Policy Summary

In order to continue receiving services with your therapist, psychologist, or prescriber, you will need to sign and accept these updated policies. These include an updated Consent to Treat, and Consent to Telehealth, as well as updates to our payment policies and cancellation policies.

You can read the full text of our update terms and conditions in the next section, but here’s the straightforward version:

All clients must have a valid credit card or other payment method on file. Effective immediately, we will begin removing clients from their providers’ schedules if there is no valid payment method on file. You will not be able to schedule again until we have an updated method on file.
For those of you have an active balance on file, you must either pay the balance in full, or initiate a payment plan. Until clients do one of these two things, you will be unable to see your provider. We will remove clients from the schedule if they have a balance and are not actively involved in a payment plan.
You are entirely responsible for providing updated and accurate information on your insurance coverage. If your insurance denies our claim, we will always appeal it, but if they ultimately say the cost of care is your responsibility, you will be responsible for it. If you believe this is erroneous, and you provide us with updated information, we will bill them again.
In accordance with #3, if your insurer says your coverage is no longer active, you will become immediately responsible for all charges. We will charge the card on file for these services.
We must comply with billing a patient when an insurance company has told us that the cost is patient responsibility. If we do not do this, we are out of compliance with our contract with your insurer, and we cannot allow you to keep seeing your provider. This dollar amount is not dictated by Oria; it’s from your insurer. Conflicts, questions, or corrections should be directed to your insurer. You can find the way to contact them on the back of your insurance card.
Oria is a team of people helping people. Your providers’ careers are dedicated to serving you. Out of respect for their time, investment, and commitment to your overall wellbeing, all visits that are not cancelled before 24 hours of the appointment time — or prior to the last business day before your appointment (e.g. contact us by Friday for a Monday appointment) — will be charged $150 fee for the missed appointment. If you do not attend your session to receive care from your provider, we cannot bill your insurance, and so you will be entirely responsible for the fee of $150.
Just like you learn in therapy: boundaries are absolutely key to a healthy life. As such, we have to set this boundary: The team at Oria will enforce these policies without exception. Your provider does not have the authority to revert charges. If you truly feel you were unable to make your appointment due to extreme circumstances, you can email appeals@oria.zendesk.com Again, your provider cannot comment on financial activity, or on your communications with the above address. Please do not ask them to intervene.
The only exceptions to these policies will be for our clients with active coverage on a Medicaid health plan or those whose provider has agreed to pro-bono services.

Terms & Conditions
Oria, LLC and its jointly owned sister practice, Connell & Associates, LLC
Informed Consent For Telemedicine Medical Services

Introduction:
Please read this document thoroughly and completely. To better serve the needs of the community, especially in light of the 2020-2023 public health emergency, health care services are now available using telecommunications or information technology (“Telemedicine”). Telemedicine involves the use of real-time evaluation, diagnosis, consultation, and treatment of health conditions using interactive telecommunications technology, allowing the health care provider to see and communicate with you in real-time.

Consent for Treatment:
You have voluntarily requested that a health care provider of Oria and/or Connell & Associates participate in your medical care through the use of Telemedicine. In doing so, you understand, acknowledge and agree to the following:

a. The health care provider may practice in a location different than where you normally go to receive in-person medical care.

b. Unlike traditional medicine, the health care provider providing the Telemedicine services will not have the opportunity to meet with you face-to-face.

c. The health care provider providing the Telemedicine services must rely on the information you provide.

d. To the best of your ability, you agree to provide complete and accurate information concerning your medical history, condition, and care as may be requested by the health care provider.

e. You understand that if the health care provider feels that your medical needs cannot be adequately addressed using Telemedicine, you may be required to seek an in-person evaluation.

f. You understand you can stop your Telemedicine session at any time, but in the event that you arrive at an appointment and leave before a billable time period (15 minutes) has elapsed, the insurance company will not cover the appointment. Therefore, you will be charged the self-pay rate for the appointment.

g. You understand you can ask questions or seek clarifications of the Telemedicine procedures and technology at any time.

h. You understand that no guarantee of any specific result or cure is made by the health care provider rendering the Telemedicine services.

i. If you experience an emergency after the Telemedicine session, you should alert your primary treating physician and dial 911 or go to the nearest emergency department.

Risks:
You agree and acknowledge that there are potential risks associated with receiving medical care using Telemedicine:

a. The Telemedicine session may be interrupted or disconnected due to a technological problem or equipment failure.

b. There may be electronic tampering.

c. The advice provided by the health care provider may be based on factors not within his/her control, such as incomplete or inaccurate information provided by you or distortions of diagnostic images or specimens due to their electronic transmission.

Informed Consent
Consent to Treatment
By signing this document, you voluntarily agree to receive care, treatment, and/or services from Oria / Connell & Associates, including via telehealth consultations, and authorize Oria / Connell & Associates to provide such care, treatment, and/ or services as are considered necessary and advisable. Signing indicates that you understand and agree that you will participate in the planning of your care and treatment, and that you may stop such care, treatment, and/or services at any time. By signing, you acknowledge that you have both read and understood all the terms and information contained herein. If you would like to ask any questions or seek clariﬁcation before signing, please let us know.

Be Early. Don’t Be Late.

To ensure your appointment starts on time, please arrive 10 minutes prior to your appointment start time.

If you arrive 15 minutes past your appointment start time, you will be considered a No Show and you will not be seen. As a no show is not billable to insurance, you will be responsible for the self-pay rate for that session.

Insurance Information

We participate in most insurance plans. Please bring a current insurance card with you, or we may require you to pay in advance for the visit. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage. Our team will be happy to assist you and do what we can to help you secure benefits you expect from your insurer.

Proof of Insurance
All clients must complete our client intake and consent forms before seeing our providers. We must obtain a copy of your current valid insurance to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, all sessions will be self-pay and adhere to the self-pay fee structure outlined by Oria Health / Connell & Associates. Once we have this on file, our team will verify eligibility prior to every session.

Claims Submission
We will submit your claims to insurers for which we are in network. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Your insurance benefit is a contract between you and your insurance company; we are not part of that contract, and if they deny the service as a result of your failure to provide the proper information, you may be responsible for payment.

Coverage Changes
If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. In the event that the insurer does not make timely payment, we will encourage you to follow-up with the insurer.

Timely Payment
When not using insurance, full payment is made prior to receiving services. When you use insurance, if your insurer has not paid our group for services in the typical timeframe expected, future appointments for services may be postponed or discontinued at our sole discretion. If this happens, we will notify you and we will work with you to secure the benefits you pay for.

Patient Responsibility
All co-payments, co-insurance, and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. In the unusual event that a required co-payment, co-insurance, or deductible amount is not collected at the time of service, your signature on this policy provides your consent and authorization for us to charge the credit card we have on file for you in the amount of any required co-payment, co-insurance, or deductible that is required pursuant to the terms of your insurance policy. Such charges will typically be made within 24 hours of the time of service.

If we are unable to collect charges for any reason, you will be removed from the schedule until your balance is paid or a payment plan is put into place.

Non-Covered Services
Please be aware that some - and perhaps all - of the services you receive may be deemed non-covered by insurers. In some cases, we will be able to notify you at the same time of your visit that the services are not covered and you must pay for these services in full at the time of the visit. In some cases, we are unable to determine whether the services will be covered at the time of the visit. In those cases, we will submit a super bill to you after your visit if your insurer notifies us that the services were not covered. You will be personally financially responsible for payment of this bill, and by signing this policy, you agree that it is your responsibility to pay for these services and hereby authorize us to charge your credit card on file for these services.

Payment Plans
If you have an overdue balance, you will be able to set up a payment plan with our team. This will split your balance over 3 months. This payment plan will be in addition to any charges that are incurred based on appointments during that time period.

Nonpayment
Appointments will not be scheduled if you have an outstanding unpaid balance. Please be aware that if a balance remains unpaid, we will refer your account to a collection agency and you will remain unable to schedule appointments.

Payment Method and Balances
Clients of Oria / Connell & Associates must maintain a valid method of payment on file at all times. This includes a credit card or debit card bearing the Visa, MasterCard, American Express, or Discover logo. The only exceptions to this policy are Medicaid clients and those who are being seen pro-bono. When paying for products or services, you must use a credit card or debit card. For safety and security reasons, we do not accept cash or checks. This credit card will be charged for all patient responsibility including: copayments, self-pay fees, no show fees, late cancellation fees, and any outstanding balances after insurance payments have been applied. Connell & Associates and Oria Health will keep all credit card information secure and confidential on our HIPAA compliant Health Records System.

