​BY CLICKING “I AGREE,” CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE TO THIS CONSENT, DO NOT CREATE AN ACCOUNT OR USE THE SERVICE. YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON THE “I AGREE” BUTTON OR OTHERWISE INDICATES ACCEPTANCE TO THIS CONSENT ON YOUR BEHALF.

This Informed Consent for Clinical Services and Telehealth Services (the “Consent”) sets forth the terms and policies for the clinical services provided by Superpower Medical Group of CA PC, a California professional medical corporation, and other third-party medical groups (the “Medical Groups”) through the online technology platform (“Platform” or “Superpower Platform”), which is owned and operated by Superpower Health, Inc. (“Superpower”).

The purpose of the Consent is to obtain your informed consent to care and the use of telehealth in the delivery of healthcare to you by physicians, physician assistants, and/or nurse practitioners (“Healthcare Providers”) of the Medical groups using the Superpower Platform. Superpower’s goal is to provide users with access to a broad array of health focused strategies and an integrated multidisciplinary approach to health. The Superpower Platform provides users with access to both typical biomedical standards of care as well as integrative and functional medicine approaches which may not be considered standard for conventional care. By signing up to receive Clinical Services and Telehealth Services (as defined herein) through the Superpower Platform, you authorize the Medical Groups and their Healthcare Providers to provide you with telehealth and other clinical services.

In this Consent, the terms “you” and “yours” refer to the person using the Clinical Services and Telehealth Services and, the person signing this Consent as a representative for another person (a “Family Member”) as such Family Member’s lawful guardian, conservator, or custodian.  Please read this Consent carefully and ask any questions you might have before agreeing. 

‍General Information

‍The Healthcare Providers of the Medical Groups provide certain virtual medical services as described in this Consent (the “Clinical Services”) via the Superpower Platform. Superpower is a non-clinical entity that provides technology services to the Medical Groups and does not engage in the practice of medicine. This Consent describes the Medical Groups’ Clinical Services.

 The Clinical Services and the Superpower Platform

‍When you become a patient of a Medical Group (a “Patient”), you will be given access to the Healthcare Providers. The Platform provides simple tools for scheduling your blood draw, ordering your laboratory results, viewing your laboratory results, ordering prescription medications prescribed by a Healthcare Provider after appropriate intake and review, connecting you with Healthcare Providers, and serving as your hub of information. 

‍Clinical Services 

‍This authorization includes, but is not limited to, diet/nutrition therapy inclusive of herbs and supplements, standard and specialized lab options and result interpretation, atypical medication options including but not limited to off-label uses of FDA approved drugs, and specialized or experimental therapies such as, bio-identical hormones, cosmetic skin treatments and injectables, vitamin injections and IV therapies as well as pharmaceuticals to reduce hair loss, improve weight loss, and support healthy aging. 

We strive to provide individualized care relevant to your case which could include external referrals or specialized procedures such as regenerative injections, acupuncture, Chiropractic/OMT, biotherapies, and physical medicine. Other ancillary treatments include, but or not limited to V02 max testing, DEXA scans, full-body MRI, laser, red-light therapy, electromagnetic therapy, and other services or procedures, which my provider considers helpful and/or necessary.

The Healthcare Providers will discuss with you the risks, benefits and alternatives to recommended treatments. You understand that Clinical Services may be rendered by nurses or other medical professionals such as medical assistants or phlebotomists under supervision. 

‍No Guarantees:

Although the Medical Groups strive to achieve the best possible results, there is no guarantee of outcomes.

‍Common Pharmaceutical Treatments include:

‍Estrogen/Progesterone HRT in Women: The Healthcare Providers provide an individualized approach to estrogen/progesterone hormone replacement therapy (HRT) which, while not standard, is designed with your specific health needs in mind. While risks, such as increased likelihood of blood clots, stroke, and certain types of cancer, including breast and endometrial, are quite rare, they can occur. Other potential side effects like nausea, mood swings, and weight gain are usually mild and temporary. Potential benefits included improved mood and reduced menopausal symptoms.

