Watkinsville Urgent Care
Notice of Privacy Practices
Your Information.
Your Rights.
Our Responsibilities.
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.
Your Rights
When it comes to your health information, you have certain rights.This section explains your rights
and some of our responsibilities to help you.
• Get an electronic or paper copy of your medical record. You can ask to see or get an
electronic or paper copy of your medical record and other health information we have about
you. Ask us how to do this. We will provide a copy or a summary of your health information,
usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• Ask us to correct your medical record. You can ask us to correct health information about
you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your
request, but we’ll tell you why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way
(for example, home or office phone) or to send mail to a different address. We will say “yes”
to all reasonable requests.
• Ask us to limit what we use or share. You can ask us not to use or share certain health
information for treatment, payment, or our operations. We are not required to agree to your
request, and we may say “no” if it would affect your care. If you pay for a service or health
care item out-of-pocket in full, you can ask us not to share that information for the purpose
of payment or our operations with your health insurer. We will say “yes” unless a law
requires us to share that information.
• Get a list of those with whom we’ve shared information. You can ask for a list
(accounting) of the times we’ve shared your health information for six years prior to the date
you ask, who we shared it with, and why. We will include all the disclosures except for those
about treatment, payment, and health care operations, and certain other disclosures (such
as any you asked us to make). We’ll provide one accounting a year for free but will charge a
reasonable, cost-based fee if you ask for another one within 12 months.
• Get a copy of this privacy notice. You can ask for a paper copy of this notice at any time,
even if you have agreed to receive the notice electronically. We will provide you with a paper
copy promptly.
• Choose someone to act for you. If you have given someone medical power of attorney or if
someone is your legal guardian, that person can exercise your rights and make choicesabout your health information. We will make sure the person has this authority and can act
for you before we take any action.
• File a complaint if you feel your rights are violated. You can complain if you feel we have
violated your rights by contacting us using the information on the back page. You can file a
complaint with the U.S. Department of Health and Human Services OOice for Civil Rights by
sending a letter to 200 Independence Avenue, S.W., Washington, D.c. 20201, calling 1-877-
696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate
against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear
preference for how we share your information in the situations described below, talk to us. Tell us
what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to
tell us to:
• Share nformation with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead
and share your information if we believe it is in your best interest. We may also share your
information when needed to lessen a serious and imminent threat to health or safety.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
• Treat you. We can use your health information and share it with other professionals who are
treating you. Example: A doctor treating you for an injury asks another doctor about your
overall health condition.
• Run our organization. We can use and share your health information to run our practice,
improve your care, and contact you when necessary. Example: We use health information
about you to manage your treatment and services.
• Bill for your services. We can use and share your health information to bill and get
payment from health plans or other entities. Example: We give information about you to
your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute
to the public good, such as public health and research. We have to meet many conditions in the lawbefore we can share your information for these purposes. For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
• Help with public health and safety issues. We can share health information about you for
certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
• Do research. We can use or share your information for health research.
• Comply with the law. We will share information about you if state or federal laws require it,
including with the Department of Health and Human Services if it wants to see that we’re
complying with federal privacy law.
• Work with a medical examiner or funeral director. We can share health information with a
coroner, medical examiner, or funeral director when an individual dies.
• Address workers’ compensation, law enforcement, and other government requests.
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and
presidential protective services.
• Respond to lawsuits and legal actions. We can share health information about you in
response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health
information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or
security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy
of it.
• We will not use or share your information other than as described here unless you tell us we
can in writing. If you tell us we can, you may change your mind at any time. Let us know in
writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about
you. The new notice will be available upon request, in our office, and on our web site.
This Notice of Privacy Practices applies to the following organization.
Watkinsville Urgent Care
Watkinsville Urgent Care
1725 Electric Ave, Ste 100D
Watkinsville, GA 30677
706-262-7319
watkinsvilleurgentcare.com
Questions: info@watkinsvilleurgentcare.com
Effective October 1st, 2024