Notice of Privacy Practices

Last Updated: May 6, 2026

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this Notice of Privacy Practices (“Notice”), please ask your treating physician, your Monogram Health Program staff or provider, or contact Monogram Health’s Privacy Office at compliance@monogramhealth.com or 1-855-212-2273 (TTY 711).

Our Commitment to You

Your health information is personal. We are committed to protecting health information about you. We will create a record of the care and services you receive. This record will document the quality of care provided to you and will meet the requirements of federal and state laws and regulations. This Notice applies to all the records of your care given by Monogram Health, Inc., its affiliates, and Monogram Kidney Care, and its affiliates (“Monogram Health”), and by any of Monogram Health’s providers, employees, personnel, staff members and contractors described below.

By law, we must:

  • Keep health information about you private;
  • Give you this Notice informing you of our legal duties to keep your health information private; and
  • Follow the current requirements of the Notice in effect.


How Your Health Information May Be Used

We may use and disclose your health information without your authorization for the following purposes.

Please note: The use and disclosure of certain sensitive health information (e.g., substance use disorder information, mental health information, HIV/AIDS information, venereal disease information) may be further restricted under other applicable federal or state law.

  • For treatment, such as sending health information about you to your primary care physician as part of care management services or to another doctor as part of a referral.  We may also share your health information in order to coordinate different aspects of care that you need.  We may disclose your health information to people who provide services in connection with your health care;
  • To obtain paymentfor treatment provided, such as sending billing info to your insurance company or Medicare;
  • For our healthcare operations, such as quality assessment and improvement activities, case management, business planning, customer services, and other activities.  For example, we may use your information to compare your data to another patient’s data to improve our services or treatment methods.
  • As required by law: We may use and disclose your health information if we are required to do so by federal, state, or local law or regulation.
  • For public health purposes: We may disclose your health information to public health authorities for the purposes of controlling the spread of disease.  For example, we may disclose to local public health authorities if you test positive for Ebola or, in a disaster, we may share your health information with relief authorities so that your family can be notified of your location and health condition.
  • For abuse or neglect reporting: We may disclose your health information to a government authority if we reasonably believe you are a victim of abuse, neglect, or domestic violence.  We will disclose this type of information only to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent or lessen a serious and imminent threat to you or another person.
  • For health oversight audits or inspections:We may disclose your health information in the event of an audit or investigation of our organization by a local, state or federal health oversight agency.
  • To Medical Examiners or for funeral arrangements or organ donation: We may disclose your health information as needed for the purpose of identifying a deceased person, determining a cause of death, or as otherwise authorized by law; and to funeral directors as necessary to carry out their duties. We may also disclose your health information to respond to organ donation groups for the purpose of facilitating organ donation and transplantation.
  • For Workers’ Compensation purposes: We may disclose your health information as required by Workers’ Compensation laws or other similar programs.  For example, we may disclose your health information to Workers’ Compensation authorities regarding work-related injuries.
  • For Emergencies: Unless you specifically request a restriction before you are incapacitated, we may use or disclose your health information during a period of your incapacitation, if we determine, using our professional judgment, the use or disclosure is in your best interest.
  • For national security or other specialized government functions: We may disclose your health information to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by the National Security Act. For example, we may disclose your health information to provide protective services to the President or other important officials.
  • For members of the Armed Forces as required by Military Command authorities: If you are a member of the United States Armed Forces, we may disclose your health information to appropriate military command authorities.  For example, we may disclose your health information to appropriate command authorities so they can determine your fitness for duty or for a particular assignment.
  • To respond to a request from law enforcement in specific circumstances: We may disclose your health information to law enforcement to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public.
  • In response to a valid judicial or administrative order or other legal process: We may use and disclose your health information in the course of any judicial or administrative proceeding, such as in response to a court order or other lawful process. Please see the “Protections for Substance Use Disorder Records” section of this Notice for additional information regarding restrictions on the disclosure of substance use disorder records subject to 42 CFR Part 2 in legal proceedings.
  • Individuals Involved in Your Care or Payment for Your Care: On a separate form, you may list the names of friends and family with whom we can share your health information in appropriate circumstances.
  • For Research: We may share health information about you for research when approved by an appropriate review committee or is otherwise permitted by law. This also may include preparing for research or telling you about research studies in which you might be interested.

