD uses encryption technology that is HIPAA compliant through the use of a patient portal provided by the electronic medical record company we are using to keep your information secure. You should not use any of these online services for medical emergencies or other time-sensitive matters.

Access to portions of a medical record is limited to patients who register for access directly through their Personal MD office. Communication with your physician by Email must take place using our patient portal. This form of
consultation is only for non-urgent medical issues. A small charge may be placed for patients not currently on a member program.

PERSONAL MD patients can request routine appointments for follow-up reasons, preventative healthcare, blood draws, injection, or scheduled procedures using our appointment request feature on our patient portal. The request must be made at least two days before the desired appointment.

PERSONAL MD patients can use their patient portal access to request medication refills if desired. We require 48 hours to process all requests.

PERSONAL MD allows patients to submit billing questions through our patient portal. Please allow 48 hours for a response to questions. Patients can submit updates to their personal information, including but not limited to, new phone number, address change, and new email address.

Patients active on our Patient Portal agree to check email responses and messages sent by our Web Portal Administrator and Personal MD staff members. Also, Patient Portal participants may receive information about current health topics or topics about our clinic, including announcements, medical or drug alerts, newsletters, and policy changes. Participation in the patient portal program is voluntary, and you can deactivate your account at any time and for any reason.

NOTICE OF PRIVACY PRACTICES
Personal MD Family Healthcare, P.A.

Updated 1/28/2020

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Understanding Your Health Record/ Information We understand that medical information about you and your health is personal. We are committed to protecting medical information about you.

This Notice of Privacy Practices (“Notice”) describes the privacy practices of Personal MD Family Healthcare, P.A. This Notice will tell you about how we may use and disclose medical information about you and how you can get access to this information. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Get an electronic or paper copy of your records.  You can ask to see or get an electronic or paper copy of your medical records and other health
information we have about you by contacting the main phone line at the facility where you received care.

• We will provide a copy or a summary of your health information following applicable state and federal requirements. We may charge a reasonable, cost-based fee.
• You may revoke an authorization to use or disclose your health information except to the extent that action has already been taken in reliance on your authorization. To withdraw your authorization, send written Notification to 2770 Virginia Parkway, #301 McKinney, Texas 75071.

Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
• To request an Amendment: Send written Notice to 2770 Virginia Parkway, #301 McKinney, Texas 75071.

Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
• We will not ask you the reason for your application, but there may be a reasonable, cost-based fee.
• You may request a confidential communication by Contacting us in writing at the Office of HIPAA Compliance, 2770 Virginia Parkway, #301 McKinney, Texas 75071

Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• You may request this restriction by contacting us in writing at the Office of HIPAA Compliance, 2770 Virginia Parkway, #301 McKinney, Texas 75071.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared your information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years before the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make). 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 a list of those with whom we’ve shared information contact us in writing at the Office of HIPAA Compliance, 2770 Virginia Parkway, #301 McKinney, Texas 75071

Get a copy of this privacy notice
• You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will provide you with a paper copy promptly.
• You may also view a copy of this Notice on our website at www.Personalmd.net/aboutus/polices

Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action. File a complaint if you feel your privacy rights have been violated
• You can complain if you think we have violated your privacy rights by contacting us at 214-726-0755.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W. Washington D.C., 20201 Or call toll-free at 1-877-
696-6775 Or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

YOUR CHOICES REGARDING YOUR HEALTH INFORMATION
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In the following cases, you have both the right and choice to tell us to:
• Share information with your family, close friends or others involved in your care
• Share information in a disaster relief situation
• Include your data in a hospital directory
• Contact you for fundraising efforts If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may
I also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

OUR USES & DISCLOSURES
How do we typically use or share your health information? We usually use or share your health information in the following ways.
Treat you:
We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
• We may use your health information to give you information about treatment alternatives or health-related benefits/services that may be of interest to you.
Run our organization
• We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.
• We can use and share your health information as required to operate and manage our business activities related to providing and maintaining your health care insurance. Example: We might talk to your physician to suggest a disease management or wellness program that could help improve your health, or
we may analyze data to determine how we can improve our services.
• Communications regarding treatment alternatives and appointment reminders
• We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Bill for our services
• We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for our services.
• For payment
• We can use and share your health information for payment of premiums due to us, to determine your coverage, and for the amount of health care services you receive. Example: We might tell a doctor if you are eligible for coverage and what percentage of the bill might be covered.
• For underwriting purposes. We may use or share your health information for underwriting purposes; however, we will not use or share your genetic information for such purposes.
• We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as the ways mentioned below.
• We must meet many conditions in the law before we can share your information for these purposes. For more information, see www.hhs.gov/ocr/privacy/hipaa/understandi ng/consumers/index.html.
Help with public health and safety issues.
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety
• Student immunizations to schools. We may disclose proof of your child’s vaccinations to their school based on your verbal or written permission.
• Do research. We can use or share your information for health research.
• Food and Drug Administration (FDA). We may disclose to the FDA health information relative to adverse events concerning food, medications, devices, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs or replacement.
• Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services, if it wants to see that we’re complying with federal privacy
law.
• Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations.
• Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
• Address worker’s compensation, law enforcement, and other government requests We can use or share health information about you:
• For worker’s compensation claims
• For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law
• For special government functions such as issues of national security and protective services. Effective Date: December 2018
• Respond to lawsuits and legal actions. We can share health information about you in response to a court or administrative order, or reply to a subpoena.
• Electronic Health Information Exchange (HIE). We maintain electronic health information about you from other health care providers or entities that are not part of our healthcare system who has treated you or who is treating you. This information is also stored in the HIE.
• Our healthcare system and these other providers can use the HIE to see your electronic health information for the purposes described in this Notice, to coordinate your care and as allowed by law.
• We monitor who can view your information, but the individuals and entities who use the HIE may disclose your information to other providers.
• You may opt-out of the HIE by providing a written request to our main office at 2770 Virginia Parkway, #301 McKinney, Texas 75071. If you are opt-out, your information will still be stored in the HIE, but your information will not be viewable through the HIE.
• You may opt back into the HIE at any time.
• You do not have to participate in the HIE to receive care.
OUR RESPONSIBILITIES
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of
your data.
• We must follow the duties and privacy practices described in this Notice and offer you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can get in
writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/c onsumers/noticepp.html.

Changes to the Terms of This Notice
We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available on our website at www.personalmd.net/aboutus/policies and upon written request.