We are committed to providing compassionate, respectful, and transparent patient advocacy. Our role is to help you navigate the healthcare system, coordinate care, and support informed decision-making within the limits of digital and telephonic services. Your participation in advocacy is always voluntary. If at any point you feel our services are no longer helpful or aligned with your needs, you may choose to pause or end services.
By working with our advocacy team, you agree to:
If these expectations are repeatedly not met, or if advocacy services are no longer effective or appropriate, services may be paused or discontinued. This decision is made thoughtfully and with the goal of directing you to care that better fits your needs.
Last Updated: November 1, 2025
Company: Amma Inc., a Delaware corporation ("Amma," "we," "us," or "our")
Contact: legal@withamma.co
By accessing or using Amma's website, platform, or related services (collectively, the "Services"), you agree to be bound by these Terms of Service ("Terms") and our Privacy Policy / HIPAA Notice. If you do not agree, you may not use the Services.
These Terms form a legally binding agreement between you and Amma.
Amma provides AI-assisted patient advocacy and care-navigation to help individuals and caregivers manage healthcare logistics, appointments, insurance, and administrative tasks.
Our Services are not medical care and do not provide diagnosis, treatment, or prescriptions. No advocate, AI output, or communication from Amma should be taken as medical advice. Always consult a qualified healthcare professional regarding any medical condition.
If you believe you are experiencing a medical emergency, call 911 immediately.
You must be 18 years or older to use our Services.
If you are using the Services on behalf of another adult (for example, an aging parent), you represent that you have appropriate authorization or legal authority to do so and will provide documentation if requested. Amma reserves the right to verify caregiver authorization before granting access or sharing information.
You may be required to create an account and provide accurate, complete, and current information.
You are responsible for:
You must not share your account except with authorized caregivers as permitted under Section 3.
Amma uses automated systems and artificial-intelligence tools to assist human advocates in generating educational, administrative, and navigation guidance.
AI-generated outputs are provided for informational purposes only and may occasionally contain inaccuracies. By using the Services, you acknowledge and accept automated processing as part of our operations.
Amma respects your privacy and complies with applicable U.S. health-information laws, including the Health Insurance Portability and Accountability Act (HIPAA) where applicable.
We act as a Business Associate when handling Protected Health Information (PHI) on behalf of covered entities and maintain appropriate safeguards.
Our Privacy Policy / HIPAA Notice describes how we collect, use, and disclose your information.
We may use de-identified or aggregated data to improve our AI systems, analytics, and quality of service. PHI is never used for AI training without explicit authorization.
Depending on the program, you may pay Amma directly or through third-party payers such as Medicare, insurers, or employer partners.
Amma may suspend or terminate access for unpaid balances or suspected misuse.
You agree NOT to:
Amma may suspend or terminate accounts violating this section.
All content, software, logos, trademarks, text, and graphics are owned or licensed by Amma Inc. and protected by intellectual-property laws. You are granted a limited, revocable, non-transferable license to access and use the Services for personal, non-commercial purposes. You may not copy, distribute, reverse-engineer, or create derivative works without prior written consent.
The Services may contain links or integrations with third-party sites (e.g., scheduling, payments, or teleconferencing tools). Amma does not control or endorse those third parties and is not responsible for their content, privacy practices, or services. Use them at your own discretion and subject to their own terms.
Amma may change, suspend, or discontinue any aspect of the Services at any time without notice. We strive for high uptime but do not guarantee uninterrupted access. We are not liable for delays or failures caused by events outside our control.
You may terminate your account at any time by notifying Amma at support@withamma.co.
We may terminate or suspend your account immediately if you breach these Terms, engage in misuse, or as required by law. Upon termination, rights granted to you under these Terms cease immediately.
THE SERVICES ARE PROVIDED "AS IS" AND "AS AVAILABLE."
TO THE MAXIMUM EXTENT PERMITTED BY LAW, AMMA DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT.
IN NO EVENT WILL AMMA OR ITS DIRECTORS, EMPLOYEES, OR AGENTS BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES, OR ANY LOSS OF PROFITS, DATA, OR GOODWILL, ARISING FROM YOUR USE OF THE SERVICES, EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
TOTAL LIABILITY WILL NOT EXCEED THE GREATER OF (1) AMOUNTS PAID BY YOU TO AMMA IN THE PAST SIX MONTHS OR (2) $100.