We may also use information about you to:

  • Remind you about an appointment;
  • Tell you about possible treatment options or alternatives; and
  • Offer you health-related benefits or servicesthat you might be interested in.
  • Creation of De-Identified Health Information: We may use your health information to create data that cannot be linked to you by removing certain elements from your health information, such as your name, address, telephone number, and member identification number. We may use this de-identified information to conduct certain business activities, such as conducting data analytics and aggregation.

Other Uses or Disclosures of Your Health Information that Require Your Authorization

Your written authorization is required before we use or disclose your health information for the following purposes:

  • Marketing Purposes: Except in certain circumstances authorized by law, we are required to obtain your written authorization before using or disclosing your health information for marketing purposes.
  • Sale of Health Information: We are required to obtain your written authorization before disclosing your health information for purposes that constitute a sale.
  • Other Uses and Disclosures of Health Information Not Listed in this Notice: In any other situation not covered by this Notice, we will ask for your written authorization before using or disclosing any other health information about you, including before using or disclosing psychotherapy notes.  If you choose to authorize the use or disclosure of health information about you, you may change or cancel your authorization at any time by notifying us in writing of your decision, except to the extent that we have already taken action on the information disclosed. All written requests or appeals should be submitted to compliance@monogramhealth.com or 5410 Maryland Way, Ste. 400, Brentwood, TN 37027, Attn: Compliance Department.

Please note: Once we use or disclose your health information based on your authorization, we cannot take back that use or disclosure. If you change or revoke your authorization, it will apply only going forward and will not affect any uses or disclosures we made before we received your change or revocation of authorization.

Protections for Substance Use Disorder Records

To the extent Monogram Health receives substance use disorder treatment records from programs subject to 42 CFR Part 2, or testimony relaying the content of such records, Monogram Health shall not use or disclose such records in civil, criminal, administrative, or legislative proceedings against the individual who is the subject of the records, unless the use or disclosure is based on written consent, or a court order after notice and an opportunity to be heard is provided to the individual or the holder of the record, as provided in 42 CFR Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed.

Redisclosures of Health Information May No Longer Be Protected by HIPAA

Health information disclosed by Monogram Health in accordance with this Notice may be subject to redisclosure and may no longer be protected under HIPAA.

Who Will Follow This Notice?

Monogram Health provides healthcare and other services to our clients and patients in partnership with other professionals and healthcare organizations. This Notice will be followed by:

  • Any Monogram Health healthcare professional who provides health services to you at Monogram Kidney Care;
  • All departments and affiliated covered entities of Monogram Health; and
  • All employees, health staff, affiliates, and trainees of the entities listed above.

While each of these entities and affiliates operate independently, they may share your health information for coordination of care, treatment, payment, and healthcare operations.

Your Rights Regarding Your Health Information

You have the following rights regarding your health information:

  • Right to be Notified of a Breach: We will notify you in the event of a breach involving your unsecured health information.
  • Right to Access Your Health Records: In most instances, you have the right to look at or get a copy of your health information that we create and maintain to make decisions about your care. All requests for copies or access to health records must be submitted in writing in advance to compliance@monogramhealth.com or 5410 Maryland Way, Ste. 400, Brentwood, TN 37027, Attn: Compliance Department. If your request for access to your health records is granted, we will work with you to pick a convenient time and place. If you request copies of your health records, we may charge a fee for the cost of copying, mailing or other related supplies. We may deny your request and/or ask you to contact your health plan instead. If we deny your request to review or obtain a copy, you may submit a written request to us for a review of that decision.
  • Right to Amend Your Health Records: If you believe the information in your health record is incorrect or that important information is missing, you have the right to request that we correct the health record, by submitting a request in writing that provides your reason for requesting a change or amendment to the Monogram Health Privacy Office address listed below. We could deny a request to amend or change your health record if the information is not maintained by us or if we determine that the information in your health record is accurate. You may submit a written statement of disagreement to us with the decision by us to not amend your record to the Monogram Health Privacy Officer at compliance@monogramhealth.com or 5410 Maryland Way, Ste. 400, Brentwood, TN 37027, Attn: Compliance Department.
  • Right to an Accounting: You have the right to ask for a list of any disclosures we have made of your health information. To request a list of disclosures, indicate the period of time you’d like us to provide you a list of disclosures we have made of your health information to the Monogram Health Privacy Office address listed below. Please note: We can provide a list of disclosures for up to the past 6 years.  We do not keep any disclosures made prior to 6 years ago.
  • Right to Request Confidential Communications: You have the right to request that we communicate with you about your health information in the confidential manner requested by you. For example, you may request that we send mail to you at an address other than your home.  In order to request that we communicate with you in a specific way or at a specific location, please send us a request in writing to the Monogram Health Privacy Office at compliance@monogramhealth.com or 5410 Maryland Way, Ste. 400, Brentwood, TN 37027, Attn: Compliance Department. We will accommodate all reasonable requests and will not ask you the reason for your request. Your request must clearly specify how or where you wish to be contacted.
  • Right to Request A Paper Copy of this Notice:  You may request a paper copy of this Notice even if you have agreed to receive it electronically. Please ask your treating physician, your Monogram Health Program employees, personnel, staff members and contractors, or contact Monogram Health’s Privacy Office using the contact information below.
  • Right to Request Restrictions:You may request, in writing to the Monogram Health Privacy Office address below, that we not use or disclose your health information for treatment, payment or healthcare operations or to persons involved in your care unless you specifically authorize it OR unless required by law or in an emergency. Your request should state the information you want to limit; whether you want to limit Monogram Health’s use, disclosure, or both; and to whom you want the limits to apply, for example, disclosures to your spouse.

We will consider your request and try to accommodate it, but we are not legally required to restrict the use or disclosure of your data unless all of the following conditions are met:

  • You request that we NOT share your information with an insurer for purposes of payment or other purposes unrelated to your treatment;
  • You pay all charges associated with the services you receive out-of-pocket in full; and
  • We are NOT required by law to release your information to the insurer.

We will inform you of our decision in writing. All written requests or appeals should be submitted to compliance@monogramhealth.com or 5410 Maryland Way, Ste. 400, Brentwood, TN 37027, Attn: Compliance Department.

Changes to this Notice

We may change our privacy practices and policies at any time. Any changes will apply to health information we currently have, as well as to any new information we receive after the change occurs. Before we make any significant changes to our policies, we will change our Notice and post the new Notice in waiting areas, exam rooms, and on our website at www.monogramhealth.com. You can request a current copy of our Notice at any time. The effective date of the current Notice is listed at the top of the Notice. Paper copies of the current Notice will be available to you each time you come into our facility for treatment.

Complaints

If you are concerned that your privacy rights may have been violated, or you disagree with any actions we have taken or decisions we have made with regard to your health information, you may contact the Monogram Health Privacy Office at compliance@monogramhealth.com or 5410 Maryland Way, Ste. 400, Brentwood, TN 37027, Attn: Compliance Department or 1-855-212-2273 (TTY 711). If you are not satisfied with our response, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights (“OCR”). For more information on how to file a complaint with OCR, please visit: https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html. Under no circumstances will we penalize or retaliate against you for filing a complaint.

Contact Us

For further information regarding this Notice and Monogram Health’s privacy practices, please contact the Monogram Health Privacy Office at compliance@monogramhealth.com or 5410 Maryland Way, Ste. 400, Brentwood, TN 37027, Attn: Compliance Department or 1-855-212-2273 (TTY 711).