PREMIER URGENT CARE
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND
HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have questions about this Notice, please contact our Privacy Officer, Chad Bush.
This Notice of Privacy Practices explains how PUC may use and disclose your protected health information (PHI) to
provide treatment, obtain payment, conduct health care operations, and for other purposes permitted or required by
law. It also explains your rights regarding your PHI.
Protected health information means information about you, including demographic information, that identifies you or
could reasonably identify you and relates to your past, present, or future physical or mental health or condition, or
related health care services.
PUC is required to follow the terms of this Notice while it is in effect. PUC reserves the right to change this Notice. Any
revised Notice will apply to PHI PUC already maintains, as permitted by applicable law. Upon request, PUC will
provide you with a copy of the revised Notice. You may request a copy by contacting the office or Privacy Officer.
1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
PUC may use and disclose your PHI as permitted or required by law. The following are examples of common uses and disclosures. These examples are illustrative and are not intended to be exhaustive.
Treatment: PUC may use and disclose your PHI to provide, coordinate, or manage your health care and related services. This may include sharing information with other physicians, specialists, laboratories, home health agencies, or other health care providers involved in your care when necessary for diagnosis, treatment, or coordination of care.
Payment: PUC may use and disclose your PHI as necessary to obtain or facilitate payment for health care services. This may include disclosures tohealth plans or insurers for eligibility or coverage determinations, medical-necessity reviews, utilization review, claims processing, and obtaining authorization for services.
Health Care Operations: PUC may use or disclose your PHI as necessary to support its health care operations, including quality assessment and improvement activities, employee and student training, licensing, credentialing, auditing, compliance activities, and other business and administrative functions permitted by law.
Business Associates: PUC may disclose PHI to business associates that perform services on PUC’s behalf, such as billing, transcription, information technology, or other administrative services. When required by law, PUC will maintain appropriate written agreements requiring business associates to safeguard PHI.
Treatment Alternatives and Health-Related Services: PUC may use or disclose PHI to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. You may contact the Privacy Officer to request that certain communications not be sent to you.
Fundraising: To the extent permitted by law, PUC may use limited information, such as demographic information and dates of service, to contact you regarding fundraising activities. You may opt out of fundraising communications by contacting the Privacy Officer.
2. OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES
PUC may use or disclose PHI without your written authorization when permitted or required by applicable federal or state law. Depending on the circumstances, these disclosures may include:
Required by Law: PUC may use or disclose PHI to the extent required by law, provided the use or disclosure complies with applicable legal requirements and is limited to the information required.
Public Health: PUC may disclose PHI to public health authorities for activities authorized by law, such as preventing or controlling disease, injury, or disability.
Communicable Diseases: PUC may disclose PHI when authorized by law to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
Health Oversight: PUC may disclose PHI to health oversight agencies for legally authorized activities, including audits, investigations, inspections, and oversight of health care systems or government benefit programs.
Abuse, Neglect, or Domestic Violence: PUC may disclose PHI when authorized or required by law to report suspected abuse, neglect, or domestic violence to an appropriate governmental authority.
Food and Drug Administration: PUC may disclose PHI to the Food and Drug Administration or other authorized persons or entities for purposes permitted by law, including reporting adverse events, product defects, recalls, repairs, replacements, and post-market surveillance.
Legal Proceedings: PUC may disclose PHI in the course of a judicial or administrative proceeding when authorized by applicable law, including in response to a court or administrative tribunal order or, when applicable, a subpoena, discovery request, or other lawful process that satisfies the requirements of federal and state law.
Law Enforcement: PUC may disclose PHI for law-enforcement purposes when applicable legal requirements are satisfied, including disclosures authorized by legal process or otherwise permitted by law.
Coroners, Medical Examiners, and Funeral Directors: PUC may disclose PHI to coroners, medical examiners, and funeral directors as authorized by law, including for identification, determining cause of death, or carrying out legally authorized duties.
Organ, Eye, and Tissue Donation: PUC may use or disclose PHI for cadaveric organ, eye, or tissue donation purposes as authorized by law.
Research: PUC may disclose PHI for research when the disclosure is authorized by applicable law and required privacy protections are in place, including applicable institutional review board or privacy-board requirements.
Criminal Activity: PUC may disclose PHI when permitted by law to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, or for other legally authorized law-enforcement purposes.
Military and National Security: When applicable legal conditions are satisfied, PUC may use or disclose PHI for certain military, veterans’ benefits, national security, intelligence, and protective-service activities authorized by law.
Workers’ Compensation: PUC may disclose PHI as authorized or required to comply with workers’ compensation laws and other legally established programs.
Inmates: PUC may use or disclose PHI as authorized by law when you are an inmate of a correctional facility and the PHI was created or received in the course of providing care to you.
SPECIAL PROTECTION FOR SUBSTANCE USE DISORDER RECORDS
To the extent that PUC creates, receives, or maintains substance use disorder (SUD) patient records subject to 42 CFR Part 2, those records, or testimony describing their contents, will not be used or disclosed in a civil, criminal, administrative, or legislative investigation or proceeding against you unless you provide written consent or the use or disclosure is authorized by a court order entered after you and the holder of the records receive notice and an opportunity to be heard.
A court order authorizing the use or disclosure of Part 2 records must be accompanied by a subpoena or other legal requirement compelling disclosure, as applicable under Part 2. Part 2 records may also be subject to additional limitations that provide greater protection than HIPAA. PUC will comply with the applicable law that provides the greater protection, to the extent required by law.
These protections apply only to records that are subject to 42 CFR Part 2. Other federal or state privacy laws may impose additional requirements or protections.
3. USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your PHI will be made only with your written authorization unless otherwise permitted or required by law. You may revoke an authorization in writing at any time, except to the extent PUC or others have already relied on the authorization. Certain uses and disclosures, including those for purposes specified by applicable law, may require a separate authorization.
4. USES AND DISCLOSURES FOR WHICH YOU MAY AGREE OR OBJECT
PUC may use and disclose certain PHI when you have an opportunity to agree or object. If you are not present or are unable to agree or object, PUC may use professional judgment to determine whether the disclosure is in your best interest, as permitted by law.
Persons Involved in Your Care or Payment: Unless you object, PUC may disclose PHI that is directly relevant to another person’s involvement in your health care or payment for your care to a family member, relative, close friend, or another person you identify. PUC may also disclose PHI as necessary to notify or assist in notifying a family member, personal representative, or another person responsible for your care about your location, general condition, or death, when permitted by law.
Disaster Relief: PUC may disclose PHI to an authorized public or private entity assisting with disaster-relief efforts when permitted by law.
5. YOUR RIGHTS
Right to Inspect and Copy: You have the right to inspect and obtain a copy of PHI about you that PUC maintains, subject to applicable federal and state law. PUC may charge a reasonable fee where permitted by law. Certain records, such as psychotherapy notes and information compiled in reasonable anticipation of a legal proceeding, may be excluded or subject to special access rules.
Right to Request Restrictions: You may request restrictions on PUC’s use or disclosure of your PHI for treatment, payment, or health care operations, or on disclosures to persons involved in your care. Your request should identify the information to be restricted and the persons or uses to which the restriction should apply. PUC is not required to agree to every requested restriction, except where applicable law requires otherwise.
Right to Request Confidential Communications: You may request that PUC communicate with you about your health care by alternative means or at an alternative location. PUC will accommodate reasonable requests as required by law and may ask for information about how payment will be handled or where communications should be directed. You do not have to provide a reason for the request.
Right to Request an Amendment: You may request an amendment to PHI that PUC maintains about you in a designated record set, subject to applicable law. In certain circumstances, PUC may deny the request. If a request is denied, you may have the right to submit a statement of disagreement.
Right to an Accounting of Disclosures: You may have the right to receive an accounting of certain disclosures of your PHI, subject to applicable federal and state law and its exceptions, limitations, and implementation requirements.
Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically.
6. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with PUC or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
To file a complaint with PUC or to obtain additional information about this Notice or the complaint process, contact:
| Privacy Officer | Chad Bush |
| Telephone | (281) 886-8964 |
7. EFFECTIVE DATE AND GENERAL NOTICE
This revised draft is based on the supplied Notice of Privacy Practices and incorporates the requested substance use disorder record protections. The supplied notice states that it was reviewed on October 20, 2016. Before adoption or distribution, PUC should have the final Notice reviewed for applicable federal and state law, including any state privacy requirements that may provide greater protection.
This document is not legal advice. Federal and state privacy requirements may change, and PUC should update this Notice as required by applicable law.