You agree to indemnify and hold harmless Amma Inc., its officers, employees, and agents from and against any claims, damages, liabilities, and expenses arising out of your use of the Services or violation of these Terms.
By providing contact information, you consent to receive emails, texts, calls, and notifications (including via automated systems) related to your account or Services.
You can opt out of non-essential messages by following provided instructions (e.g., replying STOP to texts). Electronic communications satisfy any legal requirement for written notice.
These Terms and any dispute arising from them are governed by the laws of the State of New York, without regard to conflicts of law.
Binding Arbitration: Except where prohibited by law, disputes will be resolved by confidential, binding arbitration under the American Arbitration Association rules in New York County, NY. You and Amma waive any right to a jury trial or to participate in a class or representative action. Either party may bring an individual claim in small-claims court instead of arbitration if within jurisdictional limits.
If you have questions about these Terms or our Services, please contact legal@withamma.co.
I agree to receive the non-clinical, AI-assisted advocacy and care-navigation services offered by Amma Inc. These services are designed to help me manage healthcare logistics, scheduling, insurance coordination, and related administrative support.
I understand that Amma's services do not include medical diagnosis, treatment, or prescriptions, and that I may refuse or discontinue use of the services at any time.
I authorize Amma Inc. to collect, use, and share my personal, insurance, and limited health-related information as necessary to provide the services I request.
This may include communicating with my healthcare providers, insurance companies, and authorized caregivers for coordination, billing, or navigation purposes.
I understand that:
Amma Inc. may bill me directly or submit claims to my insurer on my behalf for covered services.
I am responsible for any costs not covered by insurance.
I am responsible for the full cost of services if I do not have eligible insurance coverage or if a claim is denied.
If I have designated a caregiver, I authorize that individual to act on my behalf for care-navigation and communication through Amma's services.
I may update or revoke caregiver access at any time by contacting support@withamma.co.
I consent to participate in telehealth consultations or virtual coordination sessions through secure video, audio, or messaging technologies used by Amma Inc. or its partners.
I understand that:
Telehealth involves the electronic transmission of information and may include audio, video, or data exchanges.
Potential risks include interruptions, technical difficulties, or unauthorized access, though Amma uses safeguards to protect confidentiality.
Benefits include convenience, reduced travel, and timely access to support and coordination.
I may withdraw consent to telehealth at any time without affecting my ability to seek in-person care elsewhere.
I understand that:
To help us improve the quality of our services and train our care team, we may record telephone or video conversations with your consent. These recordings are used strictly for quality assurance, staff training, or documentation purposes and are handled in accordance with our privacy and security policies.
You may decline or request that recording be paused or stopped at any time.
Recordings are stored securely and deleted after the applicable retention period.
I understand that Amma Inc. does not provide emergency or clinical care.
If I believe I am experiencing a medical emergency, I will call 911 or go to the nearest emergency department immediately.
For mental-health crises, I can contact the 988 Suicide and Crisis Lifeline.
I agree that this digital version of the consent is valid and binding as if I had signed a paper copy.
Amma provides its services directly and may partner with Cloud Medical Group to bill insurance for such services.
I, hereby give my informed consent for medical treatment and procedures to be administered by the healthcare professionals at Cloud Health Medical Group, P.A., Cloud Health Medical Group of California, P.C., Cloud Health Medical Group of New Jersey, P.A. and Cloud Health Medical Group of Kansas, P.C. (collectively “Cloud Health Medical”). Cloud Health Medical provide remote monitoring services to patients (“RPM Services”) using remote monitoring technologies (“RPM Technology”). By agreeing to this informed consent (“Consent”), you have elected to receive RPM Services via telehealth from Cloud Health Medical. If you have questions about use of the RPM Technology itself and whether it is appropriate for your medical condition, the risks associated with using the RPM Technology, or the provider’s credentials and professional background, please ask your Cloud Health Medical provider. All capitalized terms used in this Consent but not defined herein will have the meanings provided in the Consent for Healthcare Services or Notice of Privacy Practices. Only use the Services if you have read this information and subsequently made an informed decision that the Services are right for you. If you have any questions, please email us at legal@usebridge.com.
