Notice of Privacy Practices

1. Who We Are

TintPass operates as a Management Services Organization (MSO) that provides administrative and technology services to facilitate medical evaluations conducted by independently licensed Texas physicians. This Notice of Privacy Practices applies to the protected health information (PHI) we collect, maintain, and transmit on behalf of the evaluating physicians.

2. Uses and Disclosures of Protected Health Information

Your PHI may be used and disclosed for the following purposes:

A. Treatment

Your PHI may be used and disclosed to provide, coordinate, or manage your medical evaluation. This includes sharing your intake information with the independently licensed physician who conducts your evaluation.

B. Payment

Your PHI may be used and disclosed as necessary for payment activities, including processing your service fee through our payment processor, billing, and collections.

C. Healthcare Operations

Your PHI may be used for healthcare operations, including quality assessment, credentialing of physicians, compliance activities, and business management.

D. As Required by Law

We may use or disclose your PHI when required to do so by federal, state, or local law, including reporting to public health authorities, responding to court orders or subpoenas, and cooperating with law enforcement.

E. With Your Authorization

Other uses and disclosures of your PHI not covered by this Notice or applicable law will be made only with your written authorization. You may revoke your authorization at any time in writing, except to the extent that we have already acted in reliance on it.

3. Your Rights Regarding Your PHI

A. Right to Access

You have the right to inspect and obtain a copy of your PHI maintained by us. To request access, submit a written request to us at the contact information below. We may charge a reasonable fee for copies.

B. Right to Amend

You have the right to request an amendment to your PHI if you believe it is inaccurate or incomplete. Submit your request in writing, including the reason for the amendment. We may deny your request in certain circumstances, as permitted by law.

C. Right to Restrict

You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to your request, except in cases where the disclosure is to a health plan for payment or healthcare operations purposes and the PHI pertains to a service you paid for in full out of pocket.

D. Right to Request Confidential Communications

You have the right to request that we communicate with you about your PHI in a specific way or at a specific location. For example, you may request that we contact you only by email at a specific address.

E. Right to Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your PHI. This list will not include disclosures made for treatment, payment, healthcare operations, or certain other exceptions. Submit your request in writing.

F. Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically.

4. Our Duties

• We are required by law to maintain the privacy of your PHI and to provide you with this Notice of our legal duties and privacy practices.
• We are required to abide by the terms of this Notice currently in effect.
• We will notify you if a breach of your unsecured PHI occurs.
• We will not use or disclose your PHI without your authorization except as described in this Notice.
• We reserve the right to change the terms of this Notice and to make new provisions effective for all PHI we maintain. Revised notices will be posted on our website.

5. How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

6. Contact Information

For questions about this Notice or to exercise any of your rights, please contact: