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.

Our pledge regarding your health information

Premium Walk-In Clinic is committed to protecting the privacy of your protected health information ("PHI") — information that may identify you and that relates to your past, present, or future health, treatment, or payment for care. This Notice applies to all records of your care generated by the clinic and describes our legal duties and your rights concerning your PHI. We are required by law to maintain the privacy of your PHI, to provide you this Notice, and to follow the terms of the Notice currently in effect.

How we may use and disclose your health information

We may use and disclose your PHI, without your written authorization, for the following purposes:

For treatment

We may use your PHI to provide, coordinate, or manage your medical care, including sharing information with physicians, nurses, technicians, pharmacies, or other providers involved in your care.

For payment

We may use and disclose your PHI to bill and obtain payment for the services we provide — for example, sharing information with your health plan to confirm coverage or obtain reimbursement.

For health care operations

We may use and disclose your PHI to support the business activities of the clinic, such as quality assessment, staff training and review, accreditation, licensing, and general administration.

Appointment reminders & health-related communications

We may contact you to provide appointment reminders, test results, or information about treatment alternatives or other health-related benefits and services that may interest you.

As required or permitted by law

We may use or disclose your PHI when required by federal, state, or local law and for public-health and safety purposes — for example, to prevent or control disease; to report abuse, neglect, or domestic violence; for health oversight activities; in response to a valid court order or subpoena; to law enforcement as permitted by law; to coroners or medical examiners; for workers' compensation; or to avert a serious threat to health or safety.

Uses and disclosures that require your authorization

Other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. This includes most uses and disclosures of psychotherapy notes (if any), uses and disclosures for marketing purposes, and any sale of PHI. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Your rights regarding your health information

You have the following rights with respect to your PHI:

• Right to inspect and copy — you may request to inspect and obtain a copy of your medical and billing records, in the form and format you request if readily producible. We may charge a reasonable, cost-based fee.
• Right to amend — you may request that we correct PHI you believe is incorrect or incomplete. We may deny your request under certain circumstances and will explain why in writing.
• Right to an accounting of disclosures — you may request a list of certain disclosures we made of your PHI.
• Right to request restrictions — you may ask us to limit how we use or disclose your PHI. We are not required to agree, except that we will comply with a request to restrict disclosure to a health plan for services you paid for in full out of pocket.
• Right to confidential communications — you may ask us to contact you in a specific way or at a specific location.
• Right to a paper copy of this Notice — you may request a paper copy at any time, even if you agreed to receive it electronically.
• Right to be notified of a breach — you have the right to be notified following a breach of unsecured PHI.

To exercise any of these rights, please submit your request in writing to our Privacy Officer at the contact information below.

Our duties

We are required to maintain the privacy of your PHI, provide this Notice of our legal duties and privacy practices, and abide by the terms of the Notice currently in effect. We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as any information we receive in the future. A current copy of this Notice will be posted in the clinic and on this website, and you may request a copy at any time.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the clinic by contacting our Privacy Officer, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.

Contact & Privacy Officer

To exercise your rights, ask questions, or file a complaint, contact our Privacy Officer:

Attn: Privacy Officer
Premium Walk-In Clinic
12211 Regency Village Dr #2, Orlando, FL 32821
Phone: (407) 713-6010