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PrimeTime Urgent CareNotice of Privacy PracticesYour Information.Your Rights.Our Responsibilities.This notice describes how medical informationabout you may be used and disclosed andhow you can get access to this information.Please review it carefully.
Your RightsWhen it comes to your health information, you have certain rights.This section explains your rights and some of our responsibilities to help you.Get an electronicor paper copyof your medicalrecordYou can ask to see or get an electronic or paper copyof your medical record and other health informationwe have about you. Ask us how to do this.Ask us to correctyour medicalrecordYou can ask us to correct health information aboutyou that you think is incorrect or incomplete. Ask ushow to do this.We will provide a copy or a summary of your healthinformation, usually within 30 days of your request.We may charge a reasonable, cost-based fee.We may say “no” to your request, but we’ll tell youwhy in writing within 60 days.RequestconfidentialcommunicationsYou can ask us to contact you in a specific way (forexample, home or office phone) or to send mail to adifferent address.We will say “yes” to all reasonable requests.Ask us to limitwhat we useor shareYou can ask us not to use or share certain healthinformation for treatment, payment, or our operations.We are not required to agree to your request, andwe may say “no” if it would affect your care.If you pay for a service or health care item outof-pocket in full, you can ask us not to share thatinformation for the purpose of payment or ouroperations with your health insurer.We will say “yes” unless a law requires us to sharethat information.
Get a listof thosewith whomwe’ve sharedinformationYou can ask for a list (accounting) of the times we’veshared your health information for six years prior tothe date you ask, who we shared it with, and why.We will include all the disclosures except forthose about treatment, payment, and health careoperations, and certain other disclosures (such as anyyou asked us to make). We’ll provide one accounting ayear for free but will charge a reasonable, cost-basedGet a copy ofthis privacynoticeYou can ask for a paper copy of this notice at anytime, even if you have agreed to receive the noticeelectronically. We will provide you with a paper copypromptly.Choose someoneto act for youIf you have given someone medical power of attorneyor if someone is your legal guardian, that person canexercise your rights and make choices about yourhealth information.We will make sure the person has this authority andcan act for you before we take any action.File a complaintif you feel yourrights are violatedYou can complain if you feel we have violated yourrights by contacting us using the information on theback page.You can file a complaint with the U.S. Departmentof Health and Human Services Office for Civil Rightsvisiting www.hhs.gov/ocr/privacy/hipaa/complaints/.We will not retaliate against you for filing a complaint.
Your ChoicesFor certain health information, you can tell us your choices about whatwe share. If you have a clear preference for how we share your information inthe situations described below, talk to us. Tell us what you want us to do, andwe will follow your instructions.In these cases,you have both theright and choice totell us to:Share information with your family, close friends, orothers involved in your careShare information in a disaster relief situationInclude your information in a hospital directoryIf you are not able to tell us your preference, forexample if you are unconscious, we may go ahead andshare your information if we believe it is in your bestinterest. We may also share your information whenneeded to lessen a serious and imminent threat tohealth or safety.In these cases wenever share yourinformation unlessyou give us writtenpermission:Marketing purposesIn the case offundraising:We may contact you for fundraising efforts, but youcan tell us not to contact you again.Sale of your informationMost sharing of psychotherapy notes
Our Uses and DisclosuresHow do we typically use or share your health information?We typically use or share your health information in the following ways.Treat youWe can use your healthinformation and share itwith other professionalswho are treating you.Example: A doctortreating you for an injuryasks another doctorabout your overallhealth condition.Run ourorganizationWe can use and shareyour health information torun our practice, improveyour care, and contactyou when necessary.Example: We use healthinformation about you tomanage your treatmentand services.Bill for yourservicesWe can use and shareyour health informationto bill and get paymentfrom health plans orother entities.Example: We giveinformation aboutyou to your healthinsurance plan so it willpay for your services.continued on next page
Our Uses and DisclosuresHow else can we use or share your health information?We are allowed or required to share your information in other ways – usuallyin ways that contribute to the public good, such as public health and research.We have to meet many conditions in the law before we can share yourinformation for these purposes. For more information nsumers/index.html.Help with publichealth and safetyissuesWe can share health information about you forcertain situations such as:Preventing diseaseHelping with product recallsReporting adverse reactions to medicationsReporting suspected abuse, neglect, ordomestic violencePreventing or reducing a serious threat toanyone’s health or safetyDo researchWe can use or share your information for healthresearch.Comply withthe lawWe will share information about you if stateor federal laws require it, including with theDepartment of Health and Human Services if itwants to see that we’re complying with federalprivacy law.Respond toorgan and tissuedonation requestsWe can share health information about you withorgan procurement organizations.
Work with amedical examineror funeral directorWe can share health information with a coroner,medical examiner, or funeral director when anindividual dies.Address workers’compensation,law enforcement,and othergovernmentrequestsWe can use or share health informationabout you:For workers’ compensation claimsFor law enforcement purposes or with a lawenforcement officialWith health oversight agencies for activitiesauthorized by lawFor special government functions such asmilitary, national security, and presidentialprotective servicesRespond tolawsuits andlegal actionsWe can share health information about you inresponse to a court or administrative order, or inresponse to a subpoena.
Our ResponsibilitiesWe are required by law to maintain the privacy and security of yourprotected health information.We will let you know promptly if a breach occurs that may havecompromised the privacy or security of your information.We must follow the duties and privacy practices described in this noticeand give you a copy of it.We will not use or share your information other than as described hereunless you tell us we can in writing. If you tell us we can, you may changeyour mind at any time. Let us know in writing if you change your mind.For more information see: ers/noticepp.html.Changes to the Terms of This NoticeWe can change the terms of this notice, and the changes will apply to allinformation we have about you. The new notice will be available uponrequest, in our office, and on our web site.This Notice of Privacy Practices applies to the following organizations.PrimeTime Urgent CareWe also work alongside Prime Time Pediatrics, shareing electronicmedical records (EMR) software and records for the purpose of providingcomprehensive urgent/prompt care for the entire family.PrimeTime Urgent Care1618 Mars Hill Rd, Ste AWatkinsville, GA 30677706-705-4543primetimeurgentcare.comQuestions: EffectiveAugust 1st,20th,2020
PrimeTime Urgent Care We also work alongside Prime Time Pediatrics, shareing electronic medical records (EMR) software and records for the purpose of providing comprehensive urgent/prompt care for the entire family. PrimeTime Urgent Care 1618 Mars Hill Rd, Ste A Watkinsville, GA 30677 706-705-4543 primetimeurgentcare.com
