Terms of Service
By signing to TOS on the intake form, telehealth, or group telehealth, you have agreed to the following terms of service as arranged in 8 sections:
NOTICE OF HIPAA 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.
Uses and Disclosures
The following categories describe the different ways in which we may use and disclose your individually identifiable health information, unless you object:
Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members. Additionally, we may disclose your health information to others who may assist in your care, such as other healthcare providers, your spouse, your children or parent.
Payment. Your health information may be used in order to bill and collect payment for the services and items you may receive from us. For example, we may use and disclose your health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also we may use your health information to bill you directly for services and items.
Health Care Operations. Your health information may be used as necessary to support the day to day activities and management of Coze Health, LLC. For example, information on the services you received may be used to support budgeting and financial reporting, activities to evaluate and promote quality, to develop protocols and clinical guidelines, to develop training programs, and to aid in credentialing medical review, legal services, and insurance.
Appointment Reminders. Your health information will be used by our staff to contact you and send you appointment reminders.
Information About Treatments. Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health related products and services that we believe may interest you.
Law Enforcement. Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.
Release of Information to Family/Friends. Our practice may release your health information to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child for an appointment. In this example, the babysitter or friend may have access to this child’s medical information.
Patient Mass Communication. We may use your name and email address(es) and/or text numbers to contact you with bulk messaging. For instance, to share new promotions for the clinic, to send clinic newsletters, or to notify you of a physician’s upcoming absence, such as for vacations.
Other uses and disclosures in certain special circumstances.
• Public Health Risks - (i.e. vital statistics, child abuse/neglect, exposure to communicable diseases, reporting reactions to drugs or problems with products or devices.)
• Health Oversight Activities
• Lawsuits and Similar Proceedings – May use or disclose in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding or in response to a discovery request, subpoena, or other lawful process.
• Deceased Patients – may be required to release to a medical examiner or coroner. If necessary, we may also release information in order for funeral director to perform their jobs.
• Organ and Tissue Donation
• Serious Threats to Health or Safety
• Military - If you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
• National Security
• Inmates – Our practice may disclose your health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
Disclosure would be necessary for the institution to provide health care services to you, for the safety and security of the institution, and/or to protect your health and safety or the health and safety of others.
• Worker’s Compensation
Disclosures of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before your notified us of your decision to revoke your authorization.
You have certain rights under the federal privacy standards. These include:
● The right to request restrictions on the use and disclosure of your protected health information for treatment, payment, or health care operations. You have the right to restrict our disclosure to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do not agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you. You must make your request in writing to the attention of the Privacy Officer. Your request must be described in a clear and concise fashion: a) the information you wish restricted; b) whether you are requesting to limit our practice’s use, disclosure or both; c) to whom you want the limits to apply.
● The right to receive confidential communications concerning your medical condition and treatment
● The right to inspect and copy your protected health information. We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, costbased fee. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of the denial.
● The right to amend or submit corrections to your protected health information. This request must be made in writing and submitted to Privacy Officer with reasons to support your request. We may deny your request if you ask us to amend information that is in our opinion: a) accurate and complete; b) not part of the health information kept by or for the practice; c) not part of the health information which you are permitted to inspect and copy; or d) not created by our practice, unless the individual or entity that created is not available to amend the information. We will provide a written explanation for any denial in 60 days.
● The right to receive an accounting of how and to whom your protected health information has been disclosed. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any that you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
● The right to receive a printed copy of this notice, even if you have agreed to receive the notice electronically.
Requests to Inspect Protected Health Information
You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting your physician and/or privacy officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.
Coze Health Medical LLC Family Practice’s Duties
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:
COZE Health Medical LLC
Attn: Privacy Officer
156 Sagamore Pkwy W Ste A
West Lafayette, IN 47906
If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.
NOTICE OF INFORMED CONSENT
Practices and Consent to Use and Disclose Health Information
I consent to all necessary steps taken for examination, diagnosis and treatment. If at any time I have questions about my examination, diagnosis or treatment, I will not proceed until my questions have been answered so that I am fully informed. I understand that giving the providers all relevant information i important for my proper diagnosis and treatment. I understand complete compliance with my provider’s instructions is critical to the success of any treatment prescribed.
