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Notice of Privacy Practices

For Protected Health Information

Upperline Health  |  Effective Date: April 15, 2025

THIS NOTICE DESCRIBES:

PLEASE REVIEW THIS NOTICE CAREFULLY.

Questions? Contact: Privacy Officer, Madison Bryant | (844)-427-4216 | compliance@upperlinehealth.com

Upperline Health is dedicated to protecting your health information. Upperline is required by law to maintain the privacy of protected health information, to provide you with adequate notice of your rights and our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. “Protected Health Information” includes past, present and future health information created or received by a provider, including demographic information that may identify you and relate to your past, present or future physical or mental medical condition, providing health care services to you, or payment for the health care services we provide. We will use or disclose Protected Health Information consistently with this notice.

Section 1 — What Is This Notice?

Upperline Health maintains a record (paper/electronic file) of the information we receive and collect about you and of the care we provide to you. This record may include, without limitation, physicians’ orders, medication lists, the dispensing of pharmaceutical products, and billing information. This Notice describes how we may use and disclose your Protected Health Information to carry out treatment, payment or health care operations and for other purposes permitted or required by law. It also describes your rights regarding your Protected Health Information.

This notice applies to our workforce members and other health care providers we work with in a clinically integrated setting (e.g., members of our professional staff), any e-prescribing or health information exchange that we or one of our business associates operate, and other participants in our organized health care arrangements.

Section 2 — How Health Information About You May Be Used and Disclosed

As our patient, information about you may be used and disclosed to other parties for purposes of treatment, payment and health care operations without obtaining your written authorization. Examples of information that may be disclosed:

1. Treatment

Providing, coordinating or managing health care and related services, consultations with and referrals to and from health care providers relating to your health care. For example, we use your health information to dispense medications and contact you about refill reminders and treatment alternatives.

2. Payment

Billing and collecting for services provided, determining plan eligibility and coverage, utilization review (UR), precertification, and medical necessity review. For example, an insurance company may request a copy of your records for a coverage review prior to paying the bill. We may also share your information with someone involved in paying for your medications.

3. Health Care Operations

General Upperline administrative and business functions; quality assurance/improvement activities; medical review; auditing functions; developing clinical guidelines; determining the competence or qualifications of health care professionals; evaluating Upperline performance; conducting training programs with students or new employees; licensing, survey, certification, accreditation and credentialing activities; internal auditing; and certain fundraising activities, if applicable; and with your authorization, marketing activities. For example, we may use your information or combine it with other Upperline patient information to review the effectiveness of our treatment and services, to evaluate the performance of our staff in providing services to you, or to make decisions about additional services we should offer.

Section 3 — Uses and Disclosures That Do Not Require Your Consent

The following uses and disclosures do not require your consent, and include, but are not limited to, the release of information contained in financial records and/or medical records, including information concerning communicable diseases such as HIV, AIDS, drug/alcohol abuse, psychiatric diagnosis and treatment records and/or laboratory test results, if applicable, to:

  1. Your insurance company, self-funded or third-party health plan, Medicare, Medicaid or any other person or entity that may be responsible for paying or processing for payment of any portion of your bill for services;
  2. Any person or entity affiliated with or representing us for purposes of administration, billing and quality and risk management;
  3. Any physician or other provider providing you care;
  4. Licensing and accrediting bodies;
  5. You regarding refill reminders for drugs, biologicals and/or drug delivery systems that have already been prescribed to you;
  6. You with marketing communications promoting health products, services and information programs or communications if the communication is made face to face with you or the only financial gain consists of a promotional gift of nominal value provided by Upperline Health; and
  7. Other health care providers to initiate treatment.

Section 4 — Uses and Disclosures Permitted Without Consent or Authorization

We are permitted to use or disclose information about you without consent or authorization in the following circumstances:

  1. In emergency treatment situations, if we attempt to obtain consent as soon as practicable after treatment;
  2. Where substantial barriers to communicating with you exist and we determine that the consent is clearly inferred from the circumstances;
  3. Where we are required by law to provide treatment and we are unable to obtain consent;
  4. Where the use or disclosure is required by federal, state or local law;
  5. To provide information for public health activities, including to state or federal public health authorities as required by law to prevent or control disease, injury or disability, report births and deaths, or report child abuse or neglect; to the FDA to report reactions to medications or problems with products, track FDA-regulated products, or notify persons of recalls; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease; and to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence (if the patient agrees or when required or authorized by law);
  6. For health care oversight activities such as audits, investigations, inspections and licensure by a government health oversight agency as authorized by law to monitor the health care system, government programs and compliance with civil rights laws;
  7. To business associates regulated under HIPAA that work on our behalf under a contract that requires appropriate safeguards of Protected Health Information;
  8. In certain judicial and administrative proceedings if you are involved in a lawsuit or a dispute. We may disclose medical information about you in response to a court or administrative order, a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested;
  9. For certain law enforcement purposes such as helping to identify or locate a suspect, fugitive, material witness or missing person, or to comply with a court order or subpoena and other law enforcement purposes;
  10. To coroners, medical examiners and funeral directors, in certain circumstances, for example, to identify a deceased person, determine the cause of death or to assist in carrying out their duties;
  11. For cadaveric organ, eye or tissue donation purposes to communicate to organizations involved in procuring, banking or transplanting organs and tissues (if you are an organ donor);
  12. For certain research purposes under very select circumstances. Before we disclose any of your health information for research purposes, the project will be subject to an extensive approval process;
  13. To avert a serious threat to health and safety: To prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public, such as when a person admits to participation in a violent crime or is an escaped convict. Any disclosure would only be to someone able to help prevent or lessen the threat;
  14. For specialized government functions, including military and veterans’ activities, national security and intelligence activities, protective services for the President, foreign heads of state and others, medical suitability determinations, correctional institution and custodial situations; and
  15. For Workers’ Compensation purposes: Workers’ compensation or similar programs provide benefits for work-related injuries or illness.

Section 5 — Uses and Disclosures Requiring Advance Notice and Opportunity to Restrict

We are permitted to use or disclose information about you provided you are informed in advance and given the opportunity to agree, prohibit, or restrict the use or disclosure in the following circumstances:

  1. To use or disclose to public or private entities to assist in disaster relief efforts; and
  2. To provide a family member, relative, friend, or other identified person, prior to or after your death, the information relevant to such person’s involvement in your care or payment for care (unless doing so is inconsistent with any prior expressed preference of yours that is known to us) or to notify a family member, your personal representative, or other person responsible for your care of your location, general condition or death.

Section 6 — Uses and Disclosures Requiring Your Written Authorization

Other uses and disclosures not covered in this notice will be made only with your written authorization. Consent is required and may be revoked, in writing, at any time, except in limited situations, for the following disclosures:

  1. Marketing of products or services or treatment alternatives, including any subsidized treatment communications, that may be of benefit to you when we receive direct payment from a third party for making such communications, other than as set forth above with regard to certain refill reminders and face-to-face communications and promotional gifts of nominal value; and
  2. Any sale of Protected Health Information resulting in financial gain by Upperline Health unless HIPAA otherwise permits (for example, if we were to sell our business to another provider).

Section 7 — Your Rights With Respect to Your Health Information

You have the right, subject to certain conditions, to:

1. Request Restrictions on Uses and Disclosures

You may request restrictions on uses and disclosures of your Protected Health Information for treatment, payment or health care operations by contacting our Privacy Officer as listed at the end of this Notice. Except as stated below, we are not required to agree to any requested restriction. Restrictions to which we agree will be documented. Agreements for further restrictions may, however, be terminated under applicable circumstances (e.g., emergency treatment).

2. Confidential Communication of Protected Health Information

We will arrange for you to receive confidential communications by reasonable alternative means or at alternative locations. Your request must be in writing to the contact person listed at the end of this notice. We do not require an explanation for the request as a condition of providing communications on a confidential basis and will attempt to honor reasonable requests for confidential communications. If you request your Protected Health Information to be transmitted directly to another person designated by you, your written request must be signed and clearly identify the designated person and where the copy of Protected Health Information is to be sent.

3. Inspect and Obtain Copies of Protected Health Information

You may inspect and obtain copies of Protected Health Information maintained in a designated record set, except for psychotherapy notes, information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding, or Protected Health Information that may not be disclosed under the Clinical Laboratory Improvements Amendments of 1988, by contacting our Privacy Officer. If you request a copy of your health information, we will charge a reasonable, cost-based fee that includes only the cost of labor for copying, supplies, postage (if applicable), and preparing an explanation or summary of the Protected Health Information if agreed to, in accordance with applicable state and federal regulations.

