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.

This Notice of Privacy Practices (“Notice”) is being provided to you as a requirement of a federal law, the Health Insurance Portability and Accountability Act (“HIPAA”). This Notice describes how we may use and disclose your protected health information (“PHI”) to carry out treatment, payment, or health care operations and for other purposes that are permitted and/or required by law. It also describes your rights to access and control your PHI in some cases. Under federal law, your PHI is protected and confidential. Your PHI means any written, electronic, or oral health information about you, that also includes demographic data that can be used to identify you. It includes information about your symptoms, diagnosis, test results, treatment, and any other related medical information. It also includes payment, billing, and insurance information. Your PHI is stored electronically and is subject to electronic disclosure.

I. Uses and Disclosures of Protected Health Information for Treatment, Payment, and Healthcare Operations

We will use and disclose your PHI for treatment, payment, and health care operations. Treatment involves providing and coordinating your care. For example, a health care provider, such as a physician, nurse, or other person providing health services will access your health information to understand your medical condition and history. Payment involves uses and disclosures to assist in obtaining payment for our services. For example, we may disclose your information to health plans or other payors to determine whether you are enrolled with the payor or eligible for health benefits, submit claims for payment, and provide information to entities that help us submit bills and collect amounts owed. Health care operations involve our standard internal operations, such as quality assurance activities, peer review, arranging for legal services, and training.

II. Other Uses and Disclosures

We may also use or disclose your PHI without your permission or authorization as follows:

A. When Legally Required. We will use and disclose your PHI when we are required to do so by any federal, state, or local law.

B. For Public Health Activities. We may use and disclose your PHI for public health activities, including disease prevention, injury, or disability; reporting births and deaths; reporting reactions to medications or product problems; notification of recalls; and infectious disease control.

C. To Report Suspected Abuse, Neglect or Domestic Violence. We may notify government authorities to report suspected abuse or neglect of a child or vulnerable adult, or suspected domestic violence. We will make this disclosure only when specifically required or authorized by law or when you agree to the disclosure.

D. To Conduct Health Oversight Activities. We may use and disclose your PHI for health oversight activities including audits; civil, administrative, or criminal investigations, proceedings, or actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate health oversight as authorized by law.

E. In Connection with Judicial and Administrative Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as authorized by such order. In certain circumstances, we may disclose your PHI in response to a subpoena or other discovery process if we receive satisfactory assurances that you have been notified of the request or that an effort was made to secure a protective order.

F. For Law Enforcement Purpose We may disclose your PHI to a law enforcement official for law enforcement purposes including: in response to a court order, subpoena or similar process; for the purpose of identifying or locating a suspect,  fugitive,  material  witness,  or missing person; in an emergency to report a crime; to a law enforcement official if we have a suspicion that your health condition was the result of criminal conduct; as required by law for reporting of certain types of wounds or other physical injuries; and under certain limited circumstances, when you are the victim of a crime.

G. To Coroners, Funeral Directors, and for Organ Donation. We may disclose PHI to a coroner or medical examiner for identification purposes, to determine cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. PHI may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.

H. For Research Purposes. We may use or disclose your PHI for research in limited circumstances such as when the use or disclosure for research has been approved by an institutional review board that has reviewed the research protocols to address the privacy of your PHI.

I. In the Event of a Serious Threat to Health or Safety. We may, consistent with applicable law and ethical standards of conduct, use or disclose your PHI if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

J. For Specified Government Functions. In certain circumstances, we may use or disclose your PHI to facilitate specified government functions relating to military and veterans activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.

K. For Workers’ Compensation. We may release your PHI to comply with workers’ compensation laws or similar programs.

L. To Business Associates. We may disclose your PHI to third parties known as “Business Associates” that perform various activities (e.g. legal services, delivery of goods) for us provided they agree to safeguard the information.

M. To Family Members and Others Involved in Your Care and Disaster Relief Agencies. Unless you object, we may disclose to your family members or others involved in your care or payment for your care, information relevant to their involvement in your care or payment for your care or information necessary to inform them of your location and condition. We may also disclose your PHI to disaster relief agencies so they may assist in notifying those involved in your care of your location and general condition.