I acknowledge that I was provided with a copy (digital, URL, or paper version) of the COZE Health Medical LLC Notice of HIPAA Privacy Practice
Practices regarding uses and disclosure of information regarding me and my health (“Health Information”).
I hereby consent to the use and disclosure of my health information, for the purposes and activities permitted under the federal privacy and state privacy laws, which are described in the COZE Health Notice of Privacy Practices.
I specifically authorize the release, to the fullest extent permitted by law, for treatment, payment or operations purposes as described in the Notice of Privacy Practices, of information regarding the results of any HIV/AIDS testing or treatment, mental health treatment and substance abuse treatment.
I authorize COZE Health Medical LLC to release information to my health plan or to a health and wellness provider approved by my health plan for purposes of advising me concerning appropriate measures to maintain or improve my health or any condition reflected in my records.
I authorize COZE Health Medical LLC to release information to my designated insurance plan for the purpose of health plan administration, including receiving or making payment for services rendered on my behalf. I understand a patient is responsible for all charges incurred, subject to contract and program rules, regardless of my insurance states. If it becomes necessary to send this account to collections, the patient will be responsible for all additional charges.
I authorize COZE Health Medical LLC to communicate via e-mail and text messaging regarding appointment reminders and other reminders or notifications regarding available documents or messages on the patient portal.
Informed Consent Delegating Physician/Provider and Delegatee Performing Medical Services
The delegating physician/provider is delegating the following services and is accountable for the performance of these services by the delegate. Counseling and patient education related to therapeutic lifestyle changes including:
1. Perform initial and serial follow up Vitals and/or anthropometry,
2. Perform initial and serial follow up bioimpedence measurements,
3. Assessment/review of a lifestyle-associated health history,
4. Review and serial follow up of a symptom based health assessment,
5. Provide patient education regarding Physician’s instructions, lab values, etc.,
6. Diet/Menu plan counseling and monitoring,
7. Exercise/activity plan counseling and monitoring,
8. Therapeutic nutritional protocol implementation and monitoring,
9. Stress management counseling and monitoring,
10. Sleep/recuperation/restoration counseling and monitoring, and
11. Keeping detailed medical chart records of all counseling/services performed.
These delegated medical services are specific and detailed per physician/provider approved, evidence based protocols. I understand my COZE Health Medical LLC physician/provider is delegating therapeutic lifestyle changes to a lifestyle educator and agree to receive services from the delegatee.
An Explanation of Our Financial Policy
As doctors and staff, we are passionate about what we do, and we feel that we have a calling to provide as many people as possible with the highest quality natural health care possible. Just as our services are unique to this region, our financial policies set us apart from mainstream medicine. We have prepared this handout to answer questions you or your family members may have about the rationale for our financial policies. If, after reading this, you still have questions, feel free to speak with our staff.
Why We Sell Nutritional Supplements and How We Price Them
We recommend nutritional supplements as an adjunct to dietary and lifestyle modification. This approach is central to the well-researched and science-based practice of functional medicine, which all of our professional staff have studied. We sell therapeutic, quality nutritional supplements as a service to our patients. With a few exceptions, we do not sell nutritional products of similar quality to those that are widely available over the counter. We purchase high-quality nutritional products from the top nutritional research laboratories in North America and Great Britain, and we price them to cover our costs of providing them. However, we keep our markups as low as possible, and we intentionally do not profit from the sale of nutritional products. Many other clinics have commended our pricing policy as ethical and fair.
Selling Nutritional and Herbal Supplements
According to the Federal Food, Drug, and Cosmetic Act, as amended, Section 201(g)(1), the term drug is defined as an “article intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.” Technically, vitamins, minerals, trace elements, amino acids, herbs, or homeopathic remedies are not classified as drugs. However, these substances can have significant effects on physiology and must be used rationally. In this office, we provide nutritional counseling and make individualized recommendations regarding use of these substances in order to upgrade the quality of foods in a patient’s diet and to supply nutrition to support the physiological and bio-mechanical processes of the human body. Although these products may also be suggested with a specific therapeutic purpose in mind, their use is chiefly designed to support given aspects of metabolic function. Use of nutritional supplements may be safely recommended for patients already using pharmaceutical medications (drugs), but some potentially harmful interactions may occur. For this reason, it is important to keep all of your healthcare providers fully informed about all medications and nutritional supplements, herbs, or hormones you may be taking.
