The law requires your doctor, hospital, or other health care provider you see in person to ask you to state in writing that you received the notice. Often, that means the doctor will ask you to sign a form stating that you received the notice that day.
- The law does not require you to sign the “acknowledgement of receipt of the notice.”
- Signing does not mean that you have agreed to any special uses or disclosures of your health records.
- Refusing to sign the acknowledgement does not prevent the entity from using or disclosing health information as the Rule permits it to do.
- If you refuse to sign the acknowledgement, the provider must keep a record that they failed to obtain your acknowledgement.
What is in the Notice
The notice must describe:
- the ways that the Privacy Rule allows the covered entity to use and disclose protected health information. It must also explain that the entity will get your permission, or authorization, before using your health records for any other reason.
- the covered entity’s duties to protect health information privacy.
- how to contact the entity for more information and to make a complaint.
When and how you can receive a Notice of Privacy Practices
- Most covered health care providers must give notice to their patients at the patient’s first service encounter (usually at your first appointment). In emergency treatment situations, the provider must give the patient the notice as soon as possible after the emergency. It must also post the notice in a clear and easy to find location where patients are able to read it. When and how you can receive a Notice of Privacy Practices
- A health plan must give its notice to each new enrollee at enrollment, and send a reminder to every enrollee at least once every three years that the notice is available upon request. A health plan can give the notice to the “named insured,” that is, the subscriber for coverage. It does not also have to give separate notices to any covered spouses and dependents.
- A covered entity must give a copy of the notice to anyone who asks for one. If a covered entity has a web site for customers, it must post its notice in an obvious spot there.
Courtesy of Health and Human Services Department
Pacific Urgent Care and Wellness Center
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL/PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
By law, we are required to provide you with our Notice of Privacy Practices (NPP). This Notice describes how your medical information may be used and disclosed by us. It also tells you how you can obtain access to this information.
As a patient, you have the following rights:
- The right to inspect and copy your information.
- The right to request corrections to your information.
- The right to request that your information be restricted.
- The right to request confidential communications.
- The right to a report of disclosures of your information, and
- The right to a paper copy of this notice.
- We want to assure you that your medical/protected health information is secure with us. This Notice contains information about how we will insure that your information remains private. If you have any questions about this Notice, please contact us at the telephone number listed on this page.
Acknowledgement of Notice of Privacy Practices
“I hereby acknowledge that I have received a copy of this practice’s NOTICE OF PRIVACY PRACTICES. I understand that if I have questions or concerns regarding my privacy rights that I may contact the person listed above. I further understand that the practice will offer me updates to the NOTICE OF PRIVACY PRACTICES should it be amended, modified or changed in any way.”
This privacy notice discloses the privacy practices for www.pacificucwc.com This privacy notice applies solely to information collected by this web site. It will notify you of the following:
- What personally identifiable information is collected from you through the web site, how it is used and with whom it may be shared.
- What choices are available to you regarding the use of your data.
- The security procedures in place to protect the misuse of your information.
- How you can correct any inaccuracies in the information.
Information Collection, Use, and Sharing
We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you. We will not sell or rent this information to anyone.
We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request, e.g. to ship a prescription.
Your Access to and Control Over Information
You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via the email address or phone number given on our website:
- See what data we have about you, if any.
- Change/correct any data we have about you.
- Have us delete any data we have about you.
- Express any concern you have about our use of your data.
We take precautions to protect your information. When you submit sensitive information via the website, your information is protected both online and offline.
Wherever we collect sensitive information (such as credit card data), that information is encrypted and transmitted to us in a secure way. You can verify this by looking for a closed lock icon at the bottom of your web browser, or looking for "https" at the beginning of the address of the web page.
While we use encryption to protect sensitive information transmitted online, we also protect your information offline. Only employees who need the information to perform a specific job (for example, billing or customer service) are granted access to personally identifiable information. The computers/servers in which we store personally identifiable information are kept in a secure environment.
Effective Date: 1 February 2016