Effective Date: October 2019
We, Urgent Care for Kids (DBA: Virtual Care for Families), respect patient confidentiality and only release personal health information about you in accordance with the State of Texas and federal law. We are required by law to maintain the privacy and security of your protected health information, and we are required to follow the duties and privacy practices described in this notice and provide you with a copy. This notice describes our policies related to the use of the records of your care and how you may get access to this information. Please review this policy carefully.
If you have any questions about this policy or your rights contact our privacy officer.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
In order to effectively provide care, there are times when we will need to share your personal health information with others beyond the urgent care practice for:
With your permission, we may use or disclose personal health information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside of the urgent care practice that we are consulting with or referring you to.
Information will be used to obtain payment for the treatment and services provided. This will include contacting your health insurance company for prior approval of planned treatment or for billing purposes. You understand that you are responsible for all fees incurred for services. Urgent Care for Kids will submit claims to your insurance for Primary and Secondary insurance coverage. We will prepare a statement of any out of pocket amounts you owe (eg: copayments, deductibles, non-covered services, etc.). Payment or arrangements for payments of such out of pocket amounts should be made within thirty (30) days of your receipt of a statement from Urgent Care for Kids. All delinquent payments will be handled in accordance with applicable laws and regulations.
Third-Party Testing Fees
The patient agrees to pay any fees assessed by third-party lab companies who may be contracted to process these tests.
We may use information about you to coordinate our business activities. This may include reviewing your care and training staff.
Information Disclosed Without Your Consent
Under state and federal law, information about you may be disclosed without your consent in the following circumstances:
Sufficient information may be shared to address the immediate emergency you are facing.
Follow Up Appointments/Care
We will be contacting you to remind you of future appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
As Required by Law
This would include situations where we have a subpoena, court order, or are mandated to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.
Coroners, Funeral Directors
We may disclose personal health information to a coroner or personal health examiner and funeral directors for the purposes of carrying out their duties.
We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations inspections and licensure. There also might be a need to share information with the Food and Drug Administration related to adverse events or product defects.
We are also required to share information if requested with the Department of Health and Human Services to determine our compliance with federal laws related to health care.
Criminal Activity or Danger to Others
If a crime is committed on our premises or against our personnel we may share information with law enforcement to apprehend the criminal. We also have the right to involve law enforcement and to warn any potential victims when we believe an immediate danger may exist to someone, or if we believe you present a danger to yourself.
PATIENT RIGHTS AND RESPONSIBILITIES
You have the following rights under state and federal law:
Copy of Record
You are entitled to inspect the personal health record we have generated about you. We may charge you a reasonable fee for copying and mailing your record.
Release of Records
You may consent, in writing, to release of your records to others, for any purpose you choose. This could include your attorney, employer, or others who you wish to have knowledge of your care. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization.
Restriction on Record
You may ask us not to use or disclose part of the personal health information. This request must be in writing. We are not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information.
You may request that we send information to another address or by alternative means. We will honor such request as long as it is reasonable and we are assured it is correct. We have a right to verify that the payment information you are providing is correct.
If you believe that something in your record is incorrect or incomplete, you may request we amend it. Your request should be made in writing. In certain cases, we may deny your request. If we deny your request for an amendment you have a right to file a statement you disagree with us. We will then file our response and your statement and our response will be added to your record.
Accounting for Disclosures
You may request a listing of any disclosures we have made related to your personal health information, except for information we used for treatment, payment, or health care operations purposes or that we shared with you or your family, or information that you gave us specific consent to release. It also excludes information we were required to release. We will notify you of the cost involved in preparing this list.
Notice of a Breach
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We will not use or disclose your PHI for marketing purposes or to sell your PHI, unless you have agreed to this use or disclosure or in limited circumstances where applicable law allows such uses or disclosures without your authorization. We will not use or share your information other than as described here unless you tell us we can in writing, and you may change your mind at any time.
Questions and Complaints
If you have any questions, or wish a copy of this policy or have any complaints you may contact us in writing for further Information, at 1701 River Sun, Suite 302, Fort Worth, TX 76107. You also may complain to the Secretary of Health and Human Services if you believe this practice has violated your privacy rights. We will not retaliate against you for filing a complaint.
Changes in Policy