Sale of Nutritional Supplements through COZE Health Medical LLC
You are under no obligation to purchase nutritional supplements from our online services. As a service to you, we make nutritional supplements available through our website. We purchase these products only from manufacturers who have gained our confidence through considerable research and experience. We determine quality by considering: (1) the quality of science behind the product; (2) the quality of the ingredients themselves; (3) the quality of the manufacturing process; and (4) the synergism among product components. The brands of supplements that we carry in our facility are those that meet our high standards and tend to produce predictable results. While these supplements may come at a higher financial cost than those found on the shelves of pharmacies or health food stores, the value must also include assurance of their purity, quality, bioavailability (ability to be properly absorbed and utilized by the body), and effectiveness. The chief reason we make these products available is to ensure quality. You are not guaranteed the same level of quality when you purchase your supplements from the general marketplace. We are not suggesting that such products have no value; however, given the lack of stringent testing requirements for dietary supplements, product quality varies widely. If you have concerns about this issue, please discuss them with our staff.
Laboratory Testing Informed Consent
The purpose of optional diagnostic laboratory testing ordered by COZE Health Medical LLC is to evaluate nutritional, biochemical, or physiological imbalance and to determine any need for medical referral. These lab tests in our office identify nutritional imbalances and toxicities underlying chronic diseases, advanced hormone testing, functional medicine multi-tissue antibody testing for the early detection and monitoring of today's complex autoimmune conditions, or preventive and/or diagnostic tests to monitor health (ie., lipid panel, metabolic panel, etc.). This office utilizes conventional lab tests as well as genetic, chemical and functional medicine assessment. These tests are designed to assist our doctors and other healthcare providers in finding the underlying causes of your condition. Functional medicine has evolved through the efforts of scientists and clinicians from the fields of clinical nutrition, molecular biology, biochemistry, physiology, conventional medicine, and a wide array of scientific disciplines. We do provide an in-house site for your convenience and is subject to a sitting charge. Your medical physician may or may not agree with the necessity for—or our interpretation of—these tests. If you have any questions or concerns, please discuss them with our doctors.
Coze Health Medical LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.
To our patients: You have the right to request that Coze Health Medical LLC communicate with you by alternative means or at alternate locations. This form instructs Coze Health Medical LLC on your approved communication method and who is involved in your care. By signing this form, you are indicating that your doctor and other staff (nurses, office assistants, etc.) may share limited information with the people named on the form. Limited information will primarily be verbal information but may also include some written or printed information (e.g. care instructions). This form does not grant people names on it the right to obtain access to, or copies of, your health records. If your family member or friend wishes to obtain all or part of your health records, you must authorize their release through our Health Information Management (Medical Records) department.
I give consent for Coze Health Medical LLC to contact me via phone calls, text messages, automated messages, and voice mails regarding my healthcare per selected options on this form. I give consent to contact next of kin in the case of emergency. I give consent to contact those individuals listed for receiving shared health information in my care as documented in the electronic health record recorded at intake appointment or further provided either verbally or in writing to a Coze Health Medical LLC staff member.
Note: This form and designated list will not expire. We will act upon the information you provide on this form unless you inform us that it has changed.
