THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
1. Uses & Disclosures: Quickcare.me is permitted by law to disclose the minimum necessary personal health information of each patient to carry out treatment, payment and healthcare operations. Treatment disclosures may be made to physicians and other healthcare providers as necessary to proceed with the appropriate treatment and care of patients. Personal health information may be disclosed to the government or other third party payers (insurance) for the purpose of obtaining payment for services provided. Personal health information may be disclosed to carry out the daily operations such as scheduling appointments reminders, quality reviews, audits , healthcare oversight responsibilities, accounting and legal services. Use and disclosure of protected health information will be according to law and what is permitted and may include public health activities.
2. Required Authorizations: Quickcare.me will no disclose any patient’s personal health information for a purpose aside from payment, treatment and healthcare operations and what is required and permitted by law without the patient’s authorized consent to such disclosure. Upon request for such authorization, the patient shall have the right to refuse and /or revoke any disclosure of patient’s personal health information. The national privacy law permits disclosing personal health information to a parent or guardian; however, this information is protected for family planning services of minors, and will not be disclosed without an authorization from the patient.
3. Privacy Compliance: In accordance with the privacy regulations under the Health Insurance. And Accountability Act (HIPPA), 45 GFR Parts 160 & 164 (The “Privacy Regulations”), Quickcare.me had adopted a privacy policies regarding the use and disclosure of patient’s personal health information. Quickcare.me is committed to comply with the Privacy Regulations and all other laws and regulations regarding patient’s right to privacy.
4. Patient’s Rights: Patients have the right to access their medical record, to request amendments and an accounting of disclosures. Quickcare.me may deny the request under certain circumstances, for example, if it is determined that the information is not accurate and complete. Patients have the right to issue complaints regarding privacy rights, or if they believe their privacy rights have been violated. Complaints may be issued in writing and can be presented to Quickcare.me or the Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint.
A copy of the current Notice will be posted online and is always available for inspection by request. I am aware that a copy of the Notice of Privacy Practices is available to me upon request. I understand and agree with the terms of the Privacy Practices.
Please sign stating you agree: