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NOTICE OF PRIVACY PRACTICES (NPP)

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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.

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EFFECTIVE DATE: January 1, 2018

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1. Our Commitment to Your Privacy

Urgent Care TX is dedicated to maintaining the privacy of your Protected Health Information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you.

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2. How We May Use and Disclose Your PHI

• Treatment: We may use your PHI to treat you. For example, we may disclose your PHI to other doctors, nurses, technicians, or other personnel who are involved in taking care of you.

• Payment: We may use and disclose your PHI so that the services you receive may be billed to and payment collected from you, an insurance company, or a third party (including Value Pass administration).

• Healthcare Operations: We may use and disclose your PHI to operate our business, improve our care, and contact you when necessary.

• Appointment Reminders: We may use and disclose PHI to contact you as a reminder that you have an appointment.

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3. Use and Disclosure in Special Circumstances

We may use or disclose your PHI without your authorization in the following legal situations:

• As required by law (Public Health risks, Law Enforcement, etc.).

• To avert a serious threat to health or safety.

• For workers’ compensation or similar programs.

• For health oversight activities authorized by law.

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4. Your Rights Regarding Your PHI

• Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI that may be used to make decisions about your care.

• Right to Amend: If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information.

• Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we’ve made of your PHI.

• Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or healthcare operations.

• Right to Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.

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5. Complaints

If you believe your privacy rights have been violated, you may file a complaint with Urgent Care TX or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

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6. Contact Information

If you have any questions about this notice, please contact: Privacy Officer Urgent Care TX Email: [Insert Email, e.g., jason@urgentcaretx.com] Phone: (682) 317-1500

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