ABOUT THIS NOTICE  We understand that health information about you is personal and we are committed to protecting your information. We create a record of the care and services you receive at all divisions of Livonia urgent care We need this record to provide care (treatment), for payment of care provided, for health care operations, and to comply with certain legal requirements. This  Notice will tell you about how we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of health information. We are required by law to follow the terms of this Notice that is currently in effect.  WHAT IS PROTECTED HEALTH INFORMATION  (“PHI”) PHI is information that individually identifies you. We create a record or get from you or from another health care provider, health plan, your employer,  or a health care clearinghouse that relates to:

  • Your past, present, or future physical or mental health or conditions,
  • The provision of health care to you, or
  • The past, present, or future payment for your health care

 HOW WE MAY USE AND DISCLOSE YOUR PHI We may use and  disclose your PHI in the following  circumstances:

  • Treatment. We may use or disclose your PHI to give you medical treatment or services and to manage and coordinate your medical care. For example, your PHI may be provided to a physician or other health care provider (e.g., a specialist or laboratory) to whom you have been referred to ensure that the physician or other health care provider has the necessary information to diagnose or treat you or provide you with a service.
  • We may use and disclose your PHI so that we can bill for the treatment and services you receive from us and can collect payment from you, a health plan, or a third party. This use and disclosure may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as deciding on eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, we may need to give your health plan information about your treatment for your health plan to agree to pay for that treatment.
  • Health Care Operations. We may use and disclose PHI for our health care operations. For example, we may use your PHI to internally review the quality of the treatment and services you receive and to evaluate the performance of our team members in caring for you. We also may disclose information to physicians, nurses, medical technicians, medical students, and other authorized personnel for educational and learning purposes.
  • Appointment Reminders/Treatment Alternatives/Health-Related Benefits and Services. We may use and disclose PHI to contact you to remind you that you have an appointment for medical care, or to contact you to tell you about possible treatment options or alternatives or health-related benefits and services that may be of interest to you.
  • We may disclose the PHI of minor children to their parents or guardians unless the law otherwise  prohibits such disclosure
  • Required by Law. We will disclose PHI about you when required to do so by international, federal,  state, or local law.
  • To Avert a Serious Threat to Health or Safety. We may use and disclose PHI when necessary to prevent a serious threat to your health or safety or the health or safety of others. But we will only disclose the information to someone who may be able to help prevent the threat.
  • Abuse, Neglect, or Domestic Violence. We may disclose  PHI to the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence and the patient agrees or we are required or authorized by law to make that disclosure.
  • Public Health Responsibilities. We will disclose your health information to report problems with products, reactions to medications, product recalls, disease/infection exposure and to prevent and control disease, injury, and/or disability.
  • National Security. The health information of Armed  Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence,  counterintelligence, or other national security activities, we may disclose it to authorized federal officials.


  • Inspect and Copy. You have the right to inspect,  receive, and copy PHI that may be used to make decisions about your care or payment for your care. We have up to 30 days to make your PHI available to you and we may charge you a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. You can only direct us in writing to submit your PHI to a third party not covered in this notice. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state or federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
  • Request Amendments. If you feel that the PHI we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. A request for  amendment must be made in writing to the Privacy

The officer at the address provided at the beginning of this Notice must tell us the reason for your request. In certain cases, we may deny your request for an amendment. If we deny your request for an amendment, you have the right to file a  statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

  • Accounting of Disclosures. You have the right to  ask for an “accounting of disclosures,” which is a list  of the disclosures we made of your

PHI. To request this list or accounting of disclosures, you must submit your request in writing to the  Privacy Officer. The first accounting of disclosures you request within any 12 months will be free. For additional requests within the same period, we may charge you for the reasonable costs of providing the list. We will tell you what the costs are, and you may choose to withdraw or modify your request before the costs are incurred.

  • 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 health care operations. We are not required by federal regulation to agree to your request. If we do agree with your request, we will comply unless the information is needed to provide emergency treatment. To request restrictions, you must make your request in writing to the Privacy Officer. Your request must state the specific restriction requested,  whether you want to limit our use and/or disclosure; and to whom you want the restriction to apply.
  • Complaints If you believe your privacy rights have been violated, you may file a complaint with the Livonia urgent care  Privacy Officer, at the address listed at the beginning of this Notice or with the Secretary of the U.S. Department of Health and Human Services.