THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
Notice Effective Date: September 25, 2020
Unmute is required by state and federal law, including the Health Information Portability and
Accountability Act (HIPAA), to maintain the privacy and security of your protected health
information (PHI). PHI includes any identifiable information about your physical or mental
health, the health care you receive, and the payment for your health care. Information about care
that you received from other providers may also be included in your PHI.
Unmute is required by law to provide you with this notice to tell you how it may use and disclose
your PHI and to inform you of your privacy rights. Unmute must follow the privacy practices as
set forth in its most current Notice of Privacy Practices.
Changes to this Notice
Unmute may change its privacy practices and the terms of this notice at any time. Changes will
apply to PHI that Unmute already has as well as PHI that Unmute receives in the future. The
most current privacy notice will be posted on the Unmute intake form, on the Unmute website
(www.unmute.today), and will be available on request. Every privacy notice will be dated.
How Unmute May Use and Disclose Your PHI
Unmute may use your PHI within the Unmute organization and disclose it outside of the
organization without your authorization for the following purposes, as applicable:
1. For Treatment - Unmute may use/disclose PHI to doctors, nurses, residents or students
and other health care providers that are involved in delivering your health care and
related services. Your PHI will be used to assist in developing your treatment and/or
service plan and to conduct periodic reviews and assessments. PHI may be disclosed to
other health care professionals and providers to obtain prescriptions, lab work,
consultations, and other items needed for your care. PHI will be disclosed to health care
providers for the purposes of referring you for services and then for coordinating and
providing the services you receive.
2. For Payment - Unmute may use/disclose your PHI to bill and collect payment for your
health care services. Unmute may release portions of your PHI to the Medicaid or
Medicare program or a third party payor to determine if they will make payment, to get
prior approval, and to support any claim or bill.
3. For Health Care Operations - Unmute may use/disclose PHI to support activities such as
program planning, management and administrative activities, quality assurance,
receiving and responding to complaints, compliance programs (e.g., Medicare), audits,
training and credentialing of health care professionals, and certification and
accreditation (e.g., The Joint Commission).
4. Appointment Reminders - Unmute may use PHI to remind you of an appointment or
follow up instructions or to provide you with information about treatment alternatives or
other health related benefits and services that may be of interest to you.
5. Business Associates - Unmute may use/disclose PHI to contractors, agents and other
business associates who need the information to assist Unmute with obtaining payment
or carrying out its business operations. If Unmute discloses your PHI to a business
associate, Unmute will have a written contract with that business associate to ensure
that it also protects your PHI.
6. Family and Friends/Clergy - Unmute may disclose a limited amount of PHI for the
a. Clergy – If you agree, verbally or otherwise, your religious affiliation may be
disclosed to clergy.
b. Family, Friends, or Others – If you agree or do not object, PHI may be disclosed
to persons involved in your care or payment for your care if directly related to
their involvement in your care or payment for your care.
7. Required by Law - Unmute may use/disclose PHI as required by law, such as to report a
felony committed on its premises; pursuant to a court order; to report abuse or neglect,
and other situations where Unmute is required to make reports and/or disclose PHI
pursuant to a statute or regulation.
8. Lawsuits and Disputes - If you bring a legal action or other proceeding against Unmute
or our employees or agents, we may use and disclose PHI to defend ourselves.
9. Other Purposes - Unmute may use/disclose your PHI:
a. For guardianship or commitment proceedings when Unmute is a party;
b. For other judicial and administrative proceedings if certain criteria are met;
c. To public health authorities that are to receive reports of abuse or neglect;
d. For research purposes, following strict internal review;
e. To avert a serious and imminent threat to health or safety;
f. To persons involved in your care in an emergency situation if certain criteria are
g. To correctional institutions - If you are an inmate or you are detained by a law
enforcement officer, we may disclose your PHI to the prison officers or law
enforcement officers if necessary to provide you with health care, or to maintain
safety, security and good order at the place where you are confined;
h. To authorized public health officials for public health activities such as tracking
diseases and reporting vital statistics;
i. To government agencies authorized to conduct audits, investigations, and
inspections of our business. These government agencies monitor the operations
of the healthcare system, government benefit programs such as Medicare and
Medicaid, and compliance with government regulatory programs and civil rights
j. For workers' compensation claims;
k. For certain specialized government functions if certain criteria are met; and
l. In the unfortunate event of your death, we may disclose your PHI to coroners,
medical examiners, funeral directors, and certain organ and tissue procurement
Uses/Disclosures Requiring Written Authorization
Unmute is required to have a written authorization from you or your legally authorized personnel
representative for uses/disclosures beyond treatment, payment, and health care operations,
unless an exception listed above applies. You may cancel an authorization at any time, if you
do so in writing. A cancellation will stop future uses/disclosures except to the extent Unmute
has already acted based upon your authorization.
Authorization is required for most uses and disclosures of psychotherapy notes (these are the
notes that certain professional behavioral health providers maintain that record your
appointments with them and are not stored in your medical record), certain substance use
disorder information, HIV testing or test results, and certain genetic information even if
disclosure is being made for treatment, payment, or health care operations purposes as
Although the following types of uses/disclosures are not contemplated by Unmute, we need to
inform you that any use or disclosure of PHI for marketing that involves financial remuneration
to Unmute will require an authorization.
Unmute will not sell your PHI to third party vendors, mailing lists, or other outside organizations.
Unmute will not use or disclose your PHI for fundraising purposes.
Your Rights Concerning Your PHI
You or your legally authorized personal representative has the right to:
1. Request that Unmute use a specific email address, mailing address, online messaging
platform username, or telephone number to contact you. Unmute will try to
accommodate all reasonable requests.
2. Obtain, upon request, a paper copy of this notice or any revision of this notice, even if
you agreed to receive it electronically.
3. Inspect and request a copy of the PHI used to make decisions about your care. When
records are kept electronically, you may request an electronic copy. Access to your
records may be restricted in limited circumstances. If Unmute denies your request, in
whole or in part, you may request that the denial be reviewed. Fees may be charged for
copying and mailing. Ordinarily, Unmute will respond to your request within 30 days. If
additional time is needed to respond, Unmute will notify you within the 30 days to explain
the reason(s) for the delay and indicate when you can expect a final answer to your
request. This request must be made in writing.
4. Request additions or corrections to your PHI. Unmute is not required to agree to such a
request. If it does not comply with your request, Unmute will tell you why in writing within
60 days and notify you of your specific rights in that event. If additional time is needed to
respond, Unmute will notify you within the 60 days to explain the reason(s) for the delay
and indicate when you can expect a final answer to your request. This request must be
made in writing.
5. Request an accounting of disclosures (up to the past year) which will identify, in
accordance with applicable laws, certain other persons or organizations to which
Unmute disclosed your PHI and why. An accounting will not include disclosures that
a. made to you or your personal representative;
b. authorized or approved by you;
c. made for treatment, payment, and health care operations; and
d. some that were required by law to be made.
Ordinarily, Unmute will respond to your request within 60 days. If additional time is
needed to respond, Unmute will notify you within the 60 days to explain the reason(s) for
the delay and indicate when you can expect a final answer to your request. This request
must be made in writing.
6. Request that Unmute restrict how it uses or discloses your PHI. Unmute is not required
to agree to such restriction, with the exception that if you, or someone on your behalf,
pay for a service or health care item out-of-pocket in full, Unmute will agree to not
disclose PHI pertaining only to that service or item with your health plan for the purpose
of payment or health care operation, unless Unmute is otherwise required by law to
disclose that PHI. This request must be made in writing.
The above requests may be submitted electronically to email@example.com, or by requesting a
physical mailing address.
Your individual records will be retained as needed by Unmute, with a minimum of one month
after the date that your case was closed. After that time, your records may be destroyed.
Breach of PHI
Unmute will inform you if a breach of your unsecured PHI occurs in writing and as soon as
possible. You will be told when the breach occurred, which PHI was potentially exposed, and
what Unmute is doing to resolve the issue, and what your options are.
If you believe that your privacy or privacy rights have been violated, or you want to file a
complaint, you may do so via the US Department for Health and Human Services online Health
Information Portal at www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html. A
complaint must be made in writing.
No one may retaliate against you for filing a complaint or for exercising your rights as described
in this notice.
If you want to obtain further information about Unmute’s privacy practices, if you want to obtain
other information (non-privacy related) about Unmute and its services, or if you want to
exercise your rights, you may contact Colleen Leung and Asini Wijewardane at
firstname.lastname@example.org or request a secure mailing address.