I understand and acknowledge the following:
I understand that by signing this form, I am authorizing Cloud Health Medical and its healthcare providers to provide medical treatment, conduct diagnostic tests, and perform necessary procedures to diagnose and treat my medical condition.
I acknowledge that Cloud Health Medical may employ a variety of medical treatments, including but not limited to examinations, diagnostic tests, medical procedures, surgeries, administration of medication, and the use of medical devices. I understand that alternative treatments, risks, and potential complications will be discussed with me before any procedures are performed.
I understand and agree that:
THE RPM TECHNOLOGY IS NOT AN EMERGENCY RESPONSE UNIT. YOU MUST CALL 911 FOR IMMEDIATE MEDICAL EMERGENCIES
No warranty or guarantee has been made to me concerning any particular result related to my condition or diagnosis
I hereby consent to receive Chronic Care Management (“CCM”) services from Cloud Health Medical Group as defined by the Centers for Medicare & Medicaid Services (CMS) under CPT codes 99490, 99439, 99487, 99489, and 99491, and as recognized by my health insurance plan.
I understand that CCM services involve the ongoing management of my chronic medical conditions under the direction of my healthcare provider and may include:
I acknowledge and understand that:
I authorize Cloud Health Medical Group to bill Medicare and/or my private or commercial insurance for CCM services rendered. I agree to pay any patient-responsible amounts in accordance with my insurance benefits.
I understand that Cloud Health Medical Group and its clinical staff may use and disclose my protected health information (PHI) as necessary to provide, coordinate, and bill for CCM services in compliance with applicable HIPAA privacy and security regulations.
By signing below, I acknowledge that I have read and understand this consent form, that my participation is voluntary, and that I consent to receive and be billed for Chronic Care Management services as described above.
I hereby consent to receive Principal Illness Navigation ("PIN") and/or Community Health Integration ("CHI") services from Cloud Health Medical Group as defined by the Centers for Medicare & Medicaid Services (CMS) and as recognized by my health insurance plan.
I understand that PIN services are provided when I have been diagnosed with a single serious, high-risk disease that is the focus of a comprehensive care plan. PIN services may include:
I understand that CHI services are designed to address my health-related social needs (such as food insecurity, housing instability, or transportation barriers) and may include:
If I receive Community Health Integration (CHI) services, I understand and consent to the following:
(i) Non-Medical Service Providers: CHI services may involve referring me to and coordinating with community-based organizations that are NOT healthcare providers, including:
(ii) Information Sharing: To facilitate these referrals and ensure I receive needed services, Cloud Health Medical Group may need to share relevant health information with these organizations, including:
(iii) Privacy Limitations: These community organizations may NOT be covered by HIPAA and may have different privacy practices than healthcare providers. Cloud Health Medical Group will share only the minimum information necessary to connect me with services.
(iv) Right to Decline: I may decline any specific referral or information sharing with community organizations at any time without affecting my other medical care.
(v) Revocation: I may revoke this consent for CHI community information sharing by notifying Cloud Health Medical Group in writing or verbally, effective at the end of the calendar month.
(vi) Substance Use Disorder Treatment Information (42 CFR Part 2): If I am receiving treatment for substance use disorder, I understand that federal law (42 CFR Part 2) provides additional privacy protections for substance use disorder treatment records. For CHI services, if addressing my health-related social needs requires sharing information about my substance use disorder treatment with community organizations, I understand I may be asked to sign a separate consent form that meets 42 CFR Part 2 requirements before such information can be shared.
By signing below, I specifically authorize Cloud Health Medical Group to share my health information with community-based organizations as described above for the purpose of addressing my health-related social needs through CHI services.
I acknowledge and understand that:
Important: PIN services typically cannot be billed in the same month as Chronic Care Management (CCM) or certain other care management services. CHI services (CPT 99426/99427) may be billed with other services if the time and activities are separate and distinct. RPM services may be billed with CCM, PIN, or CHI if they involve different physiological data and separate time. Your provider will determine which combination of services is appropriate and billable for you each month.
I authorize Cloud Health Medical Group to bill Medicare and/or my private or commercial insurance for PIN and CHI services rendered. I agree to pay any patient-responsible amounts in accordance with my insurance benefits.
