TERMS AND CONDITIONS OF USE

MyChart Authorization for Use and Disclosure of Electronic Protected Health Information and Brown & Toland Physicians Care Team Notice of Privacy Practices and MyChart Terms and Conditions of Use

Brown & Toland's Notice of Privacy Practices can found under the Notice of Privacy Practices Section of this document. A paper copy of this document can be obtained by selecting the Terms and Conditions hyperlink after logging into MyChart and selecting the print icon.

"MYCHART"© SERVICE: AUTHORIZATION FOR USE AND DISCLOSURE OF ELECTRONIC PROTECTED HEALTH INFORMATION

  1. I authorize the use or disclosure of the above-named individual's electronic health information by Brown & Toland Physicians Care Team to the "MyChart" Service, as indicated below.
  2. I understand that this authorization is for the purpose of allowing the MyChart© service to provide me and/or my authorized representatives, as well as caregivers involved in my medical care or treatment, with web-based access to the records of my medical care and/or treatment.
  3. I understand that the records subject to this authorization include any and all records which pertain to my diagnosis, treatment or care including, without limitation face sheet(s), history and physical examination(s), admission note(s), discharge summary(ies), radiology and laboratory testing, consultation report(s), progress notes, physicians' orders, medication/prescription records, operative and procedure notes, nursing notes, and similar records. I understand that this authorization will extend to medical records prepared or kept by third-party healthcare providers which are contained within the medical records of Brown & Toland Physicians Care Team.
  4. I understand that the records subject to this authorization may include (if applicable) information relating to sexually transmitted diseases ("STDs"), acquired immunodeficiency syndrome (HIV/AIDS); behavioral and mental health services (including communications with psychiatrists and psychotherapy notes), records of treatment for alcohol and substance abuse, and results of genetic (DNA) testing.
  5. I understand that any disclosure of health information carries with it the potential for an unauthorized re-disclosure, and that any information which is re-disclosed may not be protected by federal or state privacy laws. I hereby agree to release and hold Brown & Toland Physicians Care Team harmless for complying in good faith with this Authorization.
  6. I understand that this authorization shall remain in effect until revoked. I understand that I have a right to revoke this authorization at any time, except to the extent that action has been taken by Brown & Toland Physicians Care Team in reliance on it. Patients may request deactivation of an account by sending an e-mail to our MyChart Support Staff at ServiceDesk@btmg.com and be sure to include your phone number and contact information. It is understood that any such revocation will not be effective until received by the MyChart Support Staff at Brown & Toland Physicians Care Team.
  7. I understand that this authorization is voluntary, and that my refusal to sign this authorization will not affect my eligibility for health care services or treatment in any way.
  8. I understand that my use of the MyChart© service is subject to the Terms and Conditions and other restrictions which apply to the use of that service as published on the website, https://mychartbt.com/ .
    1. Notice of Privacy Practices

      Effective Date: April 1, 2017

      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. If you have any questions about this notice, please contact the Brown and Toland's Privacy Officer by calling 415-972-4268.

      Your Rights

      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 a copy of health and claims records

      • You may ask to see or get a copy of your health and claims records 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 and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

      Ask us to correct health and claims records

      • You may ask us to correct your health and claims records if you think they are 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 may 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 consider all reasonable requests.

      Ask us to limit what we use or share

      • You may 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.

      Get a list of those with whom we’ve shared information

      • You may ask for a list (an 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 may 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 may 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 may file a complaint if you feel we have violated your rights by contacting us at the following:

      Privacy Officer
      Brown & Toland Health Services
      P.O. Box 72710
      Oakland, CA 94612-8910
      415.972.4268
      privacyoffice@btmg.com

      You may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at the following:

      U.S. Department of Health and Human Services Office for Civil Rights
      200 Independence Avenue, S.W.
      Washington, D.C. 20201
      877.696.6775
      www.hhs.gov/ocr/privacy/hipaa/complaints/

      We will not retaliate against you for filing a complaint.

      Your Choices

      For certain health information, you may 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 payment for your care
      • Share information in a disaster relief situation
      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

      Our Uses and Disclosures

      How do we typically use or share your health information?

      We typically use or share your health information in the following ways:

      Help manage the health care treatment you receive

      We use your health information and share it with professionals who are treating you.

      Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.

      Run our organization

      We use and disclose your information to run our organization and contact you when necessary.

      Pay for your health services

      We use and disclose your health information to pay for your health services.

      Example: We use your health information to process claims from doctors that have provided care to you.

      How else can we use or share your health information?

      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 must meet many conditions in the law before we can share your information for these purposes.

      Help with public health and safety issues

      We may 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 may 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 see that we’re complying with federal privacy law.

      Address workers’ compensation, law enforcement, and other government requests

      We may 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

      Respond to lawsuits and legal actions

      We may share health information about you in response to a court or administrative order, or in response to a subpoena.

      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.

      Questions or Requests Related to this Notice

      If you have any questions related to this notice or would like to make a request as permitted under this notice, please contact the following:

      Privacy Officer

      Brown & Toland Health Services

      P.O. Box 72710

      Oakland, CA 94612-8910

      415.972.4268

      privacyoffice@btmg.com

      Changes to the Terms of this Notice

      We may 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, on our web site, and we will notify you of the change.

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      MyChart Terms and Conditions of Use

      Brown & Toland Physicians Care Team in Oakland, CA and affiliated Physician Medical Offices are pleased to offer you access to certain health-related information via a Web-based version of our computer systems called MyChart©.

      OVERVIEW: Brown & Toland Physicians Care Team MyChart© is an internet-based service that allows patients to access certain personal medical information online. MyChart© is not the complete copy of the legal medical record. This is a voluntary service, offered as a convenience and courtesy by Brown & Toland Physicians Care Team to our patients who have recently been discharged or currently receive care from one of our Brown & Toland Physicians Care Team. Brown & Toland Physicians Care Team reserves the right to revoke or limit access to the MyChart© service at any time for any reason and without notice.

      PRIVACY: Your privacy is of the utmost importance to us. Brown & Toland Physicians Care Team will use your confidential medical information in order to provide you healthcare services. Healthcare Providers will, at all times, maintain your confidential medical information in strict confidence and will not disclose any information regarding you to any unaffiliated third party, unless you authorize that person to receive your information or the information is permitted or required to be disclosed by law. Please review Brown & Toland Physicians Care Team's Notice of Privacy Practices for a thorough description of how we gather, use and protect your confidential medical information.

      NOT MEDICAL ADVICE: NON-EMERGENCY ONLY: The MyChart© service is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Brown & Toland Physicians Care Team MyChart© services should never be used for emergencies or urgent needs. Patients experiencing a life-threatening emergency should call 911. Patients with urgent needs should call Brown & Toland Physicians Care Team or their personal healthcare provider for assistance.

      MINOR ELIGIBILITY: An individual must be age 18 or older to request a personal account.

      DEACTIVATION: Participation in Brown & Toland Physicians Care Team MyChart© is voluntary. Patients may request deactivation of an account by sending an e-mail to our MyChart Support Staff at ServiceDesk@btmg.com and be sure to include your phone number and contact information. You will then be contacted by phone by our MyChart Support Staff who will assist with deactivation. Brown & Toland Physicians Care Team reserves the right to deactivate or prevent a patient's access to any or all Brown & Toland Physicians Care Team MyChart© features at any time for any reason and without notice.

      PROTECTING LOGIN INFORMATION: Patients who wish to participate will be issued a MyChart activation code upon discharge or during their Physician's office visit. The activation code is used to gain first-time access, at which time a permanent username and password are created by the patient. It is extremely important that patients keep the activation code, username and password confidential. Anyone with access to this information will be able to access the patient's Brown & Toland Physicians Care Team MyChart© account at https://mychartbt.com/. Brown & Toland Physicians Care Team accepts no responsibility for unauthorized access to a patient's medical information resulting from lost, stolen or misused activation codes, usernames or passwords.

      PROTECTED HEALTH INFORMATION: Brown & Toland Physicians Care Team's MyChart© service includes the capability to receive personally identifiable health information which is protected by federal and other law. Your use of the MyChart© service constitutes your express authorization for Brown & Toland Physicians Care Team to disclose identifiable health information to your designated MyChart© account for the purposes described here. Patients may revoke their authorization and discontinue their account by contacting our MyChart Support Staff at (415) 972-6008 during the hours of 8am to 5pm and listen for the MyChart prompt. After hours, send an e-mail to ServiceDesk@btmg.com and be sure to include your contact information. Revocation of your authorization or discontinuance of your MyChart© account will not affect your medical care in any way. Brown & Toland Physicians Care Team reserves the right to disclose or to re-disclose such information as required or permitted by law.

      EMAIL NOTIFICATION: Patients who are users of MyChart© will be notified via email when there is new information to be viewed on MyChart. This means that any person with access to a patient's email will be able to see this notification. This could include the patient's spouse, employer or anyone else that can access a patient's email account. Although no private medical information will be sent, the notification that new medical information is available by accessing MyChart may be information that a patient would not want others to know. By providing an email address in connection with the MyChart© service, you expressly consent to email notification by the MyChart© service when there is new information to be viewed in MyChart©.

      SECURE MESSAGING: Brown & Toland Physicians Care Team MyChart© allows users to send and receive secure electronic messages with providers who are active with Brown & Toland Physicians Care Team MyChart©. Due to technical factors, the availability of appropriate staff and other circumstances, Brown & Toland Physicians Care Team cannot guarantee that messages from users will receive a timely response. Messages regarding medical issues may become part of the patient's permanent medical record, and will be available to those who participate in the patient's care and treatment in the future. As with any information contained in the medical record, Brown & Toland Physicians Care Team reserves the right to disclose or to re-disclose such information as required or permitted by law.

      WEBSITE LINKS: MyChart© may offer links to related medical or other websites not managed by Brown & Toland Physicians Care Team. These website link(s) are for a patient's informational purposes only. Brown & Toland Physicians Care Team does not endorse, and has not verified the accuracy of, the information in/on these websites, and the patient should not rely on any of the information found on the websites for purposes of treatment or diagnosis. WEBSITE CHANGES AND AVAILABILITY: Brown & Toland Physicians Care Team may revise, change or update the Brown & Toland Physicians Care Team MyChart© website periodically. The website may not always be available due to system maintenance, backups or failures.

      USE OF THIRD-PARTY SERVICES: You may choose to use other services provided by third parties in conjunction with your use of MyChart. Such services may include, but are not limited to, translation services, location services, and other third-party offerings. Any links to such services are provided for your convenience only. Neither Epic nor Brown & Toland Physicians Care Team have control over the contents of these services, and neither Epic nor Brown & Toland Physicians Care Team accept any responsibility for them or for any loss or damage that may arise from your use of them. Such services may require you to submit your information to a third party, which may result in a copy of your information be used and/or stored by a third party. If you decide to access any such services in conjunction with your use of MyChart, you do so entirely at your own risk and subject to the terms and conditions of use for such services.

      ACCURACY AND INTEGRITY OF INFORMATION When using the MyChart© service, information will be transmitted over a medium that may be beyond the control of Brown & Toland Physicians Care Team. Accordingly, Brown & Toland Physicians Care Team assumes no liability for or relating to the delay, failure, interruption, or corruption of any data or other information transmitted in connection with use of the MyChart© service. Although Brown & Toland Physicians Care Team attempts to ensure the integrity of the MyChart© website, it makes no guarantees whatsoever as to the correctness or accuracy of the Site. It is possible that the Site could include typographical errors, inaccuracies or other errors. In the event that an inaccuracy arises, please inform your Healthcare Providers so that it can be corrected. Information contained on the Site may be changed or updated without notice.

      Brown & Toland Physicians Care Team reserves the right to modify this Agreement at any time. Any modifications will become effective immediately upon posting to the Site. You agree that it is your responsibility to review the Agreement periodically to be aware of such modifications, as your continued access or use of the Site shall be deemed your conclusive acceptance of the modified Agreement.

      Portions of the materials on this website https://mychartbt.com/ © 2020 Brown & Toland Physicians Care Team of California. © 1999-2020 Epic Systems Corporation. U.S. Patent 5,301,105. Other U.S. and international patents pending. MyChart, Epic, Powered by Epic; and the MyChart logo are trademarks of Epic Systems Corporation

      USE OF THIRD-PARTY SERVICES

      You may choose to use other services provided by third parties in conjunction with your use of MyChart. Such services may include, but are not limited to, translation services, location services, and other third-party offerings. Any links to such services are provided for your convenience only. Neither Epic nor Brown & Toland Physicians Care Team have control over the contents of these services, and neither Epic nor Brown & Toland Physicians Care Team accept any responsibility for them or for any loss or damage that may arise from your use of them. Such services may require you to submit your information to a third party, which may result in a copy of your information being used and/or stored by a third party. If you decide to access any such services in conjunction with your use of MyChart, you do so entirely at your own risk and subject to the terms and conditions of use for such services.