N. Special Uses. We may use your information to contact you with appointment reminders by phone, email, or text messages. We may also use your information to contact you regarding treatment options or alternatives. Unless you object, we may disclose certain information about you including your name and confirmation of an appointment with our facility to people who ask for you by name.

III. Uses and Disclosures that You Authorize

Other than as stated above, we will not disclose your PHI other than with a written authorization from you or your personal representative. Subject to compliance with limited exceptions permitted under state or federal law, we will not use or disclose psychotherapy notes, or other sensitive PHI, use or disclose your health information for marketing purposes or sell your health information, unless you have signed an authorization. You may revoke an authorization by notifying us in writing, except to the extent we have taken action in reliance on the authorization.

IV. Your Rights

You have the rights listed below regarding your PHI. To exercise any of these rights, you must submit a written request to the Privacy Officer whose contact information is listed on the last page of this Notice.

A. Inspect and copy. Subject to limited exceptions, you may inspect and obtain a copy of your PHI. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with your request. If your information is stored electronically and you request an electronic copy, we will provide it to you in the format you request if it is readily producible in that format. If it is not readily producible in such format, we will provide you with a readable electronic copy in a format that you agree to.

B. Restrictions. You may ask us not to use or disclose your PHI for the purposes of treatment, payment, or health care operations. You may also request that we not disclose your health information to family members or friends who may be involved in your care or for notification purposes as described in this Notice. We are not required to agree to a restriction that you request except for requests to limit disclosures to your health plan for purposes of payment or health care operations when you have paid for the item or service covered by the request out-of-pocket and in full, make the request in writing, and when the uses or disclosures are not required by law or contractual agreement. If we do agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment.

C. Confidential communications. You have the right to request that we communicate with you through alternative means or locations. We will accommodate reasonable requests. We may place conditions on agreeing to a request, such as asking you for information as to how payment will be handled, or specification of an alternative address or other method of contact.

D. Amendments. You may request an amendment of your PHI if you believe such information is inaccurate or incomplete. An amendment request must be made in writing and provide a reason to support the requested amendment. In certain cases, we may deny your request for an amendment. 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. All requests will receive a response within 60 days.

E. Accounting of disclosures. You may request a list of instances where we have disclosed your PHI for certain types of disclosures. The accounting will not include disclosures that we are not required to record, such as disclosures made pursuant to an authorization or disclosures related to treatment, payment, or health care operations. The first accounting you request within a 12-month period is free, but we will charge a fee for any additional lists requested within the same 12-month period.

F. Paper Copy of this Notice. Upon request, we will provide a separate paper copy of this Notice even if you have already received a copy of the notice or have agreed to accept this Notice electronically. You may also obtain a copy of the current version of our Notice at our website, www.applecareurgentcare.com.

V. Our Duties

We are required by law to provide you with this Notice and to protect maintain the privacy of your PHI. We will be governed by this Notice for as long as it is in effect. We are also required to comply with any federal or state laws that impose stricter standards than those described in this Notice. We are required by law to notify affected individuals following a breach of unsecured PHI. We may change this Notice at any time, and these changes will be effective for the health information we have about you as well as any information we receive in the future. We will post a copy of the current Notice in the facility and on our website. You may also get a current copy by contacting our Privacy Officer at the address at the end of this Notice.

VI. Complaints

If you believe your privacy rights have been violated, you may file a complaint with the contact person listed below or with the Secretary of the United States Department of Health and Human Services.  You will not be penalized or retaliated against in any way for making a complaint.

VII. Contact Person

The contact person for all issues regarding patient privacy and your rights under the federal privacy standards is the Privacy Officer.  The contact information is as follows:

CRH Healthcare

ATTN: Privacy Officer

2675 Paces Ferry Road SE, Suite 200

Atlanta, GA 30339

The Privacy Officer can also be contacted by telephone at 678-993-0079.

VIII. Effective Date

This Notice was last revised May 13, 2024.