I understand that Cloud Health Medical Group and its clinical staff may use and disclose my protected health information (PHI) as necessary to provide, coordinate, and bill for PIN and CHI services in compliance with applicable HIPAA privacy and security regulations. For CHI services, this may include sharing relevant health-related social needs information with community-based organizations involved in addressing those needs.
By signing below, I acknowledge that I have been provided a copy of this consent, that I have read and understand this consent for PIN and CHI services, that my participation is voluntary, and that I consent to receive and be billed for these services as described above.
You may stop CCM, PIN, and/or CHI services at any time by:
Your request will take effect at the end of the calendar month in which we receive it. Stopping these services will NOT affect your ability to receive other medical care.
If you wish to restart services later, you will need to sign a new consent form.
Telehealth services involve interactive video conferencing equipment and devices that let my health care provider deliver health care services to me from a location that is different than my location. I confirm that I have read this form (or had it explained to me) and understand the following:
I understand that all medical treatments and procedures carry certain risks and potential benefits. While Cloud Health Medical will take necessary precautions to minimize risks, I acknowledge that no guarantees or assurances can be made regarding the outcome of any treatment or procedure.
I understand that use of the RPM Technology has risks associated with it, such as (1) information transmitted through the RPM Technology may be insufficient to allow for appropriate medical decision-making by Cloud Health Medical provider; (2) failures of equipment or infrastructure may cause delays in medical evaluation and treatment, or loss of information; and (3) unauthorized access to my medical information. I acknowledge that, although Cloud Health Medical and its RPM Technology vendor strive to prevent unauthorized access to information about me through encryption of information transmitted by the RPM Technology and other security measures, Cloud Health Medical and its vendor cannot guarantee that my use of the RPM Technology and the information will be private or secure, and I consent to this risk. I understand and consent to the risks associated with the use of the RPM Technology.
I acknowledge that Cloud Health Medical is committed to protecting the privacy and confidentiality of my personal health information in accordance with applicable laws and regulations. I authorize the collection, use, and disclosure of my health information for the purposes of treatment, payment, and healthcare operations.
I understand that I am financially responsible for all medical services rendered by Cloud Health Medical. I agree to pay all charges for services not covered by my insurance, including deductibles, co-pays, and any outstanding balances.
I can refuse or withdraw my consent for medical treatment at any time. I understand that this decision may have consequences and that I should discuss any concerns or questions with my healthcare provider.
I understand the importance of open and honest communication with my healthcare provider. I agree to provide accurate and complete information about my medical history, current medications, allergies, and other relevant details. I understand I should follow any post-treatment instructions and attend follow-up appointments as recommended.
I authorize Cloud Health Medical and its healthcare providers to make necessary medical decisions on my behalf if I cannot do so, based on their professional judgment and in accordance with applicable laws and regulations.
If you receive a prescription as a result of your use of the Services, you may choose to have your prescription fulfilled through the pharmacy of your choice. You give us consent to send and disclose to the pharmacy of your choice all information provided by you, health care records, and other applicable health care information and personal information (such as your name, location and demographic information) so that you may receive pharmacy services.
I have read and understood the contents of this Medical Consent Form, and I voluntarily consent to receive medical treatment and procedures from Cloud Health Medical.
The following consents apply to patients accessing Cloud Health Medical Group’s services for the purposes of participating in a telehealth consultation as required by the states listed below:
Alaska: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter. I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.
Arizona: I understand I am entitled to all existing confidentiality protections pursuant to A.R.S. § 12- 2292. I also understand all medical reports resulting from the RPM Services are part of my medical record as defined in A.R.S. § 12-2291. I also understand dissemination of any images or information identifiable to me for research or educational purposes shall not occur without my consent, unless authorized by state or federal law.
California: I understand that some or all of my CCM, PIN, and CHI services may be provided using telehealth technologies and may involve coordination with community-based organizations and social service agencies.
I consent to the sharing of my health information, including information about my social circumstances (such as housing, food security, and transportation needs), among Cloud Health Medical Group's affiliated entities, care team members, and community-based organizations for the purpose of coordinating my care and addressing my health-related social needs, consistent with the California Confidentiality of Medical Information Act (CMIA).
For CHI services, I understand that addressing my health-related social needs may require Cloud Health Medical Group to share relevant health information with non-medical community service providers (such as housing agencies, food banks, and transportation services). I consent to such disclosures when necessary to facilitate services that address my health-related social needs.
