TELEMEDORA, PC
Mailing address: 1250 Borregas Ave, Suite 62, Sunnyvale, CA 94089
HIPAA NOTICE OF PRIVACY PRACTICES
Your Information. Your Rights. Our Responsibilities.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Your Rights
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory/practice directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
Our Uses and Disclosures
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for our services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and
other government requests
• Respond to lawsuits and legal actions
To the extent that we have your substance use disorder patient records,
subject to 42 CFR part 2, we will not share that information for
investigations or legal proceedings against you without (1) your written
consent or (2) a court order and a subpoena.
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 medical record
• You can ask to see or get an electronic or paper copy of your medical
record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information,
usually within 30 days of your request. We may charge a reasonable,
cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think
is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing
within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home,
office, or cell phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
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,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.
• 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 the purpose of 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 information
• You can ask for a list (accounting) of the times we’ve shared your
health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment,
payment, and 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.
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.
Choose someone to act for you
• If someone has authority to act as your personal representative, such
as if someone has your 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 rights are violated
• You can complain if you feel we have violated your rights by
contacting us using the information on page 1.
• 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, calling
1-877-696-6775, or visiting
https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
• We will not retaliate against you for filing a complaint.
Your Choices
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 these 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 or payment for your care
• Share information in a disaster relief situation
• Include your information in a hospital directory/practice directory
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 inyour best interest. We may 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
In the case of fundraising:
• We may contact you for fundraising efforts, but you can tell us not to
contact you again.
If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically 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.
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.
Bill for your 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 your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
CONFIDENTIALITY OF SUBSTANCE USE DISORDER RECORDS
Telemedora does not have any federally assisted program providing SUD diagnosis, treatment, or referral for treatment. Therefore, we don’t have access to your records for these programs from other facilities. However, in the rare event that these records are made available to us by you or any of substance use disorder programs at any other facility or by your other providers, these records will be subject to 42 CFR part 2. It means that:
In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.
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
Do research
We can use or share your information for health research.
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 workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ 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 military, national security,
and presidential protective services
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or
administrative order, or in response to a subpoena.
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 information.
• We must follow the duties and privacy practices described in this notice
and give you a copy of it.
• We will not use or share your information other than as described in this notice unless you tell us we can 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/consumers/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 upon request, in our office, and on our web site.
CONTACT INFORMATION
If you have any questions about this Notice, wish to exercise any of your
rights, or want to file a complaint, please send a written complaint to:
Attn: Privacy Officer
Address: Telemedora, PC
1250 Borregas Ave. Suite 62, Sunnyvale, CA 94089
Effective date of this notice: February 2026.
A copy of this notice can be found on our website: https://telemedora.com/notice-of-privacy-practices-updated/
I UNDERSTAND, ACKNOWLEDGE AND AGREE TO TELEMEDORA’S NOTICE OF PRIVACY PRACTICES.