GLP-1 Therapy for Weight Loss: The Healthcare Providers may prescribe compounded or FDA approved versions of GLP-1 therapy for weight loss (semaglutide). Some patients may experience side effects like nausea, vomiting, diarrhea, and in very rare cases, pancreatitis or an increased risk of thyroid tumors. Potential benefits include weight loss and improved metabolic health.

Treatment for Hair Loss: The healthcare Providers may prescribe prescription-grade oral or topical treatments to help prevent hair loss and promote regrowth. 

Please see the full list of risks and benefits for your specific treatment in the informed consent form provided to you at the time of treatment. 

Prescriptions are only made after appropriate intake and review by a Healthcare Provider licensed in your state.

‍Use of Telehealth

‍You understand that all Clinical Services will be provided via telehealth. Telehealth involves the delivery of healthcare services using electronic communications, information technology or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, follow-up and/or patient education, and may include, but is not limited to, one or more of the following:

Electronic transmission of client medical records, photo images, personal health information or other data between a patient and a provider; 

Interactions between a patient and provider via audio, video and/or data communications (such as messaging or email communications); 

Use of output data from medical devices, sound and video files. 

Alternative methods of care may be available to you, such as in-person services, and you may choose an alternative at any time. 

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of customer identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

Expected Benefits of Telehealth:

 Improved access to care by enabling a customer to remain at a remote site while consulting with  practitioners at distant/other sites. 

More efficient client evaluation and management. 

Obtaining expertise of a distant specialist.

Possible Risks of Telehealth

There are potential risks associated with the use of telehealth. 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 decision making by the Healthcare Provider; 

Delays in 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 health information; 

In rare cases, a lack of access to complete health records may result in interactions or allergic reactions or other judgment errors.

Due to Healthcare Provider licensing reasons, you have to physically be in the state that your Healthcare Provider is licensed in during your telehealth visit. By agreeing to this Consent, you are confirming that you will only opt in to care when you are in your state of residence or in one of our locations. Furthermore, you are confirming that your state of residence is one in which the Medical Groups are licensed to treat.

‍You understand that the Clinical Services provided by the Medical Groups are extremely limited as described below. You will have asynchronous access to Healthcare Provider(s) for purposes of ordering your laboratory tests and prescription medications through the Platform. Healthcare Provider(s) will order your laboratory testing and prescription medications asynchronously and without a prior medical visit based on information you provide via the Platform. 

Once the laboratory testing that is ordered is performed and the results are received from the Lab, a Healthcare Provider will review your laboratory results and notify you of (i) abnormal values via the Platform and email and (ii) critical values via the Platform, phone and email. A Healthcare Provider will be available to discuss your laboratory results via synchronous audio-visual communication after you receive your results. You understand that the Medical Groups and Healthcare Provider(s) will only be explaining and educating you about your laboratory results; the Medical Groups and Healthcare Provider(s) will not provide any diagnosis, treatment or any additional clinical care to you following your laboratory results review and discussion. You must maintain care with a primary care physician or other licensed healthcare provider for all examinations, diagnosis, treatment, and ongoing clinical care. The Healthcare Providers do not act as your primary care provider and are not providing any medical services except for the review and explanation of your laboratory results. It is your responsibility to discuss the results of any laboratory tests with your treating physician(s) or specialists whose care you may be under for diagnosis and treatment.‍

‍Laboratory Products and Services.

‍With respect to the lab testing, the laboratory tests will require that you complete an at-home diagnostic test or have blood drawn. These diagnostic tests are provided by third-party laboratories, and neither Superpower nor the Medical Groups can guarantee the accuracy or reliability of these tests. These laboratory tests can provide false negative, false positive, or inconclusive results that could impact a Healthcare Provider’s ability to correctly explain your results.

‍Payment and Billing

‍You understand that the Medical Groups do not accept insurance of any kind. You understand that you will be fully responsible for payment for Clinical Services received via the Platform. You understand that Superpower performs billing services and acts as a paymaster on behalf of the Medical Groups and the Healthcare Providers. The fees for the Clinical Services the Medical Groups provide (“Clinical Fees”) are as shown on the invoice provided to you at checkout. Superpower will collect the Subscription fee (as described in the Superpower Terms of Service), which includes the Clinical Fees, at checkout and remit directly to the Medical Groups the full amount for the Clinical Fees. The remainder of the Subscription fee will be as described in your invoice at checkout. You understand that you must pay us any costs due unless state or federal regulations do not allow this.