CHRONIC CARE MANAGEMENT
By signing this Agreement, you consent to Coze Health Medical LLC (referred to as “Provider”), providing chronic care management services (referred to as “CCM Services”) to you as more fully described below. CCM Services are available to you because you have been diagnosed with one (1) or two (2) or more chronic conditions which are expected to last at least twelve (12) months and which place you at significant risk of further decline. CCM Services include 24-hours-a-day, 7-days-a-week access to a health care provider in Provider’s practice to address acute chronic care needs; systematic assessment of your health care needs; processes to assure that you timely receive preventative care services; medication reviews and oversight; a plan of care covering your health issues; and management of care transitions among health care providers and settings. The Provider will discuss with you the specific services that will be available to you and how to access those services. You consent to the Provider providing CCM Services to you. You authorize electronic communication of your medical information with other treating providers as part of coordination of your care. You acknowledge that only one practitioner can furnish CCM Services to you during a calendar month. You understand that cost-sharing will apply to CCM Services, so you may be billed for a portion of CCM Services even though CCM Services will not involve a face-to-face meeting with the Provider. All Medicare and lifestyle medicine patients are expected to maintain a chronic care management agreement with the practice.
You have the following rights with respect to CCM Services:
The Provider will provide you with a written or electronic copy of your care plan. You have the right to stop CCM Services at any time by revoking this Agreement effective at the end of the then current month. You may revoke this agreement verbally (by calling 765-204-1122) or in writing to (156 Sagamore Pkwy W, Ste A, West Lafayette, IN 47906).
GROUP CLASS INFORMED CONSENT [c. 2018 American College of Lifestyle Medicine)
Group Medical Visit Consent and Authorization Form
Group medical visits are medical appointments conducted in a group setting in which the physician and each patient discuss the patient’s personal medical condition and treatment in the presence of the group. Because each patient will be disclosing personal health and other personal information to the group, participation in group medical visits and the release of personal health information within the group is strictly voluntary and is not required in order to receive treatment from Coze Health Medical LLC.
Consent, Authorization to Disclose and Confidentiality Agreement
By signing this Agreement, I consent to participate in group medical visits, in the clinic or virtually, at Coze Health Medical LLC. I authorize Coze Health Medical LLC physicians/allied health professionals conducting the group medical visit in which I participate to disclose my personal health information and other private information (“Private Information”) in the presence of all participants attending the group medical visit. I also agree to respect the privacy of all participants, including their family members, who attend the group medical visit by keeping their Private Information confidential and not disclosing such information I acknowledge the possibility that my Private Information may be disclosed by other participants in group medical visits contrary to their Confidentiality Agreement, and I voluntarily assume all of the risks associated with such disclosure. I understand that I may revoke this authorization at any time by delivery of a dated and signed letter to Coze Health Medical LLC. I understand that such revocation will not prohibit Coze Health Medical LLC from making any disclosures already made or taking any actions already taken in reliance on this authorization prior to the receipt of such revocation.
Further, I understand that such revocation will preclude my participation in additional Coze Health Medical LLC group medical visits, but will not prevent me from receiving other types of treatment from Coze Health Medical LLC. If not earlier revoked, this authorization will expire at the conclusion of my treatment through Coze Health Medical LLC group medical visits.
THE INFORMATION AUTHORIZED FOR RELEASE MAY INCLUDE INFORMATION INDICATING THE PRESENCE OF CONDITIONS INCLUDING, BUT NOT LIMITED TO, DIABETES, HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, HEART DISEASE, DEPRESSION, ANXIETY, CONSTIPATION, GASTROESOPHAGEAL REFLUX DISEASE, OTHER GI CONDITIONS, KIDNEY DISEASE, OBSTRUCTIVE SLEEP APNEA, GOUT, CANCER AND ARTHRITIS.
TELEHEALTH/TELEMEDICINE INFORMED CONSENT NOTICE
A telemedicine appointment consists of a synchronous audio and video medical appointment. Telemedicine appointments are subject to co-pays, co-insurance, and deductibles as allowed by federal and local law and subject to insurance regulations. Patients who receive services in a telemedicine appointment must be located in a state in which the physician is licensed, and must confirm at the time of appointment the state in which they are located during the appointment. Teleheath is electronic communication between a licensed health care provider and patient.
1. I hereby authorize Coze Health Medical LLC to use the telemedicine/telehealth practice platform for telecommunication for evaluating, testing and diagnosing my medical condition.
2. I understand that technical difficulties may occur before or during the telemedicine/telehealth sessions and my appointment cannot be started or ended as intended.
