ONE TO ONE HEALTH
TEXTCARE PATIENT AGREEMENT
This Patient Agreement (the “Agreement”) sets forth the terms and conditions pursuant to which you will receive virtual primary care services from One to One Health’s network of affiliated entities, including One Doc, PLLC and Two Doc, PLLC (“One to One Health”) through its TextCare application (“TextCare”).
Please read the Agreement before accessing TextCare. By using TextCare or by clicking to accept the Agreement when this option is made available to you, you (i) acknowledge that you have read and understand this Agreement; (ii) represent and warrant that you have the right, power and authority to accept this Agreement and, if you are acting on behalf of another person, that you have the legal authority or legal authorization to act on behalf of that other person and bind that other person to this Agreement (and you agree that all references in this Agreement to “you” and “your” include such other person); and (iii) accept and agree to be bound and abide by this Agreement. If you do not want to agree to this Agreement, you must not access or use TextCare.
By using TextCare, you represent and warrant that you are (i) of legal age to form a binding contract with One to One Health and meet all of the foregoing eligibility requirements or (ii) the parent or legal guardian of the recipient of the virtual primary care services if the recipient is under the age of 18 and have legal authority to form a binding contract with One to One Health on behalf of the recipient. If you do not meet all of these requirements, you must not access or use TextCare.
Virtual Primary Care Services
One to One Health will provide you with virtual primary care services through TextCare (the “Services”) during the term of this Agreement. The Services include unlimited access to medical providers via text message, encrypted chat, video visit, and phone call that may include, when appropriate, consultations, diagnoses, treatment, referrals, and transfer of electronic medical data. For a further description of the Services provided through TextCare, please see the menu of services available at www.OneToOneHealth.com/TextCare. The Services will be provided by physicians, nurse practitioners, physician assistants and other medical staff employed by or otherwise contracted with One to One Health.
Consent to Treatment via Telehealth
You acknowledge and agree that One to One Health will provide the Services to you remotely by means of TextCare, a telecommunications technology platform (i.e., via telehealth). You consent to treatment by One to One Health physicians and staff via telehealth, including but not limited to consultation, diagnosis, treatment, and prescriptions for medications. You acknowledge and agree no guarantees have been made to you as to the results or outcome of your care.
Although telehealth may allow you to receive the Services more conveniently, telehealth is not without some disadvantages and risks, including without limitation potential lack of some visual or physical cues otherwise present in a face-to-face meeting or disruptions that could be caused by failures of communication equipment, technologies or service.
You agree to accurately disclose your location prior to receiving treatment. One to One Health providers are only permitted to provide treatment if you are located in a state and jurisdiction in the United States of America in which such providers are licensed to practice medicine.
One to One Health reserves the right, and each medical provider shall have the right, under their sole judgment, to require that a visit for rendering medical care be conducted using video communications.
You will not engage in any hostile, harassing or other inappropriate behavior when accessing TextCare or otherwise interacting with One to One Health ‘s professional staff to receive the Services.
You acknowledge and agree that initiating communications with One to One Health providers using standard SMS and MMS text messaging will be considered as your consent and preference to use SMS and MMS messaging for that visit. You understand that SMS and MMS text messages are not confidential methods of communications and may be insecure. You further understand that, because of this, there is a risk that messaging regarding your medical care might be intercepted and read by a third party.
Any health information received by One to One Health from you will be considered protected health information and will be subject to our notice of privacy practices.
Protected Health Information
You acknowledge and understand that, although One to One Health has implemented safeguards to attempt to protect electronic communications, communicating with One to One Health electronically may not be completely secure, creating a risk of improper disclosure of your protected health information (“PHI”) to unauthorized individuals. You hereby expressly authorize One to One Health to communicate electronically with you for all purposes, including regarding your PHI. One to One Health will not be liable to you for any damages, losses, injuries, expense or costs that you suffer or incur as a result of, or with respect to, the use of electronic communications.
