NOTICE OF PRIVACY PRACTICES
EFFECTIVE 10/20/2025
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.
THE CLINIC’S COMMITMENT TO YOUR PRIVACY
Our clinic respects your information privacy and is committed to protecting your health information. Pursuant to the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, the clinic is required by law to provide you with adequate notice of the clinic’s uses and disclosures of protected health information (“PHI”), and of your rights and the clinic’s legal duties with respect to PHI. PHI means information that identifies you individually; including demographic information, and information that relates to your past, present, or future physical or mental health condition and/or related health care services. The terms of this notice apply to all your PHI created or maintained by the clinic.
This Notice of Privacy Practices (“Notice”) contains the following important information: (a) how we may use and disclose your PHI; (b) your privacy rights; and (c) our obligations concerning the use and disclosure of your PHI.
We reserve the right to revise or amend this Notice at any time. We will post a copy of our current Notice in the clinic and online at www.micarehealthcenter.com. You may request a copy of our most recent Notice at any time.
This clinic will abide by the terms presented within this Notice. For any uses or disclosures that are not listed below, the clinic will obtain a written authorization from you for that use or disclosure, which you will have the right to revoke at your discretion, as explained in more detail below.
HOW THE CLINIC MAY USE AND DISCLOSE YOUR PHI
We are permitted to use and disclose your PHI:
For Treatment: We will use the PHI we receive from you to provide medical treatment and coordinate or manage your health care. For example, we may ask you to have laboratory tests conducted, and we may use the test results to reach a diagnosis. We might also use your PHI to write a prescription for you or disclose your PHI to other health care providers as needed for assistance with your treatment.
For Payment: The clinic may use or disclose your PHI to bill or collect payment for the services you receive. For example, we may contact your health plan to confirm your eligibility for benefits and provide your insurer with treatment details to determine available coverage for your treatment. We may also use or disclose your PHI to bill you directly for services or assist other health care providers in their billing or collection efforts.
For Health Care Operations: The clinic may use your PHI as necessary to evaluate the quality of care you received from us or conduct other business improvement activities, such as clinic workforce evaluations.
ADDITIONAL WAYS WE MAY USE OR DISCLOSE YOUR PHI WITHOUT YOUR WRITTEN AUTHORIZATION
As Required by Law: The clinic may use or disclose your PHI to the extent the use or disclosure is required by law and limited to the relevant requirements of such law.
For Public Health Activities: The clinic may use or disclose your PHI for public health activities. For example, we may disclose your PHI to a public health authority that is authorized by law to collect PHI for the purpose of preventing or controlling disease, injury, or disability, including the reporting of disease, injury, vital events such as birth or death, and the conduct of public health surveillance, public health investigations, and public health interventions. Disclosure for public health activities may also include:
- Disclosure to a public health authority or other appropriate government authority authorized by law to receive reports of child abuse or neglect.
- Disclosure to the FDA or people within the FDA’s jurisdiction for activities related to the quality, safety, or effectiveness of an FDA-regulated product or activity.
- Disclosure to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if the clinic is authorized by law to notify such person as necessary in the context of a public health intervention or investigation.
- Disclosure to an employer, if:
- The clinic provides you with health care at the request of your employer
- The PHI disclosed concerns a work-related illness, injury, or workplace-related medical surveillance.
- The employer needs the information to comply with its own obligations under federal or state law with a similar purpose (i.e., to record illness, injury, or carry out responsibilities related to workplace medical surveillance).
- The clinic provides you with written notice that PHI related to the medical surveillance of the workplace and work-related illnesses and injuries is disclosed to the employer.
- Disclosure to a school about a student or prospective student, if:
- The PHI disclosed is limited to proof of immunization;
- The school is required by law to have such proof of immunization prior to admission; and
- The clinic obtains and documents the agreement to the disclosure from either:
- The individual subject of the PHI
- That individual’s parent or guardian
About Victims of Abuse, Neglect, or Domestic Violence: The clinic may disclose PHI to a government authority, including a social service or protective services agency authorized by law to receive reports of such abuse, neglect, or domestic violence, if we reasonably believe you are a victim of abuse, neglect, or domestic violence.