3. I accept that the professionals can contact interactive sessions with video call; however, I am informed that the sessions may be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.
4. I understand that my current insurance may not cover the additional fees of the telemedicine/telehealth practices and I may be responsible for any fee that my insurance company does not cover.
5. I agree that my medical records on telemedicine/telehealth can be kept for further evaluation, analysis and documentation, and in all of these, my information will be kept private.
See Expanded Informed Consent and Policies for Telehealth/Telemedicine Services in Section 9.
REMOTE PATIENT MONITORING PROGRAM
Remote patient Monitoring consists of a second portal the patient and provider have access to track medical concerns like: nutrition, weight, and blood pressure. Only patients who require remote patient monitoring will receive a remote patient monitoring prescription by their physician. Patients will managed by a third-party Remote Patient Monitoring partner who will contact the patient to review the prescription, insurance requests, and onboard the patient into the program. Alerts will be sent directly to the physician. Remote Patient Monitoring is subject to co-pays, co-insurance, and deductibles as allowed by federal and local law and subject to insurance regulations. Patients who receive services through remote patient monitoring must be located in a state in which the physician is licensed, and must confirm at the time of appointment the state in which they are located during the appointment.
INTEGRATED BEHAVIORAL HEALTH
Integrated Behavioral Health consists of a primary care provider by monitoring behavioral health through general behavioral health screenings and coordination of medical care with behavioral counselors/psychotherapists or other behavioral health caregivers. A patient will benefit from this program if the physician prescribes this program. The program requires consent for participation and this form is acknowledgement for consent to participate in this program. Integrated Behavioral Health is subject to co-pays, co-insurance, and deductibles as allowed by federal and local law and subject to insurance regulations.
FINANCIAL POLICY: All patients are required to have an HSA, FSA, or credit card on file. We do not pass on credit card fees. We expect payment for co-pays and services received by patients with high-deductible plans (HSA) or out-of-network plans at the time of service. All additional charges after adjustments by insurance company will be charged to the card on file at the time the EOB clears. Appointments not canceled within 48 hours (2 business days) may be charged a $100 cancellation fee. We provide a courtesy digital invoice that is sent to your email on file. Mailed invoices will incur a $5 processing fee per invoice. You can elect to participate in our All Access Care if you wish to receive virtual services.
General Consent to Treat for Virtual Visit Services
I voluntarily request and authorize the physician(s), and/or Advanced Practice Provider (Nurse Practitioner, Physician Assistant or Clinical Nurse Specialist), and other health care providers or the other designees of Coze Health Medical LLC, as deemed necessary, to perform a telemedicine e-visit through the use of interactive audio, store and forward technologies and secure internet video.
I agree that this consent provides Coze Health Medical LLC with my permission to perform reasonable and necessary medical examinations, testing and treatment. By signing below I am indicating that:
I intend this consent to be continuing in nature even after a specific diagnosis has been made and treatment recommended; and
The physician or provider performing the e-visit will inform me about findings discovered during the examination.
This consent will remain in effect for one year unless earlier revoked in writing by me, the patient.
I understand that the practice of medicine is not an exact science and acknowledge that no guarantees have been made to me regarding the likelihood of success or outcomes of any e-visit.
I understand the benefits of telehealth include, but are not limited to, easier and quicker access to providers, even at a distance. As with any medical treatment, telehealth has some risks. I understand that the risks of telehealth include, but are not limited to, insufficiency or delays in information capable of being transmitted and, therefore, inability to properly or timely treat a condition. Finally, I understand that being treated by a practitioner who may have incomplete access to my complete medical history could result in adverse drug reactions or interactions or other judgment errors. I understand that these are not all of the risks, but just some of the material risks. I acknowledge and agree that no guarantee or assurances have been made to me concerning the results of telehealth. I have been informed of the alternatives to telehealth and consent to proceed with a telehealth consultation.