Colorado: I consent to the use of telehealth for my CCM, PIN, and CHI services. I understand that I will not be charged separately for the use of telehealth technology and that my privacy will be protected under Colorado law.
For CHI services, I consent to Cloud Health Medical Group sharing necessary health information with community service providers to address my health-related social needs.
Connecticut: I understand that my primary care provider may obtain a copy of my records, my RPM services and my telehealth encounter.
Florida: To view my rights under Florida’s Patient Bill of Rights and Responsibilities, I should visit the Florida Agency for Health Care Administration or click here. To view my rights under Florida’s Weight-Loss Consumer Bill of Rights, I should visit here.
I understand that my provider may not be physically located in Florida when telehealth CCM, PIN, or CHI services are provided. I consent to receive these services under Florida's Telehealth Practice Act.
For CHI services, I consent to coordination with community-based organizations to address health-related social needs affecting my health.
Georgia: I have been given clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the RPM Services.
Hawaii: I consent to the use of telehealth for CCM, PIN and CHI services as permitted by Hawaii law. I understand that my privacy will be protected under state and federal law and that I may withdraw consent at any time.
For CHI services, I consent to coordination with community organizations to address my health-related social needs.
Idaho: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.
Illinois: I understand that telehealth may be used for parts of my CCM, PIN, and CHI care. Participation is voluntary, and I may choose in-person visits when available.
For CHI services specifically, I understand that:
I consent to telehealth and community coordination consistent with Illinois law, including the Telehealth Act (225 ILCS 150).
Indiana: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.
Iowa: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.
Kansas: I understand that if I have a primary care provider or other treating physician, the person providing telemedicine, RPM, CCM, PIN, or CHI services must send a report to such primary care or other treating physician of the treatment and services rendered to me within three days of me providing consent to send such report.
Kentucky: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.
Maine: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; or, the Maine Board of Osteopathic Licensure’s website, here.
New Jersey: I understand I have the right to request a copy of my medical information and I understand my medical information may be forwarded directly to my primary care provider or health care provider of record, or upon my request, to other health care providers.
I understand that some of my CCM, PIN, and CHI services may be delivered using telehealth. I have been informed of my provider's identity, credentials, and location, and I consent to receive telehealth services consistent with New Jersey law.
For CHI services specifically, I consent to Cloud Health Medical Group coordinating with community-based organizations to address my health-related social needs. This may include sharing relevant health information with social service providers (such as housing agencies, food assistance programs, or transportation services) to facilitate access to resources that support my health.
New Hampshire: I understand that my primary care provider or treating provider may obtain a copy of my records of my telehealth encounter.
New York: I consent to receive telehealth services as part of my Chronic Care Management, Principal Illness Navigation, and Community Health Integration services.
I understand that CHI services may involve sharing health information with community-based organizations and social service providers to address my health-related social needs (such as food insecurity, housing instability, or transportation barriers). I consent to such information sharing when necessary to coordinate services that support my health.
I understand that all communications will be secure and that my information will remain confidential under New York law, including New York Public Health Law Article 27-F.
Ohio: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter.
Oklahoma: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; or, the Oklahoma Board of Osteopathic Examiners’ website, here.
Oregon: I consent to receive telehealth Chronic Care Management, Principal Illness Navigation, and Community Health Integration services under Oregon law.
For CHI services, I understand that:
I consent to information sharing necessary to connect me with community resources that address my health-related social needs.
Rhode Island: If I use e-mail or text-based technology to communicate with my Perry Health provider, then I understand the types of transmissions that will be permitted and the circumstances when alternate forms of communication should be utilized. I have also discussed security measures, such as encryption of data, password protected screen savers and data files, or utilization of other reliable authentication techniques, as well as potential risks to privacy. I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.
South Carolina: I understand that my medical records may be distributed only with my consent and in accordance with applicable laws and regulations to other treating health care practitioners.
South Dakota: I have received disclosures regarding the RPM Services RPM Technology and limitations.
Texas: I understand that with my consent, medical records related to my CCM, PIN, and CHI services may be sent to my primary care physician within 72 hours after receiving services.
I consent to the use of telecommunication technology, including telephone or electronic communications, as part of my Chronic Care Management, Principal Illness Navigation, and Community Health Integration services.