For Health Oversight Activities: The clinic may disclose your PHI to a health oversight agency for oversight activities authorized by law, which may include audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight of:
- The health care system;
- Government benefit programs for which health information is relevant to beneficiary eligibility;
- Entities subject to government regulatory programs for which health information is necessary for determining compliance with program standards; or
- Entities subject to civil rights laws for which health information is necessary for determining compliance
For Judicial and Administrative Proceedings: The clinic may disclose your PHI during any judicial or administrative proceedings, for example:
- In response to an order of a court or administrative tribunal, provided that we disclose only the PHI expressly authorized by such order; or
- In response to a subpoena, discovery request, or other lawful process, that is not accompanied by an order of a court or administrative tribunal, if satisfactory assurances are provided.
For Law Enforcement Purposes: The clinic may disclose PHI to law enforcement officials under certain circumstances including:
- As required by law, including laws that require the reporting of certain types of wounds or other physical injuries
- In response to a law enforcement official’s request for such information for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person,
- In response to a law enforcement official’s request for such information about an individual who is or is suspected of being a victim of a crime
- To alert law enforcement of the death of the individual if the clinic has a suspicion that such death may have resulted from criminal conduct
- When the clinic believes in good faith that the PHI constitutes evidence of criminal conduct that occurred on the clinic’s premises.
- If such disclosure of PHI appears necessary to alert law enforcement to:
- The commission and nature of a crime;
- The location of such crime or of the victim(s) of such crime; and
- The identity, description, and location of the perpetrator of such crime.
Disclosures about the Deceased: The clinic may disclose PHI:
- To a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law.
- To funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
For Cadaveric Organ, Eye, or Tissue Donation Purposes: The clinic may use or disclose PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for the purpose of facilitating organ, eye, or tissue donation and transplantation.
For Research Purposes: The clinic may use and disclose your PHI for research purposes, regardless of the source of funding of the research, with a valid waiver of authorization approved by an institutional review board or a privacy board and other researcher representations, as applicable.
To Avert a Serious Threat to Health or Safety: The clinic may use or disclose your PHI, consistent with any applicable law and standards of ethical conduct, if it believes in good faith that the use or disclosure:
- Is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; and
- Is to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat; or
- Is necessary for law enforcement authorities to identify or apprehend an individual.
For Specialized Government Functions: The clinic may use or disclose PHI for specialized government functions including
- Military and veteran’s activities (e.g., to determine an individual’s eligibility for VA benefits);
- National security and intelligence activities;
- Protective services for the President, other officials or foreign heads of state;
Correctional institutions and other law enforcement custodial situations (e.g., if the PHI is necessary for the provision of health care to an inmate or other person in lawful custody).
For Workers’ Compensation: The clinic may disclose your PHI as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.
For Disaster Relief Purposes: The clinic may disclose PHI about you as authorized by law to a public or private entity to assist in disaster relief efforts.
To Business Associates: The clinic may disclose your PHI to our business associates as required to assist with our provision of quality health care and health care operations. To ensure the privacy of your PHI, we require all business associates to apply appropriate safeguards to any PHI they receive from us or create on our behalf.
WE MAY USE OR DISCLOSE YOUR PHI FOR THE FOLLOWING REASONS WHEN AN OPPORTUNITY TO AGREE OR OBJECT IS PROVIDED
Uses and Disclosures for Facility Directories: To maintain or release limited facility directory information to acknowledge an individual is a patient at the facility and provide basic information about the patient’s condition in general terms (e.g., critical or stable, deceased, or treated and released) if the patient has not objected to or restricted the release of such information or, if the patient is incapacitated, if the disclosure is believed to be in the best interest of the patient and is consistent with any prior expressed preferences of the patient.
Uses and Disclosures for Involvement in the Individual’s Care and Notification purposes: The clinic may share PHI with a patient’s family members, relatives, friends, or other persons identified by the patient as involved in the patient’s care. We may also share information about a patient as necessary to identify, locate, and notify family members, guardians, or anyone else responsible for the patient’s care, of the patient’s location, general condition, or death. This may include, where necessary to notify family members and others, the police, the press, or the public at large.