If the requested Protected Health Information is maintained electronically and you request an electronic copy, we will provide access in an electronic format you request, if readily producible, or if not, in a readable electronic form and format mutually agreed upon.

IF YOU REQUEST AN ELECTRONIC COPY, UPPERLINE HEALTH HEREBY EXPRESSLY DISCLAIMS ALL DUTIES AND RESPONSIBILITY FOR THE SECURITY AND PROTECTION OF SUCH INFORMATION ONCE TRANSMITTED TO YOU AND HAS NO CONTROL OVER ACCESS TO THAT INFORMATION AFTER THE TRANSMISSION TO YOU THEREOF.

If we deny access to Protected Health Information, you will receive a timely, written denial in plain language that explains the basis for the denial, your review rights, and an explanation of how to exercise those rights. If we do not maintain the Protected Health Information you request, we will tell you where to request it if we have knowledge thereof.

4. Request to Amend Protected Health Information

You may request that we amend your Protected Health Information for as long as it is maintained in the designated record set. A request to amend your record must be in writing and include a reason to support the requested amendment. Contact our Privacy Officer as listed at the end of this Notice. We will act on your request within sixty (60) days of receipt. We may extend the time for such action by up to thirty (30) days if, within the initial sixty (60) days, we provide you with a written explanation of the reasons for the delay and the date by which we will complete action on the request.

We may deny the request for amendment if the information was not created by us (unless you provide a reasonable basis for believing the originator is no longer available), is not part of the designated medical record set, would not be available for inspection under applicable law, or the record is accurate and complete. If we deny your request, you will receive a timely, written denial in plain language explaining the basis for the denial, your rights to submit a statement disagreeing with the denial, and how to submit that statement.

5. Receive an Accounting of Disclosures of Protected Health Information

You have the right to receive an accounting of disclosures of Protected Health Information made by Upperline Health for up to six (6) years prior to the date on which the accounting is requested, for any reason other than for treatment, payment or health care operations and other applicable exceptions. The written accounting includes the date of each disclosure, the name of the entity or person who received the Protected Health Information and, if known, the address, a brief description of the information disclosed, and a brief statement of the purpose of the disclosure or a copy of the written request for disclosure.

We will provide the accounting within sixty (60) days of receipt of a written request. We may extend the time period by thirty (30) days if within the initial sixty (60) days we provide you with a written statement of the reasons for the delay and the date by which you will receive the information. We will provide the first accounting during any 12-month period without charge. Subsequent accounting requests within the same 12-month period may be subject to a reasonable cost-based fee, which will be communicated to you in advance. You will have the opportunity to withdraw or modify your request to avoid or reduce the applicable fee.

6. Receive Notification of a Breach

You have the right to receive notification of any breach in the acquisition, access, use or disclosure of unsecured Protected Health Information by Upperline Health, its business associates and/or subcontractors.

7. Obtain a Copy of This Notice

YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH PRIVACY OFFICER, MADISON BRYANT, AT compliance@upperlinehealth.com or (844)-427-4216 IF YOU HAVE ANY QUESTIONS.

You may obtain a paper copy of this notice from us upon request, even if you had previously agreed to receive this notice electronically.

Section 8 — Our Duties Regarding This Notice

We must abide by the terms of the notice currently in effect, but we reserve the right to change these terms as necessary for all Protected Health Information that we maintain. If we change the terms of this notice, we will promptly revise and distribute a revised notice to you as soon as practicable by mail, email (if you have agreed to electronic notice), hand delivery, or by posting on our website.

Section 9 — How to File a Complaint

If you believe that your privacy rights have been violated, you may complain to Upperline Health or to the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation against you for filing a complaint. The complaint should be filed in writing and should state the specific incident(s) in terms of subject, date, and other relevant matters. A complaint to the Secretary must be filed in writing within 180 days of when the act or omission complained of occurred and must describe the acts or omissions believed to be in violation of applicable requirements.

For further information regarding filing a complaint or any questions about matters covered by this notice, please contact:

Upperline Health
ATTN: Privacy Officer, Madison Bryant
4101 Charlotte Avenue, Suite F185
Nashville, TN 37209
(844)-427-4216
compliance@upperlinehealth.com