For CHI services, I understand that addressing my health-related social needs may require coordination with community organizations and social service providers. I consent to Cloud Health Medical Group sharing necessary health information with such organizations to facilitate services (such as housing assistance, food resources, or transportation support) that address my health-related social needs.
I understand that these services will comply with Texas Medical Board telemedicine standards and that I may decline telehealth at any time.
I have also been informed of the following notice:
NOTICE CONCERNING COMPLAINTS -Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit www.tmb.state.tx.us.
AVISO SOBRE LAS QUEJAS- Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.
Utah: I understand (i) any additional fees charged for RPM Services, if any, and how payment is to be made for those additional fees; (ii) to whom my health information may be disclosed and for what purpose, and have received information on any consent governing release of my patient-identifiable information to a third-party; (iii) my rights with respect to patient health information; (iv) appropriate uses and limitations of the RPM Technology, including emergency health situations. I understand that the RPM Services Cloud Health Medical provides meets industry security and privacy standards, and comply with all laws referenced in the Utah regulations. I was warned of: potential risks to privacy notwithstanding the security measures and that information may be lost due to technical failures, and agree to hold Provider harmless for such loss. I have been provided with the location of Cloud Health Medical’s website and contact information. I am able to a (i) access, supplement, and amend my patient-provided personal health information; and (ii) obtain upon request an electronic or hard copy of my medical record documenting the RPM Services, including the Consent provided; and (iii) request a transfer to another provider of my medical record documenting the telemedicine services.
For CHI services, I understand that addressing my health-related social needs may require sharing information with community-based organizations. I have been informed about (i) which types of organizations my information may be shared with; (ii) the purpose of such sharing; (iii) my rights regarding this information; and (iv) potential privacy limitations when information is shared with non-HIPAA covered entities.
Virginia: I acknowledge that I have received details on security measures taken with the use of RPM Technology, as well as potential risks to privacy notwithstanding such measures. I agree to hold harmless Cloud Health Medical for information lost due to technical failures; and I provide my express consent to forward patient-identifiable information to a third party.
I consent to the use of telemedicine for my CCM, PIN, and CHI services, consistent with Virginia law. I understand that telehealth services will be conducted securely and documented in my record.
For CHI services, I specifically consent to Cloud Health Medical Group sharing my patient-identifiable information with community-based organizations and social service providers when necessary to address my health-related social needs and coordinate access to community resources.
Vermont: I understand that I have the right to receive a consult with a distant-site provider and will receive one upon request immediately or within a reasonable time after the results of the initial consult. I understand that receiving telemedicine services via Found’s Platform does not preclude me from receiving real-time telemedicine or face-to-face services with the distant provider at a future date.
I have been informed that if I want to register a formal complaint about a provider, I should visit the Vermont Board of Medical Practice website, here or the Vermont Board of Osteopathic Examiners, here.
Washington: I consent to receive telemedicine as part of my Chronic Care Management, Principal Illness Navigation, and Community Health Integration services.
For CHI services, I understand that addressing my health-related social needs may require Cloud Health Medical Group to:
I consent to such information sharing and coordination when necessary to address my health-related social needs. I understand that this consent will be recorded in my medical record, and that all services will meet Washington privacy and security requirements.
Washington D.C.: I consent to receive telehealth services as part of my Chronic Care Management, Principal Illness Navigation, and Community Health Integration services.
I understand that my provider may not be located in the District of Columbia at the time of service, and that all telehealth interactions will comply with D.C. telemedicine standards.
For CHI services, I consent to coordination with community-based organizations to address my health-related social needs, which may involve sharing relevant health information with social service providers.
Amma provides its services directly and may partner with Cloud Medical Group to bill insurance for such services.
This notice describes how medical information about you (or the patient for whom you are a parent or authorized guardian) may be used and disclosed, and how you can get access to this information. Please review it carefully.
This notice describes BRDG, Inc.'s privacy practices and those of its affiliates, including Cloud Health Medical Group, P.A., Cloud Health Medical Group of Kansas, P.A., Cloud Health Medical Group of California, P.C., and Cloud Health Medical Group of New Jersey, their physicians, other healthcare practitioners, and other personnel (collectively, "Bridge," "we," or "us").