By providing Superpower with your credit card information and associated billing information, you are authorizing Superpower as the Medical Groups’ paymaster to charge your credit card for the Clinical Services and to save your credit card information for future transactions on your account.

‍Informed Consent - Risks and Benefits of Telehealth and Limitations of Clinical Services

‍As all of the Clinical Services provided by the Medical Groups via the Platform are virtual, and the Clinical Services are limited in scope and time. Healthcare Provider(s) will order your prescription medications and laboratory testing asynchronously and without a prior medical visit based on information you provide via the Platform. As previously stated, the Healthcare Provider(s) will not be seeing you in-person and will only be reviewing your intakes and laboratory results and then prescribing any requested medications or explaining and educating you about your laboratory results. This limited virtual care is a flexible and convenient way to get healthcare, but it may not be right for treating certain symptoms or illnesses that need in-person clinical care. 

‍PLEASE NOTE: THE MEDICAL GROUPS DO NOT ADDRESS MEDICAL EMERGENCIES. IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, ARE CONSIDERING HARMING YOURSELF OR OTHERS, OR ARE OTHERWISE IN IMMINENT DANGER, YOU SHOULD DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM.‍

‍You should seek emergency help or follow-up care when recommended by any healthcare provider or when otherwise needed. You should never discontinue medications or stop a course of treatment without first contacting your primary care provider or other medical professionals for advice. You should not delay treatment or advice from your primary care provider or other medical professionals based on information provided by the Healthcare Provider(s) via the Superpower Platform. You understand that your use of our Clinical Services will not give rise to an ongoing treatment relationship, treatment plan or course of action. Healthcare Provider(s) will only interpret and provide education regarding your laboratory results ordered through the Platform. Please discuss using the Platform with your treating provider.

‍All laws and protections for in-person medical care also apply to telehealth care. This includes confidentiality of information, access to medical records, and sharing of information that could identify you personally. You may decide that you do not want to use the Clinical Services at any time, seek treatment elsewhere and/or with in-person offerings.   

‍Privacy Practices and RecordsThe Medical Groups follow federal healthcare privacy and security laws to protect your health information and use standard physical, electronic, and business security methods to help prevent access to your health information by people who should not see it. However, the Medical Groups cannot promise that data sent over the Internet or through a data storage facility will be perfectly secure. Additionally, you are responsible for information security on your personal device, including but not limited to, computer, tablet, or phone, as well as using it in a location with secure internet connection, when you use our services. So, although the Medical Groups try to protect your personal information, they cannot guarantee the security of any information you send to the Medical Groups. You can read more information about the Medical Groups’ use of health information and other personal information in the Medical Group Notice of Privacy Practices (“Medical Group Notice of Privacy Practices”). You understand all medical reports resulting from the Clinical Services are part of your medical record.  

As part of providing Clinical Services, the Medical Groups may share your health records and health information with the following individuals under the following circumstances without further notice to you: 

With your other healthcare providers (including your primary care provider and referring provider), either directly or through our participation in health information exchanges, for healthcare coordination, payment, operations and treatment purposes. This may include information relating to genetic tests, substance or alcohol use, mental health, communicable diseases, HIV/AIDS and other health conditions. 

With other individuals involved in your care such as caregivers or family members.  

With your health plan, either directly or through our participation in health information exchanges, for healthcare payment, coordination, operations and treatment purposes (such as eligibility verification, processing your claims, and audits of our services). This may include information relating to genetic testing, substance or alcohol use, mental health, communicable diseases, HIV/AIDS and other health conditions.

As otherwise permitted in the Medical Group Notice of Privacy Practices and by applicable law.  

By signing below, you agree to let the Medical Groups share your records as described above and acknowledge receipt of the Medical Group Notice of Privacy Practices. Dissemination of any patient identifiable images or information from the telehealth visit to researchers or other educational entities will not occur without your affirmative consent.

You have the right to request a copy of your medical records.  You can request to obtain or send a copy of your medical records to your primary care or other designated health care provider by contacting compliance@superpower.com.  A copy will be provided to you at a reasonable cost of preparation, shipping and delivery.