You acknowledge and agree that, with the exception of a non-exclusive, non-transferable, limited personal use license granted to you by One to One Health during the term of this Agreement, TextCare, and intellectual property rights relating thereto, is exclusively owned by One to One Health . You will not copy, share, distribute, disseminate, rent, lease, lend, sell, license, assign, publish, transfer or otherwise make available TextCare or any related application or electronic patient portal provided by One to One Health, or any portion of any of the foregoing, to or with any other person at any time for any purpose. You will not use or access TextCare and any related application or electronic patient portal for any purpose other than to receive Services under this Agreement.
IN CASE OF AN EMERGENCY, YOU SHOULD SEEK IMMEDIATE MEDICAL ATTENTION OR EMERGENCY CARE BY IMMEDIATELY GOING TO AN EMERGENCY ROOM OR BY CALLING 911. Medical concerns that may require emergency treatment should never be raised or addressed through TextCare or its related patient portal.
One to One Health ‘s providers are licensed to write prescriptions and will provide prescriptions (to be filled at the pharmacy of your choice) as necessary for treatment or management of medical conditions that are within the scope of the Services provided via TextCare. You will be responsible for the payment for any such prescriptions, either through existing health care coverage or personally. One to One Health will never issue prescriptions for controlled substances through the Services provided by TextCare.
TextCare Is Not Insurance
You acknowledge, understand and agree that TextCare is not an insurance product and the services provided pursuant to this Agreement are not an insurance plan under the laws of Tennessee or any other state or a substitute for health insurance. It does not replace any existing or future health insurance or health plan coverage that you may obtain or maintain. One to One Health will not bill any insurance plan or other third parties. One to One Health provides only the Services as described herein that are personally provided by One to One Health or its staff. If you are uninsured, notwithstanding entrance into this Agreement, you may still be subject to tax penalties under the Patient Protection and Affordable Care Act, Public Law 111-148 (the “Act”) for failing to obtain insurance, and if you are insured by a health insurance plan that complies with the Act, you may already have coverage for certain preventative care benefits at no cost to you.
Notice to Medicare/Medicaid Patients
At this time, One to One Health does not provide the Services described herein to Medicare, Medicaid, TennCare or any other government health care beneficiaries. You acknowledge this fact, and you agree that you will not use TextCare for an issue or injury that you anticipate or expect to be covered by Medicare, Medicaid, TennCare or any other government health care plan. Further, you agree that at no time will you submit a claim to Medicare, Medicaid, TennCare or any other government agency for the Services provided to you via TextCare.
Assumption of Risk; Release; Indemnification.
You voluntarily choose to participate in, and accept and assume all risks of participation in, TextCare. YOU HEREBY VOLUNTARILY FULLY RELEASE, WAIVE, COVENANT NOT TO SUE, FOREVER DISCHARGE, AND AGREE TO INDEMNIFY AND HOLD HARMLESS, ONE TO ONE HEALTH , ITS EMPLOYEES, MEMBERS, OFFICERS, PERSONNEL AND BUSINESS PARTNERS FROM AND WITH RESPECT TO ANY AND ALL COSTS, EXPENSES, LIABILITIES, LOSSES, CLAIMS, DEMANDS, DAMAGES, ACTIONS OR CAUSES OF ACTION OF ANY KIND WHICH ARE IN ANY WAY CONNECTED WITH YOUR PARTICIPATION IN TEXTCARE OR OTHER SERVICES PROVIDED IN CONNECTION WITH THIS AGREEMENT. This paragraph shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. It is your express intent that this paragraph bind your family members, spouse, heirs, assigns, personal representatives, and anyone else entitled to act on your behalf.
Modification of the Agreement
One to One Health reserves the right to modify the terms and conditions of this Agreement, or any policies related to the access and use of TextCare, at any time and in its sole discretion; provided, that, in the event of such modification, One to One Health will use reasonable efforts to notify you and other Service recipients of the modification by posting a public notice on its website.
