This Health Information Privacy Policy (the “Notice”) describes how Fort Health Medical Group of New Jersey, P.C., all members of its Affiliated Covered Entity (collectively, “Fort Professionals”), and other independent clinical practices and/or clinicians using the Site (“Other Professionals”; and together with the Fort Professionals, “Professionals”, “we”, and “our”), operating with non-clinical support from Forth Health, Inc. (collectively, “Fort Health”), may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. An Affiliated Covered Entity is a group of health care providers under common ownership or control that designates itself as a single entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). The members of the Fort Professionals Affiliated Covered Entity will share protected health information with each other for the treatment, payment, and health care operations of the Fort Professionals Affiliated Covered Entity and as permitted by HIPAA and this Health Information Privacy Policy. For a complete list of the members of the Fort Professionals Affiliated Covered Entity, please contact info@Forthealth.com. For purposes of clarification, the Other Professionals are independent from and not affiliated with Fort Professionals Affiliated Covered Entity.

Please review this Notice carefully. Capitalized terms not defined herein shall have the respective meanings given to them in the Fort Health Terms of Service. For purposes of this Notice, “you” means you on behalf of yourself and your Family Members, including your minor children.

How is patient privacy protected?

We understand that information about you and your health is personal. By “health information,” we mean protected health information as defined under federal law (HIPAA and its implementing regulations). Not only is it our legal obligation, but it is our business imperative to ensure the confidentiality of your health information. We continuously seek to safeguard your health information through administrative, physical, and technical means, and otherwise abide by applicable federal and state laws.

How do we collect and maintain your health information?

The health information that we collect or maintain may include:

• Your name, age, email address, username, password, and other registration information.
• Health information that you provide us, which may include information or records relating to your medical or health history, health status and laboratory testing results, diagnostic images, and other health related information.
• Health information about you prepared or obtained by the clinical professionals and support staff who provide clinical services through Fort Health such as medical and records, treatment and examination notes, remote monitoring data, and other health related information.
• Billing information that you provide us, such as credit card information, or that we receive from a health plan or other provider of healthcare benefits on your behalf.

How do we use and disclose health information?

We use and disclose your health information for the normal business activities that the law sees as falling in the categories of treatment, payment and healthcare operations. Generally, we do not need your permission for these disclosures under applicable laws. Below we provide examples of those activities, although not every use or disclosure falling within each category is listed:

• Treatment – We keep a record of the health information you provide us. This record may include your test results, diagnoses, medications, your response to medications or other therapies, and information we learn about your medical condition through our services. We may disclose this information so that other doctors, nurses, and entities such as laboratories can meet your healthcare needs.
• Payment – We document the services and supplies you receive when we are providing care to you so that you, your insurance company or another third party can pay us. We may tell your health plan about upcoming treatment or services that require prior approval by your health plan.
• Health Care Operations – Health information is used to improve the services we provide, to train staff, for business management, quality assessment and improvement, and for customer service. For example, we may use your health information to review our treatment and services and to evaluate the performance of our staff in caring for you.

We may also use and disclose your health information to:

• Provide the services and customer support.
• Comply with federal, state or local laws that require disclosure.
• Assist in public health activities such as tracking diseases or medical devices.
• Inform authorities to protect victims of abuse or neglect.
• Comply with federal and state health oversight activities such as fraud investigations, audits, and requests for information.
• Respond to law enforcement officials or to judicial orders, subpoenas or other processes.
• Inform coroners, medical examiners and funeral directors of information necessary for them to fulfill their duties.
• Facilitate organ and tissue donation or procurement.
• Conduct research following internal review protocols to ensure the balancing of privacy and research needs.
• Avert a serious threat to health or safety.
• Assist in specialized government functions such as national security, intelligence and protective services.
• Inform military and veteran authorities if you are an armed forces member (active or reserve).
• Inform a correctional institution if you are an inmate.
• Inform workers’ compensation carriers or your employer if you are injured at work.
• Recommend treatment alternatives.
• Tell you about health-related products and services.
• Communicate within our organization for treatment, payment, or healthcare operations.
• Communicate with other providers, health plans, or their related entities for their treatment or payment activities, or health care operations activities relating to quality assessment and improvement, care coordination and the qualifications and training of healthcare professionals.
• Provide information to other third parties with whom we do business, such as a record storage provider. However, you should know that in these situations, we require third parties to provide us with assurances that they will safeguard your information.
• We may also use or disclose your personal or health information for operational purposes. For example, we may communicate with individuals involved in your care or payment for that care, such as family or guardians and send appointment reminders.
• For business analytics purposes.

If we believe you or an identified patient pose a serious risk of harm to yourself or someone else, or if the welfare of a child is in jeopardy, we are required to take protective actions. This may mean that we have to contact a potential victim, the police, child and family services, government authorities, or other parties to minimize the risk of harm.

All other uses and disclosures, not previously described, may only be done with your written authorization. We will also obtain your authorization before we use or disclose your health information for marketing purposes or before we would sell your information. You may revoke your authorization at any time; however, this will not affect prior uses and disclosures. In some cases state law may require that we apply extra protections to some of your health information.

What are the Healthcare Professionals’ Responsibilities?

We are required by law to:

• Maintain the privacy of your health information.
• Provide this Notice of our duties and privacy practices.
• Abide by the terms of the Notice currently in effect.
• Tell you if there has been a breach that compromises your health information.

We reserve the right to change our privacy practices and make the new practices effective for all the information we maintain. Revised notices will be posted on the Site.

Do you have any Federal Rights?

The law entitles you to:

• Inspect and copy certain portions of your health information. We may deny your request under limited circumstances. You may request that we provide your health records to you in an electronic format.
• Request amendment of your health information if you feel the health information is incorrect or incomplete. However, under certain circumstances we may deny your request.
• Receive an accounting of certain disclosures of your health information made for the prior six (6) years, although this excludes certain disclosures for treatment, payment, and health care operations. (Fees may apply to this request.)
• Request that we restrict how we use or disclose your health information. However, we are not required to agree with your requests, unless you request that we restrict information provided to a payor, the disclosure would be for the payor’s payment or healthcare operations, and you have paid for the health care services completely out of pocket.
• Request that we communicate with you at a specific telephone number or address.
• Obtain a paper copy of this notice even if you receive it electronically.

We may ask that you make some of these requests in writing.

What if I have a complaint?

If you believe that your privacy has been violated, you may file a complaint with us or with the Secretary of Health and Human Services in Washington, D.C. We will not retaliate or penalize you for filing a complaint with us or the Secretary. To file a complaint with us or receive more information contact:

Phone: (201) 208 - 2616

Email: incidents@forthealth.com

Address: 85 5th Ave, 8th floor New York, NY 10003

To file a complaint with the Secretary of Health and Human Services write to 200 Independence Ave., S.E., Washington, D.C. 20201, call 1-800-537-7697, or file an online complaint at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf.

Who will follow this Notice?

This Notice describes the health care practices of:

• Any Healthcare Professional authorized to access and/or enter information into your health record through Fort Health;
• All departments and units of Fort Health through which telehealth and in-person health services are provided; and
• All affiliates and volunteers.