HIPAA Consent
Last Updated: September 27, 2026
This Notice explains how your protected health information (“PHI”) may be used and disclosed when you use the telehealth consultation services made available through this website, and describes your rights regarding that information. Please read it carefully before continuing.
Federal law, the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), requires healthcare providers to protect the privacy of your PHI, to give you notice of their privacy practices, and to follow the terms of that notice. This Notice covers PHI created in connection with your telehealth consultation, including information you submit through intake forms and health questionnaires on this site.
PHI means individually identifiable health information relating to your past, present, or future physical or mental health, the healthcare you receive, or payment for that healthcare.
General account information, and activity on this site outside the clinical consultation (such as browsing behavior or marketing communications), is covered by Modiv Wellness’s separate Privacy Policy, not this Notice.
Two parties are involved in your care, and each has its own responsibilities:
Modiv Wellness operates this website and platform, and arranges your clinical evaluation by its contracted, licensed healthcare providers, who decide whether treatment is medically appropriate. Modiv Wellness does not issue prescriptions or dispense medication.
Partell Pharmacy is an independent, separately licensed pharmacy that issues your prescription, when treatment is medically appropriate, and dispenses and ships your medication under its own privacy and regulatory obligations. Partell Pharmacy is licensed in all 50 states.
Acknowledgment and Consent
By selecting the HIPAA Consent checkbox at checkout, you confirm that you have read this Notice and you consent to the uses and disclosures of your PHI for treatment, payment, and healthcare operations as described below.
How Your Health Information May Be Used and Disclosed
The following uses and disclosures of your PHI may occur without requiring your separate written authorization:
Treatment. To provide and coordinate your care, for example, sharing your intake information with the reviewing provider, or sharing your health information with Partell Pharmacy so it can issue and fill your prescription.
Payment. To process payment for the consultation or, where applicable, prescribed medication, and to provide documentation you may need for insurance reimbursement.
Healthcare Operations. To support quality review, internal audits, and general operation of the telehealth service.
As Required by Law. When disclosure is legally required by a federal, state, or local authority.
Public Health and Safety. For public health reporting, such as adverse-event reporting, or to prevent a serious threat to your health or safety or that of others.
Health Oversight. To a government agency authorized to conduct audits, inspections, or licensure activities.
Legal Proceedings. In response to a court order, subpoena, or other valid legal process.
Law Enforcement. Where required, such as to comply with a court order or report certain categories of injury.
Coroners and Similar Officials. As necessary for a coroner, medical examiner, or funeral director to carry out their duties.
Workers’ Compensation. As necessary to comply with workers’ compensation laws.
Appointment and Treatment-Related Communications. To contact you about your consultation, follow-up care, or related services.
People Involved in Your Care. To a family member or other person you identify as involved in your care, unless you object.
Business Associates. To vendors who perform services on our behalf (such as scheduling or payment processing) and who are contractually required to protect your information.
Uses That Require Your Written Authorization
Any use or disclosure of your PHI not described above requires your separate written authorization, including:
Use of psychotherapy notes, where applicable
Use of your PHI for marketing purposes
Any disclosure that would constitute a sale of your PHI
You may revoke a prior authorization at any time by emailing Support@modivwallness.com. Revocation will not undo any disclosures already made in reliance on that authorization.
Your Rights
Access. Request a copy of your PHI records. A reasonable, cost-based fee may apply.
Amendment. Request a correction to PHI you believe is inaccurate or incomplete.
Accounting of Disclosures. Request a list of certain disclosures made of your PHI (this excludes disclosures for treatment, payment, or healthcare operations). The first request in a 12-month period is free.
Request Restrictions. Ask that certain uses or disclosures be limited. We are not always required to agree, except where you’ve paid out of pocket in full and ask that we not disclose to a health plan.
Confidential Communications. Request that we contact you in a specific way or at a specific location.
Paper Copy. Request a paper copy of this Notice at any time.
Breach Notification. Be notified if a breach of your unsecured PHI occurs.
To exercise any of these rights, email Support@modivwallness.com.
Our Responsibilities
We are required to maintain the privacy of your PHI, provide this Notice, follow its terms, notify you if we cannot accommodate a requested restriction, maintain reasonable safeguards to protect your information, and accommodate reasonable requests for alternative communication.
Breach Notification
If a breach of your unsecured PHI occurs, you will be notified without unreasonable delay, and no later than sixty (60) days after discovery, describing what happened, what information was involved, and steps you can take to protect yourself.
Changes to This Notice
We may update this Notice from time to time. Material changes will be posted here with a new effective date, and we will notify you by email if we have one on file.
Contact and Complaints
Questions or complaints about this Notice, or about how your PHI has been handled, can be sent to Modiv Wellness:
Email: Support@modivwallness.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mail (200 Independence Avenue, S.W., Washington, D.C. 20201), by phone (1-877-696-6775), or online at hhs.gov.
We will not take any retaliatory action against you for filing a complaint.