NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY OBTAIN ACCESS TO THIS INFORMATION. PLEASE READ THIS NOTICE CAREFULLY.
This notice is available in other languages and alternative formats that meet the guidelines for the Americans with Disabilities Act (ADA). Contact Ace Urgent Care at 301-220-2277 or via fax at 301-220-4464.
As your healthcare provider, Ace Urgent Care collects and maintains protected health information about you. Ace Urgent Care knows that the information we collect and maintain about you and your health is private. Ace Urgent Care is required to protect this information by federal and state law.
This Notice of Privacy Practices tells you how Ace Urgent Care may use or disclose your PHI. This Notice may not be all-inclusive of all situations. Ace Urgent Care is required to give you notice of our privacy practices for the information we collect and keep about you. Ace Urgent Care is also required to follow the terms of the Notice currently in effect.
Ace Urgent Care is required by law to maintain the privacy of your PHI, provide you with notice of our legal duties and privacy practices concerning PHI, and notify you if your PHI is affected in a breach of unsecured PHI.
When Ace Urgent Care May Use and Disclose Information Without Your Authorization
- For Treatment. Ace Urgent Care may use or disclose information with health care providers who are involved in your health care. This may include other health care providers (doctors, nurses, licensed practitioners). For example, information may be shared to create and carry out a plan for your treatment.
- For Payment. Ace Urgent Care may use or disclose information to obtain payment for the health care services you receive. For example, Ace Urgent Care may provide PHI with a bill received for health care services provided to you.
- For Health Care Operations. Ace Urgent Care may use or disclose information to manage its programs and activities. These uses and disclosures are necessary to run the medical practice and to make sure that patients receive quality care. For example, Ace Urgent Care may use PHI to review the quality of services you receive or to evaluate a provider’s performance.
- Other Disclosures for Health Care Operations. Ace Urgent Care may use or disclose PHI to your insurance carrier or plan as required, and for underwriting purposes;
- Appointments and Other Health Information. Ace Urgent Care may send you reminders for medical care checkups. Ace Urgent Care may send you information about health services that may be of interest to you. You have a right to place restrictions on these communications and request how these communications occur.
- For Public Health Activities. Ace Urgent Care may send PHI to the state or local public health agency that keeps and updates vital records, such as births and deaths, and tracks some diseases. We may disclose medical information to these agencies as required by law.
- For Health Oversight Activities. Ace Urgent Care may use or disclose information to inspect or investigate health care providers. We may disclose medical information to health oversight agencies for activities authorized by law.
- As Required by Law and For Law Enforcement. Ace Urgent Care may use and disclose information when required by federal or state law; by court order, subpoena, warrant, summons, administrative request, or similar process; or in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
- For Abuse Reports and Investigations. Ace Urgent Care may be required by law to receive and investigate reports of abuse (administrative, related to violations of regulation).
- For Government Programs. Ace Urgent Care may use and disclose information for public benefits under other government programs. For example, Ace Urgent Care may disclose information for the determination of Supplemental Security Income (SSI) benefits.
- To Avoid Harm. Ace Urgent Care may disclose PHI to law enforcement to avoid a serious threat to the health and safety of a person or the public.
- For Research. Ace Urgent Care may use some information for studies and develop reports. These reports do not identify specific patients. These types of disclosures may only occur without specific patient authorization when you (the patient) have previously agreed to participate in a research study and the report disclosures are included in participation agreements.
- Disclosures to Family, Friends, and Others Who Are Involved In Your Medical Care. Ace Urgent Care may disclose information to your family or other persons who are involved in your medical care. You have the right to object to the sharing of this information. Disclosures may only occur without authorization in instances of emergency or incapacity to effect treatment or care.
- Other Uses and Disclosures Require Your Written Authorization. For other situations, Ace Urgent Care will ask for your written authorization before using or disclosing information. You may cancel this authorization at any time in writing. Ace Urgent Care cannot take back any uses or disclosures already made with your authorization, however, disclosures made in conjunction with a valid authorization and prior to a written revocation cannot be withdrawn.
Your PHI Privacy Rights
You have the following rights regarding health information Ace Urgent Care maintains about you:
- Right to Inspect and Receive Copies of Your Records. In most cases, you have the right to inspect or receive copies of your records. You must request in writing. You may be charged a fee for the cost of copying your records. Ace Urgent Care may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.
- Right to Request a Correction or Update of Your Records. You may ask Ace Urgent Care to amend a piece of information you feel to be incorrect or add missing information to your records. You must request in writing, and provide a reason for your request. Ace Urgent Care may deny your request in certain limited circumstances.
- Right to Get a List of Disclosures. You have the right to ask Ace Urgent Care for a list of disclosures or access made within the last three years. You must make the request in writing. The list will not include information provided directly to you or your family, or information that was sent with your authorization.
- Right to Request Limits on Uses or Disclosures of PHI. You have the right to ask that Ace Urgent Care limit how your information is used or disclosed. You must make the request in writing to Ace Urgent Care and tell Ace Urgent Care what information you want to limit and to whom you want the limits to apply. Ace Urgent Care is not required to agree to the restriction unless the restriction is for disclosures to a health plan for carrying out payment or health care operations that are not otherwise required by law, and the PHI pertains solely to a health care item or service for which you personally, and not your plan, have paid in full. You can request that the restrictions be terminated in writing or verbally.
- Right to Revoke Permission. If you are asked to sign an authorization to use or disclose information, you can cancel that authorization at any time. You must make the request in writing to Ace Urgent Care. This will not affect information that has already been shared.
- Right to Choose How We Communicate with You. You have the right to request that Ace Urgent Care share information with you in a certain way or a certain place. For example, you may ask Ace Urgent Care to send information to your work address instead of your home address. You must make this request in writing. You do not have to explain the basis for your request.
- Right to File a Complaint. You have the right to file a complaint if you do not agree with how Ace Urgent Care has used or disclosed information about you or if you believe your privacy rights have been violated. You will not be penalized for filing a complaint. To file a complaint you may write to us at:
ACE URGENT CARE AND CLINIC, LLC
Attn: Olubayo Oldara-Fadare, M.D., Privacy Officer
7347 Hanover Parkway, Suite B
Greenbelt, MD 20770
You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services Office for Civil Rights.
- Right to Get a Paper Copy of this Notice. You have the right to ask for a paper copy of this notice at any time.
For More Information
If you have any questions about this notice or need more information, please contact the Ace Urgent Care Privacy Officer, Olubayo Oldara-Fadare, M.D., at 301-220-2277.
In the future, Ace Urgent Care may change its Notice of Privacy Practices. Any changes will apply to information Ace Urgent Care already has, as well as information Ace Urgent Care receives in the future. A copy of the new notice will be posted at Ace Urgent Care as required by law. You may also ask for a copy of the current Notice anytime you visit or contact Ace Urgent Care.