This Agreement contains the entire agreement between the parties and replaces any earlier understandings and agreements whether written or oral. This Agreement, and any rights you may have under it, may not be assigned or transferred by you. You acknowledge that you understand this Agreement and have had a reasonable time to seek independent legal advice regarding the Agreement. Any portion of this Agreement deemed unlawful or unenforceable is severable and shall be stricken without any effect on the enforceability of the Agreement as a whole to the fullest extent authorized by law. This Agreement will be governed and construed under the laws of the State of Tennessee. There are no third party beneficiaries to this Agreement.
HIPAA NOTICE OF PRIVACY PRACTICES
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.
One to One Health, including One Doc, PLLC and Two Doc, PLLC, both doing business as One to One Health, and their employees are dedicated to maintaining the privacy of your health information, as required by applicable federal and state laws. These laws require us to provide you with this Notice of Privacy Practices, and to inform you of your rights and our obligations concerning Protected Health Information, or PHI, which is information that identifies you and that relates to your physical or mental health or condition. We are required to follow the privacy practices described below while this Notice is in effect.
I. Permitted Disclosures of PHI. We may use and disclose your PHI for the following reasons, except as otherwise limited by applicable federal or state law:
A. Treatment. We may use and disclose your PHI to a physician or other health care provider providing treatment to you. For example, we may disclose medical information about you to physicians, nurses, technicians or personnel who are involved with the administration of your care.
B. Payment. We may use and disclose your PHI to bill and collect payment for the services we provide to you. For example, we may send a bill to you or to a third party payor for the rendering of services by us. We may also provide your PHI to our business associates, such as billing companies, claims processing companies and others that process our health care claims.
C. Health Care Operations. We may use and disclose your PHI in connection with our health care operations. Health care operations include quality assessment activities, reviewing the competence or qualifications of health care professionals, evaluating provider performance, and other business operations. For example, we may use your PHI to evaluate the performance of the health care services you received. We may also provide your PHI to accountants, attorneys, consultants and others to make sure we comply with the laws that govern us.
D. Emergency Treatment. We may use and disclose your PHI if you require emergency treatment or are unable to communicate with us.
E. Direct Contact with You. We may use your PHI to contact you to remind you that you have an appointment, to inform you about treatment alternatives or other health-related benefits and services that may be of interest to you.
F. Family and Friends. We may disclose your PHI to a family member, friend or any other person who you identify as being involved with your care or payment for care, unless you object.
G. Required by Law. We may disclose your PHI for law enforcement purposes and as required by state or federal law. For example, the law may require us to report instances of abuse, neglect or domestic violence; to report certain injuries such as gunshot wounds; or to disclose PHI to assist law enforcement in locating a suspect, fugitive, material witness or missing person. We will inform you or your representative if we disclose your PHI because we believe you are a victim of abuse, neglect or domestic violence, unless we determine that informing you or your representative would place you at risk. In addition, we must provide PHI to comply with an order in a legal or administrative proceeding. Finally, we may be required to provide PHI in response to a subpoena discovery request or other lawful process, but only if efforts have been made, by us or the requesting party, to contact you about the request or to obtain an order to protect the requested PHI.
H. Serious Threat to Health or Safety. We may disclose your PHI if we believe it is necessary to avoid a serious threat to the health and safety of you or the public.
I. Public Health. We may disclose your PHI to public health or other authorities charged with preventing or controlling disease, injury or disability, or charged with collecting public health data.
J. Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These activities include but are not limited to audits; civil, administrative or criminal investigations or proceedings; inspections; licensure or disciplinary actions; or other activities necessary for oversight of the health care system, government programs and compliance with civil rights laws.
K. Research. We may disclose your PHI for certain research purposes, but only if we have protections and protocols in place to ensure the privacy of your PHI.
L. Workers’ Compensation. We may disclose your PHI to comply with laws relating to workers’ compensation or other similar programs.