We understand that medical information about you and your health is personal and we are committed to protecting it. We create a record of the care and services you receive at Bridge. We need this record to provide you with quality care and to comply with certain legal requirements. This notice is required by law and applies to all records of your care generated by us.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
Note for Parents and Authorized Guardians: Where a parent or authorized guardian has signed consent on behalf of a patient, references to "you" throughout this notice apply to the patient. The parent or authorized guardian has the right to exercise the rights described herein on the patient's behalf to the extent permitted by applicable law.
The following categories describe different ways that we use and disclose medical information. For each category, we will explain what we mean. Not every use or disclosure in a category will be listed; however, all ways we are permitted to use and disclose information will fall within one of these categories.
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information to doctors, nurses, technicians, or other Bridge personnel involved in providing Bridge's services. For example, Bridge personnel may discuss your prescription with your doctor to ensure we dispense the appropriate drug.
We may use and disclose medical information to obtain payment for the services we provided to you. For example, we may need to give your health plan information about your appointment so your health plan will pay us.
We may use and disclose medical information about you for healthcare operations. These uses and disclosures are necessary to run Bridge and ensure that all patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information with information from other providers to identify where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and delivery without learning who the specific patients are.
We may also use and disclose your medical information to other providers when necessary for them to treat you or receive payment for services they have rendered to you. Additionally, we may disclose your medical information in order to resolve any complaints you may have.
We may use and disclose medical information to contact you as a reminder that you have an upcoming refill.
We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
We may use and disclose medical information to tell you about our health-related products or services that may be of interest to you.
We have the right to use medical information about you to contact you in an effort to encourage you to purchase or use a health care-related product or service from us. If we receive any direct or indirect payment for making such a communication, however, we would need your prior written permission to contact you. The only exceptions are when our communication (i) describes only a drug or medication currently being prescribed for you and our payment for the communication is reasonable in amount, or (ii) is made by one of our business partners consistent with our written agreement with them.
We may release medical information about you to a friend or family member who is involved in your medical care, provided we (a) obtain your consent, (b) provide you an opportunity to object and you do not object, or (c) can make a reasonable inference that you do not object. We may also give information to someone who helps pay for your care.
Unless there is a specific written request to the contrary, we may also tell your family or friends your condition and that you are a part of Bridge. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
Under certain circumstances, we may use and disclose medical information about you for research purposes. All research projects are subject to a special approval process. Before we use or disclose medical information for research, the project will have been approved through this process. We may, however, disclose medical information to people preparing to conduct a research project (for example, to help them look for patients with specific medical needs), so long as the medical information they review does not leave Bridge's possession. We will always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are.
We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
We will, in accordance with federal and state laws, obtain your written authorization to use or disclose your PHI for marketing purposes (e.g., to use your photo in ads), but not for activities that constitute treatment or healthcare operations.
We will obtain your written authorization prior to using your PHI or making any treatment or healthcare recommendations, should financial remuneration from a third party be involved. We must clarify that financial remuneration does not include in-kind payments or payments to implement a disease management program. Any promotional gifts of nominal value are not subject to the authorization requirement.
The only exclusion to this is "refill reminders," so long as the remuneration for making such a communication is reasonably related to our cost for making it. Permissible reimbursable costs include labor, supplies, and postage. "Generic equivalents," "adherence to take medication as directed," and "self-administered drug or delivery system communications" are all considered to be "refill reminders."
Face-to-face marketing communications, such as sharing a written product brochure or pamphlet, are permissible under current HIPAA law.
We may release medical information about you for workers' compensation or similar programs as required by state law. These programs provide benefits for work-related injuries or illness.
We may disclose medical information about you for public health activities, including:
We may disclose medical information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
We may disclose medical information about you in response to a court or administrative order, or in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to notify you about the request or to obtain an order protecting the information requested.
We may release medical information to authorized law enforcement officials as required by law or due to a court order, grand jury, or administrative subpoena.
We may release medical information to a coroner, medical examiner, or funeral director as required by law.
We may disclose medical information about you to U.S. government entities with special functions, such as the military or Department of State, under certain circumstances when required by law.
We may release your medical information when required by law not specifically referenced in the preceding categories.
If you would like us to share your Protected Health Information with anyone besides you, we will need you to complete and sign an Authorization for the Use/Disclosure of Health Information.
If you previously provided us with an Authorization and would like to revoke it, please complete and sign a Revocation of Authorization to Disclose Protected Health Information.