I acknowledge and understand that I have the right, as a patient, to be informed about my condition and the recommended surgical, medical or diagnostic procedure(s) to be used so that I may make the decision whether or not to undergo any suggested treatment or procedures after knowing the risks and hazards involved. I also have the right and the responsibility to participate in my care and treatment – including the responsibility to ask questions if I do not understand something and provide Coze Health Medical LLC with accurate and complete information about my health history and presenting complaint, to agree upon a treatment plan, and to follow that plan. I also have the right at any time to revoke this consent and discontinue services.
I certify that I have read and fully understand the above statements, have had the opportunity to ask questions and consent fully and voluntarily.
Effective: January 1, 2021
COZE HEALTH MEDICAL LLC MAY REVISE THIS POLICY AT ANY TIME. SHOULD ANY NEW POLICY TAKE EFFECT, COZE HEALTH MEDICAL LLC WILL GIVE NOTICE TO YOU AND ALL USERS BY POSTING A NOTICE REGARDING THE NEW POLICY ON THIS PLATFORM, AND THE NEW POLICY WILL APPLY ONLY TO INFORMATION COLLECTED THEREAFTER. NEW POLICIES WILL BE EFFECTIVE AS OF THEIR POSTING UNLESS OTHERWISE STATED. BY ACCESSING OR USING THIS PLATFORM AFTER SUCH CHANGES ARE POSTED YOU AGREE AND CONSENT TO ALL SUCH CHANGES.
Disclosure of Information Practices
The amount and type of information that we receive depends on how you use this Platform and the information you choose to submit to us via the Platform.
Whether you are a patient (or legal representative) or a Provider-affiliated physician, we may track use of your user name and may also capture the paths taken as you move from page to page (i.e., your "click stream" activity). When you log in, your user name and password will be logged by our system in an audit log.
As a user of the Platform, you may also choose to use the secure messaging feature of the Platform, which allows the exchange of communications between patients and Providers and which may contain identifiable health information. Communications sent via this feature are recorded and maintained by COZE HEALTH MEDICAL LLC. Platform users have the ability to view the trail of messages received and sent via their Platform account. COZE HEALTH MEDICAL LLC does not edit the content of the communications between patients and Providers.
Personally Identifiable Information
You may request additional information about the Platform and the Services by submitting your information to us or otherwise contacting us as set forth on the Platform. If you elect to send us your contact information, we will use your contact information to provide you the information you requested and otherwise communicate with you to respond to your inquiry.
Identifiable Health Information
If you are a patient or the legal representative of a patient, you must provide certain identifiable health information and medical history in order to complete your registration for Platform to request Services, such as behavioral health or other medical consultations provided by the Providers.
If you are a patient (or the legal representative of a patient), we will collect identifiable health information from you during the registration process and in the event you later request information or Services. We may collect any identifiable information that you provide to us, such as your name, address, e-mail address, gender, birth date and phone number. We also need your medical history in order for you to request Services.
When you register for the Platform via the Platform, the registration process requires you to choose a user name and password for your account, which you should keep and maintain as confidential. If you choose to share your user name and password you understand that those individuals to whom you share that information will have access to your identifiable health information and will be able to add to your identifiable health information as though they were you. You will be responsible for all activities by users resulting from sharing or not maintaining the confidentiality of your user name or password.
If you are a registered patient user of the Platform, your identifiable health information (or that of the patient for whom you are the legal representative) will become accessible to COZE HEALTH MEDICAL LLC in order to provide you access to such information through the Platform. This information includes the information you provide to COZE HEALTH MEDICAL LLC for us to share with Providers and information uploaded to the Platform by Providers related to any Services.
Non-Identifiable Health Information
Either COZE HEALTH MEDICAL LLC or our third party vendor(s) on behalf of COZE HEALTH MEDICAL LLC may also collect non-identifiable information, which is automatically collected as you browse or otherwise access the Platform. We may collect such information by tracking, or asking our third party vendor to track, your click-stream activity when such information is not tied to a user ID through the use of "cookie" technology or by tracking internet protocol (IP) addresses, as explained below.