M. Specialized Government Activities. If you are active military or a veteran, we may disclose your PHI as required by military command authorities. We may also be required to disclose PHI to authorized federal officials for the conduct of intelligence or other national security activities.
N. Organ Donation. If you are an organ donor, or have not indicated that you do not wish to be a donor, we may disclose your PHI to organ procurement organizations to facilitate organ, eye or tissue donation and transplantation.
O. Coroners, Medical Examiners, Funeral Directors. We may disclose your PHI to coroners or medical examiners for the purposes of identifying a deceased person or determining the cause of death, and to funeral directors as necessary to carry out their duties.
P. Disaster Relief. Unless you object, we may disclose your PHI to a governmental agency or private entity (such as FEMA or Red Cross) assisting with disaster relief efforts.
II. Disclosures Requiring Written Authorization.
A. Not Otherwise Permitted. In any other situation not described in Section I above, we may not disclose your PHI without your written authorization.
B. Marketing and Sale of PHI. We must receive your written authorization for any disclosure of PHI for marketing purposes or for any disclosure which is a sale of PHI.
III. Patient Rights.
A. Right to Receive a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice upon request.
B. Right to Access PHI. You have the right to inspect and copy your PHI for as long as we maintain your medical record. You must make a written request for access to the Privacy Officer at the address listed at the end of this Notice. We may charge you a reasonable fee for the processing of your request and the copying of your medical record pursuant to HIPAA and applicable state law. In certain circumstances we may deny your request to access your PHI, and you may request that we reconsider our denial. Depending on the reason for the denial, another licensed health care professional chosen by us may review your request and the denial.
C. Right to Request Restrictions. You have the right to request a restriction on the use or disclosure of your PHI for the purpose of treatment, payment or health care operations, except for in the case of an emergency. You also have the right to request a restriction on the information we disclose to a family member or friend who is involved with your care or the payment of your care. However, we are not legally required to agree to such a restriction.
D. Right to Restrict Disclosure for Services Paid by You in Full. You have the right to restrict the disclosure of your PHI to a health plan if the PHI pertains to health care services for which you paid in full directly to us.
E. Right to Request Amendment. You have the right to request that we amend your PHI if you believe it is incorrect or incomplete, for as long as we maintain your medical record. We may deny your request to amend if (a) we did not create the PHI, (b) it is not information that we maintain, (c) it is not information that you are permitted to inspect or copy (such as psychotherapy notes), or (d) we determine that the PHI is accurate and complete.
F. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures of PHI made by us (other than those made for treatment, payment or health care operations purposes) during the 6 years prior to the date of your request. You must make a written request for an accounting, specifying the time period for the accounting, to the Privacy Officer at the address listed at the end of this Notice.
G. Right to Confidential Communications. You have the right to request that we communicate with you about your PHI by certain means or at certain locations. For example, you may specify that we call you only at your home phone number, and not at your work number. You must make a written request, specifying how and where we may contact you, to the Privacy Officer at the address listed at the end of this Notice.
H. Right to Notice of Breach. You have the right to be notified if we or one of our business associates become aware of a breach of your unsecured PHI.
IV. Changes to this Notice. We reserve the right to change this Notice at any time in accordance with applicable law. Prior to a substantial change to this Notice related to the uses or disclosures of your PHI, your rights or our duties, we will revise and distribute this Notice.
V. Acknowledgment of Receipt of Notice. We will ask you to sign an acknowledgment that you received this Notice.
VI. Questions and Complaints. If you would like more information about our privacy practices or have questions or concerns, please contact us using the information below. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made regarding the use, disclosure, or access to your PHI, you may complain to us by contacting the Privacy Officer at the address and phone number at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file such a complaint upon request.
We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Please direct any of your questions or complaints to:
One to One Health Privacy Officer
1067 Riverfront Parkway, Suite 201, Chattanooga, Tennessee 37401-2222
423 602 9530
This notice is effective October 1, 2022.