‍SMS and Email Communications 

‍By initializing below and providing your phone number and email, you consent to receive from the Medical Groups and/or Superpower marketing texts, and other text messages and emails related to our products and services such as appointment reminders, messages from your Healthcare Providers, lab results, and other notifications.  You understand SMS text messages are not always secure because they travel over networks that we do not control.  This consent for text messages with your Healthcare Provider is required for you to receive certain telehealth services and direct communication with your Healthcare Provider, but it is not required for marketing texts.  You may ask us to stop sending you marketing texts at any time by contacting superpower@superpower.com or replying STOP to one of our messages. You understand that messaging frequency may vary, and data rates may apply. 

‍Complaint Policy

‍All Patients have the right to communicate grievances regarding their care. Should you wish to make a formal complaint you may do so in writing and submit the concern to Practice at compliance@superpower.com.  

The Healthcare Provider(s) hold professional licenses issued by the professional licensing boards or agencies in the states where they practice. You can report a complaint relating to the care provided by a Healthcare Provider by contacting the professional licensing board in the state where the care was received. You can find the contact information for each of the state professional licensing boards governing medicine on the Federation of State Medical Boards website.

‍Your Acknowledgments

‍By clicking “I Agree”, checking a related box to signify your acceptance, using any other acceptance protocol presented through the Superpower Platform or otherwise affirmatively accepting this Consent, you are agreeing and providing your consent with respect to the following:

If you have questions about any of the contents of this Consent, the Medical Group procedures or policies, or the Clinical Services, please discuss them with us at compliance@superpower.com. 

I have read and understood this document, and I agree to abide by its terms. Further, I certify that if I am signing as a personal representative of a family member, I have legal authority to provide consent for such person.‍

‍I have read and understand the information provided above regarding telehealth and the Clinical Services provided, have discussed it with my treating physician if necessary, and all my questions have been answered to my satisfaction. I hereby give my informed consent to receive the limited Clinical Services from the Medical Groups as described in this Agreement.
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YOU CERTIFY THAT YOU ARE NOT CONSENTING ON BEHALF OF A MINOR CHILD. WE DO NOT PROVIDE SERVICES TO CHILDREN UNDER THE AGE OF 18.  
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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.​

This Notice of Privacy Practices (the “Notice”) tells you about the ways we may use and disclose your protected health information (“medical information”) and your rights and our obligations regarding the use and disclosure of your medical information. “We” refers to, and this Notice applies to third party medical groups providing clinical services through the Superpower Health, Inc. platform, including, respectively, their providers and employees (“Medical Groups”).

‍OUR OBLIGATIONS

‍We maintain the privacy of your medical information and notify affected individuals following a breach of unsecured medical information, in each case to the extent required by state and federal law. We provide you this Notice explaining our legal duties and privacy practices with respect to medical information about you.

‍HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

‍The following categories describe the different ways that we typically use and disclose medical information, the purposes for such uses and disclosures, and the reasons for such uses and disclosures. As noted below, we may contact you via different methods that you may approve, such as via text message, email, or through your Superpower account. In most instances, your initial communication with the applicable Medical Group will be through an interaction with the Medical Group through the Superpower website or app.

Specifically speaking, the applicable Medical Group may communicate with you in the following specific ways and for the following specific purposes:

Type & Purpose

Email communications; To obtain information from you necessary to provide services to you, communicate with you about your lab test results, and provide you with information on special offers and deals. By engaging in our medical services and receiving medical information via email, you understand that email is not a secure, encrypted or confidential method of communication.

Texts; To send you appointment reminders and obtain information from you necessary to provide services to you and communicate with you about your lab test results, medical recommendations, prescriptions and other medical information from your Healthcare Provider. While we take your privacy and the security of your health and other sensitive information very seriously, the transmission of information over the internet and mobile networks is not 100% secure. Text messages may be encrypted on the Superpower side only, which means that it is possible they may be intercepted by third parties. If you choose to send or receive information about your health or any other sensitive information by text message, you understand this risk.

Customer Service Emails, texts, or app notifications; To provide you with updates on and other questions applicable to your provider visit(s)

Tracking emails; If you are prescribed any medications from the Medical Groups, to notify you when prescriptions have been shipped, will arrive, and other confirmations.