We may also log and track IP addresses for systems administration purposes and for reporting usage trends. Your IP address is usually associated with the physical place from which you enter the Internet, the name of the domain and host from which you access the Internet, the browser software you use and your operating system, and may also depend on the date and time you access the Platform. By collecting your IP address, we may record the page that linked you to this Platform, the web pages you visit within the Platform, the ads you see or click on within the Platform, and other information about the type of web browser, computer, platform and settings you are using, and any search terms you enter on this Platform. IP addresses are not used to track an individual user’s session. This information helps us determine how often different areas of our Platform and Platform are visited.
We may combine non-identifiable information collected automatically (such as through IP addresses, cookies or click-stream monitoring) with any previously submitted personal information that we may have received from you.
We may collect your geographic location based on your IP address and other location-based data. However, we do not collect any device identifications.
We may also use various third party internet vendors to collect, track and analyze track analytical data regarding Platform usage and trends.
If you choose not to receive survey invitations through the Platform you may change your privacy settings within the Platform.
Any survey responses that you choose to submit may be aggregated, de-identified and provided or sold to third parties as set forth below.
How Will Your Information Be Used And Disclosed?
Like many companies, we may use "cookie" technology on and off of the Platform. “Cookies” are small pieces of information that are stored by your browser on your computer’s hard drive. They enhance your online experience by saving your preferences while you are visiting a particular website. The cookies do not contain any identifiable health information and cannot profile your system or collect information from your hard drive.
When you view or access our Platform we may place a cookie on your computer, which may be either temporary or permanent. Temporary cookies are used to complete transactions with this Platform and for other purposes such as counting the number of visits to our certain web pages. These temporary cookies are eliminated when you exit your browser.
A permanent cookie may also be stored on your computer by your browser. When you log in, this type of cookie tells us whether you've visited us before or if you are a new visitor. The cookie doesn't obtain any identifiable health information about you or provide us with any way to contact you, and the cookie doesn't extract any information from your computer.
The "help" portion of the toolbar on most browsers will tell you how to prevent your browser from accepting certain types of cookies, how to have the browser notify you when you receive a new cookie, or how to disable cookies altogether. Please note that disabling temporary cookies may prevent you from using and accessing this Platform. Disabling permanent cookies may also impact your use and access of the Platform and in particular will not allow you to see any personalization on the Platform that you may activate.
In addition, if you visit our Platform again after deleting a cookie, a new cookie may be activated.
Identifiable Health Information
We may use any identifiable health information or other information that you voluntarily provide us in order to provide you with information, products or services that you may request from COZE HEALTH MEDICAL LLC or the Providers.
If you are a patient or the legal representative of a patient, any identifiable health information that you share via the Platform will be made accessible to the Provider and will become a part of the records maintained by COZE HEALTH MEDICAL LLC on behalf of the Providers, which records are subject to the Providers’ Notice of Privacy Practices. Any information generated by the Providers in providing the Services will be provided back to COZE HEALTH MEDICAL by the Providers and will also become part of the records maintained by COZE HEALTH MEDICAL LLC.
We may also use your identifiable information to send you appointment reminders or other notifications regarding the Services. If you elect to provide us a cell phone number, you expressly consent that we can provide these communications to you via text message. Data or text charges may apply. You may change your preferred method of communication in your “My Account” setting.
To the extent permitted by applicable law, COZE HEALTH MEDICAL LLC may use your information to communicate to you special offers and featured items from third parties, COZE HEALTH MEDICAL LLC, COZE HEALTH MEDICAL LLC's affiliates, and/or other suppliers and vendors. If you are receiving additional communications and special offers, you may revoke your authorization to receive such materials from COZE HEALTH MEDICAL LLC via the Platform at any time by contacting us using the contact information below or as outlined in the applicable communication. We will implement your revocation as soon as is commercially reasonable and as required by law. COZE HEALTH MEDICAL LLC cannot control any communications and other materials that you may receive directly from third parties.
We will also use your information to customize your browsing experience and communicate with you and otherwise respond to your questions and suggestions regarding use of the Platform as may be permitted by applicable law.
We will share your information only with the Providers and our suppliers and vendors to the limited extent necessary to provide this Platform and the Services. We require those suppliers and vendors to comply with all applicable data privacy laws and regulations, including HIPAA. We do not sell, lease or rent your identifiable health information.