All outstanding balances not paid at the time of service will be automatically billed to your method of payment on file, and by signing this agreement, you give us authority to do so.

If we are unable to collect charges for any reason, you will be removed from the schedule until your balance is paid or a payment plan is put into place.

If the credit card we have on file changes, please notify the Oria / Connell & Associates team immediately with updated payment information.

Our CREDIT CARD ON FILE policy in no way will compromise your ability to dispute a charge or question your insurance company’s determination of payment.

Authorization Of Payment For Services & Communication Methods
I authorize Oria / Connell & Associates to charge my card on file for services rendered, as well as for late cancellations, no shows, or late arrivals.
I understand that unpaid balances that I personally owe to Oria / Connell & Associates will be turned over to a collection agency and acknowledge that appointments will not be provided if I have an unpaid balance outstanding.
I authorize the group to use SMS Text Messaging, Email, and Phone Calls to provide communication and appointment reminders.
I understand my provider works by Appointment only.
I hereby authorize Oria / Connell & Associates to furnish my insurance carrier with all information necessary to process any insurance claims for services and to act on my behalf if necessary.

Assignment of Benefits
I hereby authorize and assign providers associated with the group the right to receive reimbursement from my insurance carrier for payments associated with services rendered to me.
I understand that furnishing my email address authorizes the communication of potentially sensitive material via email. I understand that email may not be secure. I will not email my provider regarding emergencies, but instead, I will call 911 immediately.

Self-Pay
At Oria / Connell & Associates, the self-pay rates are as follows:

Individual Therapy Sessions:

Initial Session - $200

Follow Up Sessions - $150

Medication Management Sessions:

Initial Assessment - $350

Follow Up Sessions - $150

Psychological Evaluation - $850

Appointment Cancellation & No-Show Policy
Here at Oria / Connell & Associates, we value our providers’ time and your commitment to your mental health. When you schedule an appointment with Oria / Connell & Associates, we make intentional time to provide you with the best care possible. Should you need to cancel or reschedule an appointment, in order to avoid a late fee, you must use the Tebra Patient Portal or call the office no later than 24 hours prior to your scheduled appointment. Our goal is to be your active partner in your mental health journey, and our hope is that our no-show policy enforces how important that journey is.

Please refer to our Appointment Cancellation / No Show Policy below:

Effective May 1, 2023 any client who fails to attend a scheduled appointment will be charged the fee of $150. If you do not attend your session to receive care from your provider, we cannot bill your insurance, and so you will be entirely responsible for the $150 fee.
Effective May 1, 2023 In the case of a technological issue or an emergency that prohibits you from connecting with your provider, please contact the office on the day of the session to communicate with your provider. This is the only way to have a no show fee waived for a missed session.
This applies to all clients except those on traditional Medicaid / Medicaid Health Plans, and pro-bono clients.
In the event that a client arrives at an appointment and leaves before a billable time period has elapsed, the insurance company will not cover the appointment. Therefore, the client will be charged the self-pay rate for the appointment.
In the event that a client arrives at an appointment 15 mins after the scheduled time, the insurance company will not cover the appointment. Therefore, the client will be charged the self-pay rate for the appointment.
A new client who fails to show for their initial visit will be rescheduled and the client will be charged (not the insurance company). The $150 fee is due before the next scheduled session.
We are committed to keeping our clients engaged. We send out reminder emails & notifications for appointments to all of our clients. If you did not receive a reminder call or message, the above Policy will still remain in effect. If a client is not receiving any of these reminders, we invite them to contact Oria / Connell & Associates immediately so they can get their contact information updated appropriately.
Saturday, Sunday, or Monday Appointments:
If you have a Saturday, Sunday, or Monday Appointment, you must cancel by 4pm on Friday to avoid paying the Late Cancellation & Missed Appointment price.

