Privacy Policies
Notice of Privacy Practices
Your Information. Your Rights. Our Responsibilities.
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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.
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Ember
Privacy Officer
Naomi Major
(603) 696-4641
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Your Rights
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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
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Your Choices
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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
• Provide mental health care
• Market our services and sell your information
• Raise funds
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Our Uses and Disclosures
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We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your 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
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Your Rights
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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 or office 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” if it would affect your care.
• 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 you have given someone 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
Your Choices
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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
• Share information in a disaster relief situation
• Include your information in a hospital 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 in your 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.
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Our Uses and Disclosures
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How do we typically use or share your health information?
We typically use or share your health information in the following ways.
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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?
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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. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
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 verify that we are complying with federal privacy law.
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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
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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.
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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 here 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.
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Other Instructions for Notice
• Effective Date of this Notice: 04/14/2026
• Privacy Officer: Naomi Major, 603-696-4641
• We will never market or sell personal information.
• We will never share any substance abuse treatment records with non -treatment entities without your written permission.
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Consent for Telehealth Appointments
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Telemedicine involves the use of electronic communications to enable health care providers at different locations to share individual patients' medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:
Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
Expected Benefits
• Improved access to medical care by enabling a patient to remain in his/her provider’s office (or at a remote site) while the physician obtains test results and consults from healthcare practitioners at distant/other sites.
• More efficient medical evaluation and management.
• Obtaining expertise from a distant specialist.
Possible Risks
As with any medical procedure, there are potential risks associated with the use of telemedicine.
These risks include, but may not be limited to:
• In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician and consultant(s);
• Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment.
• In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information.
• In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
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Consent for AI-Enhanced Medical Telehealth
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Purpose
This form documents informed consent to receive telehealth services that may use AI-enabled tools as part of clinical care. It explains what technologies may be used, benefits, risks, privacy safeguards, and the patient’s rights.
Description of Services and AI Use
• Telehealth formats available: video visits; audio-only visits; secure messaging; remote monitoring.
• AI-enabled features that may be used: automated transcription; visit summarization and note-generation; clinical decision support; symptom triage or risk-flagging; natural language processing for safety signals; scheduling and administrative automation.
• How AI is used in care: AI tools assist clinicians by summarizing visit content, generating draft documentation, flagging clinical concerns, suggesting information to consider, and supporting administrative tasks. AI outputs are tools to assist clinicians and are not final clinical judgments.
Benefits
• Improved efficiency: faster documentation and quicker access to visit summaries and after-visit instructions.
• Augmented detection: AI may help identify issues or patterns clinicians might otherwise miss.
• Access and convenience: telehealth and AI features can reduce wait times and increase access to care.
Risks and Limitations
• Inaccuracy and bias: AI outputs may be incorrect, incomplete, or biased; they should not be relied on as sole determinants of diagnosis or treatment.
• Privacy and data processing: AI features involve additional data processing and storage that may increase privacy risk despite safeguards.
• Technical failures: connection loss, poor audio/video quality, or AI errors may interrupt or limit the visit.
• Unintended data use: de-identified or aggregated data may be used for system improvement, quality monitoring, or research consistent with law and organizational policy.
• Regulatory and scope limits: AI recommendations are advisory; clinicians retain ultimate responsibility for clinical decisions.
Privacy, Security, and Data Use
• Confidentiality protections: Ember uses encryption and access controls to protect health information handled during telehealth visits.
• Third-party vendors: AI tools may be provided by external vendors; vendor data practices (processing, retention, reuse) vary and are available on request.
• Records and access: AI-generated summaries and clinical notes become part of your medical record and are accessible according to applicable medical record rules.
• De-identification: de-identified or aggregated data derived from your visit may be used for quality improvement, training, or research where permitted by law.
Clinician Responsibilities
• Disclosure: clinicians will explain when AI meaningfully affects diagnosis or treatment.
• Oversight: clinicians will review and interpret AI outputs and exercise independent clinical judgment.
• Documentation: use of AI tools that materially affect care will be documented in the medical record.
Patient Rights and Choices
• Right to refuse or limit AI use: you may decline use of AI-assisted tools and still receive care; declining may reduce certain efficiencies but will not deny clinically necessary services.
• Right to ask questions: you may ask which AI tools are used, what data they access, and how they inform care at a high level.
• Right to access records: you may request copies of your telehealth records, including AI-generated summaries, consistent with medical record policies.
• Right to withdraw consent: you may withdraw this consent at any time; withdrawal will not affect records created while consent was in effect.
Alternatives and Limitations
• Alternatives: in-person visits without AI-assisted telehealth features are available when clinically appropriate and feasible; request options from your clinician or clinic staff.
• Limitations: telehealth may not be suitable for certain clinical situations or emergencies; clinicians may direct you to in-person care or emergency services when needed.
Vendor Disclosure Summary (available on request)
• What will be provided on request: vendor name; purpose of the AI tool; types of data processed; data retention period; contact for privacy questions.
• How to request disclosure: contact Ember’s privacy office or use the privacy contact information provided in your intake materials.