Non- identifiable Health Information
The non-identifiable health information we collect may be deidentified and shared with our suppliers and vendors and used in the aggregate to create COZE HEALTH MEDICAL LLC statistics that help us analyze Platform usage trends, assess what information is of most and least importance, determine technical design specifications, arrange the Platform in the most user-friendly way, and identify system performance or problem areas.
We may also use your geographic location to provide you with specific content and direct you to your closest service providers to the extent permitted by applicable law.
We may aggregate and de-identify identifiable health information in accordance with HIPAA, either alone or with other data to create anonymous "aggregate data" regarding the users of our Platform. Aggregate and deidentified data is information that describes the habits, treatment plans, usage patterns and/or demographics of users as a group but does not reveal the identity of particular users. This data will not identify you, but will be used as statistical information to determine such things as user demographics and usage patterns of our Platform. COZE HEALTH MEDICAL LLC may use aggregate data to understand the needs of our community of users and determine what kinds of programs and services we can help provide. Aggregate data may also be provided or sold to third parties, including to give third party vendors, suppliers, business partners and/or affiliates a picture of our community and services.
Other Use and Ownership
We also reserve the right to share your information collected from this Platform with third parties to the extent permitted by applicable law and, in the case of identifiable health information, pursuant to COZE HEALTH MEDICAL LLC's business associate agreement with the applicable Provider.
Transfer of Data
While no web site can guarantee security, we maintain physical, administrative, electronic, technical and procedural safeguards to help protect your personal information collected via the Platform as required by applicable law. While we cannot guarantee that loss, misuse or alteration to data will not occur, the Platform uses industry standard technology, such as Transport Layer Security (“TLS”), to help safeguard against such occurrences. In certain areas, the information passed between your browser and our system is encrypted with TLS technology to create a protected connection between you and our website to ensure confidentiality.
Our vendor(s) data center are both physically and electronically secured. Servers are protected behind the Internet by using firewall and encryption technology. All data is stored and transferred in encrypted formats that exceed standards defined by HIPAA. No data is transferred to users that do not have specific data access keys. We limit access to personally identifiable information about you to our employees and third-party agents, who we reasonably believe need to have access to your information to provide you with the information or services you request via the Platform. In the event that a breach in our security systems occurs and there is a possibility that an unauthorized person acquires your personal information, we will notify you of such a breach as may be required by applicable law. In order to help maintain security, you should never share your user ID or password and should always sign out when you are finished using the Platform.
We will maintain your information and allow you to request updates at any time by logging into your Platform account to access your information. We will also take steps to make sure that any updates that you provide are processed in a timely and complete manner.
Third Party Platforms
What if I am accessing this Platform from outside of the United States?
COZE HEALTH MEDICAL LLC is located in the United States, as are the Providers who provide Services under the Portal pursuant to each Provider’s credentials within the United States. The Platform is directed solely to individuals located in the United States and we rely upon your representation of which U.S. state you are located in order to connect you with Providers credentialed in your state. While COZE HEALTH MEDICAL LLC, its third party vendor, and/or its Providers may offer language translation services, such services are intended to assist individuals seeking our services within the United States and are not directed to individuals in any foreign country.
In the event we offer services that are subject to the General Data Protection Regulation (GDPR), we will comply with requests which could include the right to access information we hold about you, have inaccurate or unnecessary information rectified or deleted or to ask us to stop using your information in a certain way. In the unlikely event your use of the Services is subject to GDPR, you would also have a right to lodge a complaint with your local EU regulator.
Important Note Regarding Children
This Platform and Platform is not directed toward children under 18 years of age and COZE HEALTH MEDICAL LLC does not knowingly collect information from children under 18 through this Platform or Platform. Any information submitted via the Platform regarding a minor under the age of 18 must be submitted by the minor's legal representative. To the extent permitted by applicable state law, minors may access their identifiable health information through their physician.
COZE HEALTH MEDICAL LLC
156 Sagamore Pkwy W Ste A
West Lafayette, IN 47906
effective 3/1/2020. updated 1/1/2021. updated 5/1/2021, updated 12/23/2021