We understand there may be times when an unforeseen emergency occurs and you are not able to keep your scheduled appointment. If you should experience extenuating circumstances, please call the office to discuss. We invite you to contact Oria / Connell & Associates anytime at 866-592-5888.

Relationship Termination
We understand that Oria / Connell & Associates is not a fit for everyone. We Interpret repeated late arrivals, late cancellations, or no shows as your desire to end the relationship with us. If this happens, we will contact you to confirm that you are no longer interested in continuing a relationship with our team, and will remove you from the schedule.

Notice of Privacy Practices
May 3, 2023

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) this notice describes how health information about you (as a patient of a Oria/Connell & Associates provider) may be used and disclosed and how you can get access to your health information.

PLEASE REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY:

Oria / Connell & Associates is dedicated to maintaining the privacy of your health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of protected health information that identifies you (“PHI”). We also are required by law to provide you with this Notice of our legal duties and the privacy practices that we maintain concerning your PHI.

We realize that these laws are complicated, but we must provide you with the following important information:

How we may use and disclose your PHI,
Your privacy rights in your PHI,
Our obligations concerning the use and disclosure of your PHI.
The terms of this Notice apply to all records containing your PHI that are created or retained by Oria/Connell & Associates. We reserve the right to revise or amend this Notice. Any revision or amendment to this Notice will be effective for all of your records that Oria/Connell & Associates has created or maintained in the past, and for any of your records that we may create or maintain in the future.

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Oria/Connell & Associates

3106 S. WS Young Drive Suite B-202

Killeen, TX 76542

866-592-5888

C. WE MAY USE AND DISCLOSE YOUR PHI IN THE FOLLOWING WAYS:

1. TREATMENT

Oria/Connell & Associates may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work for our Oria/Connell & Associates – including, but not limited to, our doctors and nurses – may use or disclose your PHI in order to treat you or to assist others in your treatment.

2. PAYMENT

Oria/Connell & Associates may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.

3. HEALTHCARE OPERATIONS

Oria/Connell & Associates may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, Oria/Connell & Associates may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for Oria/Connell & Associates. We may disclose your PHI to other health care providers and entities to assist in their health care operations.

4. APPOINTMENT REMINDERS

Oria/Connell & Associates may use and disclose your PHI to contact you and remind you of an appointment.

5. TREATMENT OPTIONS AND HEALTH-RELATED BENEFITS AND SERVICES

Oria/Connell & Associates may use and disclose your PHI to inform you of potential treatment options or alternatives. Oria/Connell & Associates may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.

6. INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE

When appropriate, we may share your PHI with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

7. DISCLOSURES REQUIRED BY LAW

Oria/Connell & Associates will use and disclose your PHI when we are required to do so by federal, state or local law.

8. PSYCHOTHERAPY NOTES

Psychotherapy notes have additional protections and, in certain cases, are subject to additional requirements and restrictions related to disclosures to you and third parties

D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES:

The following categories describe unique scenarios in which we may use or disclose your PHI:

1. PUBLIC HEALTH RISKS

Oria/Connell & Associates may disclose your PHI to public health authorities that are authorized by law to collect information, including:

Maintaining vital records, such as births and deaths,
Reporting child abuse or neglect,
Preventing or controlling disease, injury or disability,
Notifying a person regarding potential exposure to a communicable disease,
Notifying a person regarding a potential risk for spreading or contracting a disease or condition,
Reporting reactions to drugs or problems with products or devices,
Notifying individuals if a product or device they may be using has been recalled,
Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information,
Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2. HEALTH OVERSIGHT ACTIVITIES

Oria/Connell & Associates may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3. LAWSUITS AND SIMILAR PROCEEDINGS

Oria/Connell & Associates may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4. LAW ENFORCEMENT

We may release PHI if asked to do so by a law enforcement official:

Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement,
Concerning a death we believe has resulted from criminal conduct,
Regarding criminal conduct at our offices,
In response to a warrant, summons, court order, subpoena or similar legal process,
To identify/locate a suspect, material witness, fugitive or missing person,
In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

5. CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS

We may release Health Information to a coroner or medical examiner. We also may release Health Information to funeral directors as necessary for their duties.

6. RESEARCH

Under certain circumstances, we may use and disclose PHI for research. Before we use or disclose PHI for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of the PHI.

