Patient Portal

Notice of Privacy Practices

Effective Date: 9/1/2025

This Notice describes how your medical information may be used and disclosed and how you can access this information. Please review it carefully.

[Your Company Name] is committed to protecting your health information as required by the Health Insurance Portability and Accountability Act (HIPAA).

1. Our Responsibilities

We are required by law to:

  • Maintain the privacy and security of your protected health information (PHI).
  • Provide you with this Notice of our legal duties and privacy practices.
  • Notify you if a breach occurs that may have compromised your information.
  • Follow the terms of this Notice.

How We May Use and Share Your Health Information

We may use and disclose your PHI for the following purposes:

  • Treatment: To provide, coordinate, or manage your healthcare and related services.
  • Payment: To bill and collect payment for the healthcare services we provide.
  • Healthcare Operations: To support business functions such as quality assessment, training, and accreditation.

We may also use and share your PHI when:

  • Required by law (e.g., public health reporting, abuse/neglect reporting).
  • For health oversight activities (e.g., audits, compliance checks).
  • To avert a serious threat to health or safety.
  • For law enforcement or legal proceedings, when legally permitted.

We will not use or share your PHI for marketing, sale, or fundraising purposes without your written authorization.

3. Your Rights

You have the right to:

  • Access your records: Request a copy of your health information.
  • Request corrections: Ask us to correct information you believe is inaccurate or incomplete.
  • Request confidential communications: Ask us to contact you in a specific way (e.g., phone, email, mail).
  • Request restrictions: Limit how your information is used or shared (though we may not be required to agree).
  • Receive a list of disclosures: Request an accounting of certain disclosures of your PHI.
  • Receive a paper copy of this Notice: You may request this at any time.
  • File a complaint: If you believe your privacy rights have been violated, you can file a complaint with us or with the U.S. Department of Health and Human Services (HHS).

You will not face retaliation for filing a complaint.

4. Our Duties Regarding Electronic Communications

We use secure technology to protect your PHI when shared electronically through our telehealth platform. However, no system is completely free of risk. By using our services, you consent to the electronic exchange of PHI as part of your care.

5. Changes to This Notice

We may change this Notice at any time. Updates will apply to all PHI we maintain and will be posted with a new “Effective Date.”

6. Contact Us

If you have questions about this Notice or wish to exercise your rights, please contact:

Simply Well Urgent Care
privacy@simplywellurgentcare.com

You may also contact:
U.S. Department of Health & Human Services – Office for Civil Rights (OCR)
https://www.hhs.gov/ocr/privacy/hipaa/complaints/