Privacy Policy at AFC Urgent Care of Memphis, TN
AFC Urgent Care of Memphis, TN cares about our patients’ privacy
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.
AFC Urgent Care of Memphis is required by law to maintain
the privacy of your Protected Health Information (PHI). This Notice describes how we will treat your PHI and how
we may use and disclose your PHI to carry out treatment, payment or health care operations and for other
purposes that are permitted or required by law. We may share your health information for treatment, payment and
health operations as described in this Notice. This Notice also describes your rights to access and control your
PHI. PHI 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.
Uses and Disclosures of Protected Health Information: Your PHI may be used and disclosed by the
physician, our office staff and others outside of our offices 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 business, and any other use required by law. We may disclose PHI to family members, close friends or others
concerned with your care and treatment.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care
and any related services. This includes the coordination or management of your health care with a third party.
For example, your PHI may be provided to a physician to whom you have been referred or are receiving treatment
from to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your PHI will be used to obtain payment for your health care services. For example, we
may provide PHI to your insurance company to obtain authorization and payment for services rendered. We may
contact the Guarantor for your visit in order to obtain payment.
Healthcare Operations: We may use or disclose your PHI in order to support our business
activities. These activities include, but are not limited to business associates, quality assessment activities,
internal investigations, performance reviews, and training employees. In addition, we will use a sign-in sheet
at the registration desk where you will be asked to provide your name and insurance company. We may also call
you by name in the waiting room when the physician is ready to see you. We may use or disclose your PHI to
contact you to remind you of an appointment, to notify you of test results, to inform you of health-related
services that may be of interest to you, and to check on your treatment, progress, and satisfaction with our
services.
We may use or disclose your PHI in the following situations without your authorization: As required by Law, for
Public Health issues, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration
requirements, Legal proceedings, Law Enforcement, Coroners, Funeral Directors, Organ Donation, Preliminary
Research Identification, Research with an IRB waiver, Criminal Activity, Military Activity, to avert a serious
and imminent threat to a person or the public, National Security, to comply with Worker’s Compensation laws,
Inmates, Disaster Relief and other Required Uses and Disclosures. Under the law, we must make disclosures to you
and when required by the Secretary of the Department of Health and Human Services.
Other permitted and required uses and disclosures, such as for marketing or sale of your
PHI to third parties, will be made only with your authorization. Once given, you may withdraw authorization at
any time in writing delivered to the address given below.
You have the right to inspect and copy your protected health information. Under federal
law, you may not inspect or copy psychotherapy notes, information compiled in anticipation of, or use in, a
legal proceeding, and PHI that is otherwise prohibited.
You have the right to request a restriction of your protected health information. This
means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or
health care operations. Your request must be in writing, delivered to the address given below, and state the
specific restriction requested and to whom you want the restriction to apply. If you have paid for your services
in full and ask us not to disclose your visit to your insurance company, we will honor that request. We are not
required to agree to any other restriction that you may request and if we believe it is in your best interest to
permit use and disclosure of your PHI, it will not be restricted. You then have the right to use another
healthcare professional.
You have the right to receive confidential communications from us by alternative means
or at an alternative location by notifying us in writing, delivered to the address given below.
You have the right to obtain a paper copy of this notice from us, upon request to (901) 254-8040
You may have the right to ask us to amend your protected health information. If we deny
your written request for amendment, you have the right to deliver a statement of disagreement with us at the
address given below 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. Your request must be in writing, delivered to the address given below. We
are required to notify you if your unsecured PHI is involved in a reportable breach.
You may complain to us or to the Secretary of Health and Human Services if you believe
your privacy rights have been violated. Or, you may file a complaint with us by mail or by contacting David Kiger i.e. our Privacy Officer at the
following address or phone number: 5475 Poplar Ave. Suite 106
Memphis, TN 38119 We will not retaliate against you for filing a complaint.
We reserve the right to change the terms of this notice. Any change will apply to all
PHI that we maintain. We post our current policy at each location and on our website. All written requests must
be delivered to the Clinic Manager or mailed to HIPAA Privacy Officer.