7. SERIOUS THREATS TO HEALTH OR SAFETY

Oria/Connell & Associates may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

8. MILITARY

Oria/Connell & Associates may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

9. NATIONAL SECURITY

Oria/Connell & Associates may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the president, other officials or foreign heads of state, or to conduct investigations.

10. INMATES

Oria/Connell & Associates may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary:

(a) for the institution to provide health care services to you

(b) for the safety and security of the institution, and/or

11. WORKERS’ COMPENSATION

Oria/Connell & Associates may release your PHI for workers’ compensation and similar programs.

E. YOUR RIGHTS REGARDING YOUR PHI:

YOU HAVE THE FOLLOWING RIGHTS REGARDING THE PHI THAT WE MAINTAIN ABOUT YOU:

1. CONFIDENTIAL COMMUNICATIONS

You have the right to request that Oria/Connell & Associates communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to appeals@oria.zendesk.com specifying the requested method of contact, or the location where you wish to be contacted. Oria/Connell & Associates will accommodate reasonable requests. You do not need to give a reason for your request.

REQUESTING RESTRICTIONS
You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose to someone involved in your care or the payment for your care, like a family member or friend.
To request a restriction, you must make your request, in writing, to Oria/Connell & Associates. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your PHI to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
A. OUT-OF-POCKET PAYMENTS

If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.

2. INSPECTION AND COPIES

You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, with limited exceptions.

To inspect and/or obtain a copy of your PHI, you must submit your request in writing to:

Oria/Connell & Associates

3106 S. WS Young Drive Suite B-202

Killeen, TX 76542

Oria/Connell & Associates may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Oria/Connell & Associates may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial.

A. RIGHT TO AN ELECTRONIC COPY

If your PHI is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

3. AMENDMENT

If you feel that PHI we have 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 or for our office.

To request an amendment, you must make your request, in writing to:

Appeals at Oria/Connell & Associates
3106 S. WS Young Drive Suite B-202
Killeen, TX 76542

-or-

appeals@oria.zendesk.com

A. ADDENDUM

All of our patients have the right to provide Oria/Connell & Associates with a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. Oria/Connell & Associates is obligated to attach the addendum to the patient’s records and will include the addendum if Oria/Connell & Associates makes a disclosure of the allegedly incomplete or incorrect portion of the patient’s records to any third party.

4. ACCOUNTING OF DISCLOSURES

You have the right to request a list of certain disclosures we made of your PHI for six years prior to the date of your request.

To request an accounting of disclosures, you must make your request, in writing, to:

Appeals at Oria/Connell & Associates

3106 S. WS Young Drive Suite B-202

Killeen, TX 76542

-or-

appeals@oria.zendesk.com

5. RIGHT TO NOTICE OF A BREACH

You have the right to be notified upon a Breach of any of your unsecured PHI.

6. RIGHT TO A PAPER COPY OF THIS NOTICE

You are entitled to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.

To obtain a paper copy of this Notice, contact:

Oria/Connell & Associates

3106 S. WS Young Drive Suite B-202

Killeen, TX 76542

866-592-5888

7. RIGHT TO FILE A COMPLAINT

If you believe your privacy rights have been violated, you may file a complaint with Oria/Connell & Associates or with the Secretary of the Department of Health and Human Services.

To file a complaint with Oria/Connell & Associates, contact:

Oria/Connell & Associates, Appeals

3106 S. WS Young Drive Suite B-202

Killeen, TX 76542
-or-

appeals@oria.zendesk.com

All complaints must be submitted in writing. You will not be penalized for filing a complaint.

9. RIGHT TO PROVIDE AN AUTHORIZATION FOR OTHER USES AND DISCLOSURES

Oria/Connell & Associates will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization.

THIS NOTICE APPLIES TO:

The Oria/Connell & Associates health care providers, which, together, make up the Oria/Connell & Associates affiliated covered entity (“Oria/Connell & Associates”).

Again, if you have any questions regarding this notice or our health information privacy policies, please contact Oria/Connell & Associates, 3106 S. WS Young Drive Suite B-202 Killeen, TX 76542 866-592-5888,appeals@oria.zendesk.com