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HIPAA Notice of Privacy Practices



We are required by law to maintain the privacy of protected health information and to provide individuals with this notice of our legal duties and privacy practices with respect to protected health information. 


This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your protected health information (or “PHI”) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected Health Information” 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 health care services. We are required to abide by the terms of this Notice, as currently in effect. We reserve the right to revise or change this Notice and to make any such change applicable to all PHI that we maintain (including PHI obtained before the change). If we change our Notice, we will provide a copy of the revised Notice to you or your representative upon request. You may also view the most current version of this Notice at any time at our website:


USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION: Your protected health information may be used and disclosed by your clinician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the health center, and any other use required by law. 

  • Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health agency that provides care to you. For example, your protected health information may be provided to a clinician to whom you have been referred to ensure that the clinician has the necessary information to diagnose or treat you. 

  • Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a certain procedure may require relevant protected health information be disclosed to the health plan to obtain approval for the procedure. 

  • Health Care Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our health center. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we  may disclose your protected health information to medical students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when we are ready to see you. We may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services we offer. 


We may use or disclose your protected health information in the following situations without authorization. Not every use or disclosure in a category will be listed. Your PHI may be stored in paper, electronic or other form and may be disclosed electronically and by other methods. 


  1. Public Health Activities. We report various diseases to government officials in charge of collecting that information. We provide coroners, medical examiners, and funeral directors necessary information relating to an individual’s death. 

  2. Health Oversight Activities. We provide information to assist the government when it conducts health oversight activities authorized by law, such as an investigation or inspection of health care providers or organizations. 

  3. To Avoid Harm. In order to avoid serious threat to the health and safety of a person or the public, we may provide PHI to law enforcement personnel or other persons to prevent or lessen such harm. 

  4. Specific Government Functions. We may disclose PHI of military personnel and veterans for specialized government functions in certain situations. We may disclose PHI in certain circumstances for inmates in custody. We may disclose PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We may also disclose PHI to an authorized federal official so they may provide protection to the President, other authorized persons, and foreign heads of state or to conduct special investigations. 

  5. Required By Law. We may use and disclose PHI about you as required by law. For example, we may disclose PHI about you to the US Department of Health and Human Services if it requests such information to determine that we are complying with federal privacy law. 

  6. Business Associates. We may disclose PHI to individuals and entities (“business associates”) that perform various functions on our behalf (such as our billing company) and that agree to safeguard all PHI that they create or receive on our behalf. 

  7. Law Enforcement. We may disclose PHI to law enforcement officials under certain circumstances such as responding to a subpoena or warrant or reporting wounds or injury required by law. 

  8. Judicial and Administrative Proceedings. We may disclose PHI as authorized by court order, subpoena or discovery request. 

  9. Worker’s Compensation. We may disclose PHI as necessary to comply with laws relating to workers’ compensation or similar programs. 

  10. Reporting of Abuse, Neglect, or Domestic Violence. We may disclose PHI to the appropriate government authorities if we believe abuse of a child or adult has occurred. 

  11. Health Information Exchanges. We may participate in one or more Health Information Exchanges (“HIEs”) and may electronically share your PHI for treatment, payment, health care operations and other permitted purposes with other participants in the HIE. HIEs allow your health care providers to efficiently access and use your PHI as necessary for treatment and other lawful purposes. 

  12. Organ and Tissue Donation. If you are an organ donor, we may release PHI to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. 

  13. Individuals Involved In Your Care or Payment For Your Care. We may disclose PHI about you to a friend or family member who is involved in, or helps pay for, your care or to assist in disaster relief efforts to notify your family about your condition, status and location. If you do not want us to share information with your family or others involved in your care, please contact Bonnie Butler, Privacy Officer. 

Authorization for other uses and disclosures of PHI: Other than as stated above, we will not use or disclose your PHI without your written authorization. For example, we may not disclose psychotherapy notes, use or disclose your PHI for marketing, or sell your PHI without your authorization. You may revoke an authorization, at any time, in writing, except to the extent that your clinician or QuickVisit Urgent Care has taken an action in reliance on the use of disclosure indicated in the authorization. 


YOUR RIGHTS: The following is a statement of your rights with respect to your protected health information. If you have given another individual a medical power of attorney, if another individual is appointed as your legal guardian or if another individual is authorized by law to make health care decisions for you (known as a “personal representative”), that individual may exercise any of the following rights listed below. 


You have the right to inspect and copy your protected health information. You may also direct us to send a copy of your PHI to another person designated by you in writing. In most cases, we will provide this access to you or the person you designate within 30 days of your request However, under federal law you may not inspect copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. If you request copies of your PHI, we can charge a reasonable, cost-based fee for labor, supplies, and/or postage consistent with applicable laws. Instead of providing the PHI you requested we may provide you with a summary or explanation of PHI. You may request that your PHI be sent to you electronically. 


You have the right to request a restriction of your protected health information. You may request that any part of your protected health information not be disclosed for treatment, payment or health care operations. For example, you may request to restrict disclosures to family members who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your written request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to your request for restrictions, except we must agree to a request to restrict certain PHI from disclosure to your health plan for services that you pay for out-of-pocket in full, unless the disclosure is otherwise required by law. 


You have the right to request to receive confidential communications from us by alternative means. You must provide information regarding alternate means to us in writing. 


You have the right to request that your clinician amend your protected health information. If you believe that there is a mistake in your PHI or that a piece of information is missing, you have the right to request that we correct the existing information or add the missing information. If we deny your request for amendment, you have the right to file a statement of disagreement with us 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 protected health information. You have the right to get a list of instances in which we have disclosed your PHI within the prior six (6) years. The list will not include disclosures that do not require your authorization, as listed above in this Notice or disclosures directly to you or certain other permitted disclosures. 


You have the right to be notified of a breach of privacy involving your PHI. We are required by law to notify you if the privacy of your PHI has been breached. 


You have the right to a paper copy of this Notice. You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will provide you with a paper copy promptly. 


COMPLAINTS: You may complain to us and to the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint. If you wish to file a complaint with us, please send a written complaint to the contact information listed below. 


CONTACT PERSON: If you have any questions or comments about our privacy practices, or you wish to exercise any of your rights as described in this Notice, you may contact Jessica Columbia, Privacy Officer at the address listed below: 


1600 US Hwy 79 S 

Henderson, TX 75654 



EFFECTIVE DATE: The effective date of this Notice is April 25, 2020. 


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