Order information; To provide information on content of orders (additional products or samples).

For Treatment. We may use and disclose medical information about you to provide you with health care treatment and related services, including coordinating and managing your health care through the Superpower platform. We may disclose medical information about you to physicians, nurses, other health care providers and personnel who are providing or involved in providing healthcare to you (both within and outside of the applicable Medical Group(s)). For example, should your care require referral to a pharmacy for the provision of prescription drugs, we may provide that pharmacy with your medical information in order to aid the pharmacy in its fulfillment of services to you.

For Health Care Operations. We may use and disclose medical information about you for our health care operations. These uses and disclosures are necessary to operate and manage our practice and to promote quality care. For example, we may need to use or disclose your medical information in order to assess the quality of care you receive or to conduct certain cost management, business management, administrative, or quality improvement activities or to provide information to our insurance carriers.

Quality Assurance and Utilization Review. We may need to use or disclose your medical information for our internal processes to assess and facilitate the provision of quality care to our patients. We may need to use or disclose your medical information to perform a review of the services we provide in order to evaluate whether that the appropriate level of services is received, depending on condition and diagnosis.

Credentialing and Peer Review. We may need to use or disclose your medical information in order for us to review the credentials, qualifications and actions of our health care providers.

Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that we believe may be of interest to you.

Appointment Reminders and Information about Health Related Benefits and Services. We may use and disclose medical information, in order to contact you (including, for example, contacting you by phone and leaving a message on an answering machine) to provide appointment reminders and other information. We may use and disclose medical information to tell you about health-related benefits or services that we believe may be of interest to you. See also the specific types of communications noted above.

Vendors. There are some services (such as billing or legal services) that may be provided to or on behalf of the Medical Groups through contracts with third parties, such as Superpower Health, Inc. who provides us with management and billing services via the Superpower platform. When these services are contracted, we may disclose your medical information to our vendor so that they can perform the job we have asked them to do. To protect your medical information; however, we require the business associate to appropriately safeguard your information.

Individuals Involved in Your Care or Payment for Your Care. We may disclose medical information about you to a friend or family member who is involved in your health care, as well as to someone who helps pay for your care, but we will do so only as allowed by state or federal law (with an opportunity for you to agree or object when required under the law), or in accordance with your prior authorization.

As Required by Law. We will disclose medical information about you when required to do so by federal, state, or local law or regulations.

Other. Subject to applicable legal requirements, and where appropriate for your medical care or required by law, we may also use your medical information (i) to avert an imminent threat of injury to health or safety, (ii) for organ donation purposes, for research, (iii) to appropriate military authorities if you are in the armed forces, (iv) for workers’ compensation programs, (v) for public health activities, (vi) for health oversight activities, (vii) for other legal matters, (viii) for law enforcement purposes, (ix) to coroners and medical examiners, or (x) for marketing or fundraising purposes

Electronic Disclosures of Medical Information. Under the law of certain states, we are required to provide notice to you if your medical information is subject to electronic disclosure. This Notice serves as general notice that we may disclose your medical information electronically for treatment, payment, or health care operations or as otherwise authorized or required by state or federal law.

‍OTHER USES OF MEDICAL INFORMATION

‍Authorizations. There are times we may need or want to use or disclose your medical information for reasons other than those listed above, but to do so we will need your prior authorization. Other than expressly provided herein, any other uses or disclosures of your medical information will require your specific written authorization.

Right to Revoke Authorization. If you provide us with written authorization to use or disclose your medical information for such other purposes, you may revoke that authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your medical information for the reasons covered by your written authorization. You understand that we are unable to take back any uses or disclosures we have already made in reliance upon your authorization, and that we are required to retain our records of the care that we provided to you.

‍YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU​

Certain laws and regulations provide you with certain rights regarding the medical information we have about you. The following is a summary of those rights.​

Right to Inspect and Copy. Under most circumstances, you have the right to inspect and/or copy your medical information that we maintain in our possession in a designated record set, which generally includes your medical and billing records. To inspect or copy your medical information, you must submit your request to do so in writing to the applicable Medical Group at compliance@superpower.com. If you request a copy of your information, we may charge a fee for the costs of copying, mailing, or certain supplies associated with your request. The fee we may charge will be the amount allowed by state law. If your requested medical information is maintained in an electronic format (e.g., as part of an electronic medical record, electronic billing record, or other group of records maintained by the applicable Medical Group that is used to make decisions about you) and you request an electronic copy of this information, then we will provide you with the requested medical information in the electronic form and format requested, if it is readily producible in that form and format. If it is not readily producible in the requested electronic form and format, we will provide access in a readable electronic form and format as agreed to by the applicable Medical Group and you. In certain very limited circumstances allowed by law, we may deny your request to review or copy your medical information. We will give you any such denial in writing. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the applicable Medical Group will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.

Right to Amend. If you feel the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by the applicable Medical Group. To request an amendment, your request must be in writing and submitted to compliance@superpower.com. In your request, you must provide a reason as to why you want this amendment. If we accept your request, we will notify you of that in writing. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that (i) was not created by us (unless you provide a reasonable basis for asserting that the person or organization that created the information is no longer available to act on the requested amendment), (ii) is not part of the information kept by the applicable Medical Group, (iii) is not part of the information which you would be permitted to inspect and copy, or (iv) is accurate and complete. If we deny your request, we will notify you of that denial in writing.

Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures” of your medical information. This is a list of the disclosures we have made for up to six years prior to the date of your request of your medical information, but may not include disclosures for Treatment, Payment, or Health Care Operations (as described in this Notice) or disclosures made pursuant to your specific authorization (as described in this Notice), or certain other disclosures. To request a list of accounting, you must submit your request in writing to compliance@superpower.com. Your request must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve-month period will be free. For additional lists, we may charge you a reasonable fee for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for Treatment, Payment, or Health Care Operations. You also have the right to request a restriction or limitation on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. Except as specifically described below in this Notice, we are not required to agree to your request for a restriction or limitation. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. In addition, there are certain situations where we won’t be able to agree to your request, such as when we are required by law to use or disclose your medical information. To request restrictions, you must make your request in writing to compliance@superpower.com. In your request, you must specifically tell us what information you want to limit, whether you want us to limit our use, disclosure, or both, and to whom you want the limits to apply. As stated above, in most instances we do not have to agree to your request for restrictions on disclosures that are otherwise allowed. However, if you pay or another person (other than a health plan) pays on your behalf for an item or service in full, out of pocket, and you request that we not disclose the medical information relating solely to that item or service to a health plan for the purposes of payment or health care operations, then we will be obligated to abide by that request for restriction unless the disclosure is otherwise required by law. You should be aware that such restrictions may have unintended consequences, particularly if other providers need to know that information (such as a pharmacy filling a prescription). It will be your obligation to notify any such other providers of this restriction. Additionally, such a restriction may impact whether an insurance company will pay for related care that you may not want to pay for out of pocket (and which would not be subject to the restriction).

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you through a personal email address and not at work or, conversely, only at work and not a personal email address. To request such confidential communications, you must make your request in writing to compliance@superpower.com. We will not ask the reason for your request, and we will use our best efforts to accommodate all reasonable requests, but there are some requests with which we will not be able comply. Your request must specify how and where you wish to be contacted.

Right to an Email or Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. To obtain a copy of this Notice, you must make your request in writing to compliance@superpower.com.

Right to Breach Notification. In certain instances, we may be obligated to notify you (and potentially other parties) if we become aware that your medical information has been improperly disclosed or otherwise subject to a “breach” as defined in and/or required by applicable law.

‍CHANGES TO THIS NOTICE

‍We reserve the right to change this Notice at any time, along with our privacy policies and practices. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well, as any information we receive in the future. We will post a copy of the current notice, along with an announcement that changes have been made, as applicable, on our website and in any physical office in which the Medical Groups practice medicine. When changes have been made to the Notice, you may obtain a revised copy by writing to compliance@superpower.com.

‍COMPLAINTS

‍If you believe that your privacy rights as described in this Notice have been violated, you may file a complaint with the applicable Medical Group at compliance@superpower.com.The Medical Groups will not retaliate against any individual who files a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.​In addition, if you have any questions about this Notice, please contact compliance@superpower.com.

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