NOTICE OF PRIVACY PRACTICES
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.
Southlake Doctors Express, PA d/b/a AFC Urgent Care and SmitCo & Baxter Healthcare, LLC are required by law to maintain the privacy of your Protected Health Information (PHI). This Notice of Privacy Practices (the Notice) describes how we will treat your PHI and how we may use and disclose your PHI to carry out treatment, payment or healthcare operations and for other purposes that are permitted or required by law. We may share your health information for treatment, payment, and health operations as described in this Notice. This Notice also describes your rights to access and control your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services.
Uses and Disclosures of Protected Health Information: Your PHI may be used and disclosed by the physician, our office staff, and others outside of our offices who are involved in your care and treatment for the purpose of providing healthcare services to you, to pay your healthcare bills, to support the operation of the business, and for any other use required by law. We may disclose PHI to family members, close friends, or others concerned with your care and treatment.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party. For example, your PHI may be provided to a physician to whom you have been referred or are receiving treatment from to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your PHI will be used to obtain payment for your healthcare services. For example, we may provide PHI to your insurance company to obtain authorization and payment for services rendered. We may contact the guarantor for your visit in order to obtain payment if a third party has guaranteed payment.
Healthcare Operations: We may use or disclose your PHI in order to support our business activities. These activities include but are not limited to services performed by business associates, quality assessment activities, internal investigations, performance reviews, and employee training. We may call you by name in the waiting room when the physician is ready to see you. We may use or disclose your PHI to contact you to remind you of an appointment, to notify you of test results, to inform you of health-related services that may be of interest to you, and to check on your treatment, progress, and satisfaction with our services.
We may use or disclose your PHI without your authorization, when required or permitted by law in relation or response to public health issues, communicable diseases, health oversight, abuse or neglect cases, Food and Drug Administration requirements, legal proceedings, law-enforcement warrants, coroners, funeral directors, organ donation, preliminary research identification, research with an IRB waiver, military activity, to avert a serious and imminent threat to a person or the public, national security, to comply with workers’ compensation laws, treatment of inmates, disaster relief, and other legally required uses and disclosures. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services.
Other permitted and required uses and disclosures, such as for marketing or sale of your PHI to third parties, will be made only with your authorization. Once given, you may withdraw authorization at any time in writing delivered to the address given below.
You have the right to inspect and copy your PHI. Under federal law, you may not inspect or copy psychotherapy notes, information compiled in anticipation of, or use in, a legal proceeding, and PHI that is otherwise protected.
You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. Your request must be in writing, be delivered to the address given below, and state the specific restriction requested and to whom you want the restriction to apply. If you have paid for your services in full and ask us not to disclose your visit to your insurance company, we will honor that request. We are not required to agree to any other restriction that you may request, and if we believe it is in your best interest to permit use and disclosure of your PHI, it will not be restricted from lawful disclosure. You then have the right to use another healthcare professional.
You have the right to receive confidential communications from us by alternative means or at an alternative location by notifying us in writing, delivered to the address given below.
You have the right to obtain a paper copy of this notice from us, upon request to the Clinic Manager or our Privacy Officer.
You may have the right to ask us to amend your PHI. If we deny your written request for amendment, you have the right to deliver a statement of disagreement with us at the address given below, and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. Your request must be in writing and delivered to the address given below. We are required to notify you if your unsecured PHI is involved in a reportable breach.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. Or, you may file a complaint with us by writing to our HIPAA Privacy Officer, Justin M. Rains, J.D., at the following address: Attn: HIPAA Privacy Officer, AFC Urgent Care, 2315 E. Southlake Blvd., Ste. 110, Southlake, Texas 76092.
We will not retaliate against you for filing a complaint.
We reserve the right to change the terms of this Notice. Any change will apply to all PHI that we maintain. We post our current policy at each clinic location and on our website. All written requests must be delivered to the Clinic Manager or mailed to the above-identified HIPAA Privacy Officer.