If you would like to request a copy of your medical records, please fill out and sign a Patient Request for Health Information.
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information. If your medical information is maintained in an electronic health record, you may obtain an electronic copy and, if you choose, instruct us to transmit such copy directly to an entity or person you designate in a clear, conspicuous, and specific manner.
To inspect and copy your medical information, you must submit your request in writing to Bridge's Privacy Officer at the address listed at the end of this notice. An authorization form must be completed. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request. Our fee for providing an electronic copy will not exceed our labor costs in responding to your request.
We may deny your request to inspect and copy in certain limited circumstances. If you are denied access, you may request that the denial be reviewed by another licensed health care professional chosen by Bridge. We will comply with the outcome of the review.
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend it. To request an amendment, you must submit your request in writing to Bridge's Privacy Officer, along with a reason supporting your request.
We will act on your request within 60 days (or 90 days if additional time is needed) and will inform you in writing as to whether the amendment will be made or denied. Even if we deny your request for amendment, you have the right to submit a written addendum of not more than 250 words regarding any item or statement in your record you believe is incomplete or incorrect.
You have the right to request an "accounting of disclosures" — a list of disclosures we made of medical information about you other than for treatment, payment, and healthcare operations, and subject to other exceptions permitted by law. To request this list, you must submit a written request to Bridge's Privacy Officer specifying a time period of no more than six years. We will respond within 60 days (or 90 days if needed). The first list within a 12-month period is free; additional lists may incur a charge.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations, or to someone involved in your care. We are not required to agree to your request, except where the disclosure is to a health plan for payment or healthcare operation purposes and the medical information relates solely to a healthcare item or service for which you have paid out-of-pocket in full.
To request restrictions, you must submit a written request to Bridge's Privacy Officer specifying (1) what information you want to limit, (2) whether you want to limit our use, disclosure, or both, and (3) to whom you want the limits to apply.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request to Bridge's Privacy Officer. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
You have the right to a paper copy of this notice at any time, even if you have agreed to receive it electronically. You may obtain a copy of this notice at our website or by contacting Bridge's Privacy Officer.
If you believe your privacy rights have been violated, you may file a complaint with Bridge or with the Office of Civil Rights, U.S. Department of Health and Human Services. To file a complaint with Bridge, contact Bridge's Privacy Officer at the address listed below. All complaints must be submitted in writing. We will not retaliate against you if you file a complaint with us or the Director.
Other uses and disclosures of medical information not covered by this notice or applicable law will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission in writing at any time. Revoking permission will stop any further use or disclosure for the purposes covered by your written authorization, except where we have already acted in reliance on your permission.
If you are a parent or authorized guardian who has signed this Notice or related consent forms on behalf of a patient online, your electronic acceptance of this Notice carries the same legal force and effect as a handwritten signature. By accepting this Notice electronically, you confirm that you have read and understood its contents, and that you are authorized to do so on the patient's behalf.
We reserve the right to change our privacy practices and to make any such change applicable to the protected health information we obtained about you before the change. If a change in our practices is material, we will revise this Notice to reflect the change. We will post a copy of the current notice on www.cloudhealthmedicalgroup.com. You may also obtain any new notice by contacting the Privacy Officer.
Address all correspondence in writing to Bridge's Privacy Officer at:
Privacy Officer legal@usebridge.com
Updated: February 2026
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I request and agree that any benefits due me for my treatment by all insurance companies or other third-party payers responsible for my care shall be paid or assigned to Cloud Health Medical. This includes any insurance company settlements related to my treatment. If my insurance company or other payer will not pay Cloud Health Medical directly for my care and treatment at Cloud Health Medical, I will immediately forward payments I receive to Cloud Health Medical.
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If you are a beneficiary of a government health program, you agree that neither you, your healthcare provider, the affiliated physician practices, nor any of the healthcare organization(s) or provider(s) with whom we partner to provide healthcare and pharmacy services to you will submit a claim for reimbursement to any federal or state healthcare program except Medicare Advantage plans for the costs of the services and products provided to you through the Services. Submission of claims to Medicare Advantage plans is expressly permitted. All other government program claims (e.g., Medicare Part B (FFS), Medicaid, Tricare, Veterans Affairs) are strictly prohibited.
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