Privacy Policy at AFC Urgent Care Seneca
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.
Bon Secours Urgent Care SC LLC 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 health care 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, even if you have previously
agreed to receive this notice electronically, upon request to the Clinic Manager or our Privacy
Officer
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 for six years prior to the date of your request. Your request must be
in writing, delivered to the address given below. The first accounting you receive in a 12-month
period will be free. We may charge you a reasonable, cost-based fee for responding to additional
requests in that same period.
Please note that a covered entity may not use or disclose protected health information for
fundraising purposes unless a statement is included in the notice of privacy practices
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 at the following
address: 975 Bypass 123 Seneca SC 29678 or by contacting site administrator / Privacy Officer
via BSMH Privacy phone number (888.302.9224). 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. I have reviewed the Notice of Privacy Practices and understand that I
may request a copy of the policy at any time.