WE REQUIRE YOUR WRITTEN AUTHORIZATION TO:
Use or disclose psychotherapy notes except to carry out treatment, payment, or health care operations.
Use or disclose PHI for marketing except if the communication is in the form of a face-to-face communication made to you by the clinic or a promotional gift of nominal value provided by the clinic.
Make any disclosure which is a sale of PHI. In such case, the authorization will state that the disclosure will result in remuneration to the clinic.
You may revoke an authorization for an applicable PHI use or disclosure in writing at any time. Please contact miCare’s HIPAA Privacy Officer, to submit a revocation of authorization request. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. However, we cannot take back any uses or disclosures of your PHI already made in reliance on your authorization.
OTHER USES AND DISCLOSURES
The clinic may contact you for the following purposes:Appointment Reminders: The clinic may contact you to remind you of your appointment for treatment or medical care at the clinic.
Information about Treatment Alternatives: The clinic may contact you to notify you of alternative treatments and/or products.
Health Related Benefits or Services: The clinic may use your PHI to notify you of benefits and services the clinic provides.
Individuals Involved in Your Care: Unless you object, the clinic may disclose to a family member, other relative, close personal friend, or any other person you identify, PHI directly relevant to that person’s involvement with your care. The clinic will also disclose PHI to an individual if it can reasonably infer from the circumstances, based on the exercise of professional judgment, that you do not object to the disclosure.
Electronic Medical Record (EMR): The EMR helps physicians, specialists, and hospitals know a patient’s entire health history, drugs that have been prescribed, and test results. To improve overall quality, safety, and cost of care, the clinic may disclose information held in the EMR to other health care providers or Business Associates of the clinic.
Incidental Disclosures: Despite our best efforts to protect your privacy, your PHI may be overheard or seen by people not involved in your care. For example, other individuals at the clinic could overhear a conversation about you or see you getting treatment. Such incidental disclosures are not a violation of HIPAA.
WE WILL OBTAIN YOUR WRITTEN AUTHORIZATION. FOR ALL OTHER USES AND DISCLOSURES NOT SPECIFIED IN THIS NOTICE.
HOW WE HANDLE PHI RELATED TO REPRODUCTIVE HEALTH CARE
The clinic will not use or disclose your PHI to investigate, punish, or identify anyone seeking, assisting with, or providing reproductive health care which is otherwise lawful under the circumstances under which it was provided. Some uses and disclosures of PHI related to reproductive health care are permitted. In applicable circumstances, we may require a written confirmation, called an attestation, before using or disclosing PHI related to reproductive health care.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights with respect to the PHI we maintain about you:
To request restrictions: You have the right to request restrictions of the clinic’s uses and disclosures of your PHI. We are not required to agree to a request. However, if we do agree, we are bound by our agreement except as otherwise required by law. You may submit a request in person at the clinic or by contacting the miCare HIPAA Privacy Officer at 800-777-3575.
To receive communications containing PHI by alternate means or locations: You have the right to request that the clinic communicate confidentially with you using a different address or phone number. However, state and federal laws may require the clinic to maintain an accurate address and home phone number for you in case of emergencies. The clinic will consider and accommodate all reasonable requests. You may submit a Request for Alternative Arrangements for Confidential Communication by contacting the miCare HIPAA Privacy Officer at 800-777-3575.
To inspect and/or obtain a copy of your PHI: You have the right to request access and/or obtain a copy (paper or electronic) of your PHI that is contained in the clinic for the duration the clinic maintains PHI about you. You may submit a Request for Access to Records by contacting the miCare HIPAA Privacy Officer at 800-777-3575. A reasonable, cost-based charge may be associated with your request. You will be notified in advance of incurring any such charges. If we deny your request, you may request a review of our denial.
To amend your PHI: You have the right to request an amendment of your PHI for as long as the information is maintained by the clinic, if you believe that the PHI is inaccurate or otherwise incomplete. Under certain circumstances, we may deny your request for amendment. If we do, you will have the right to have the denial reviewed by someone we designate, who was not involved in the initial review. You may also ask the Secretary, United States Department of Health and Human Services (“HHS”), or their appropriate designee, to review such a denial. You may submit a Request for Amendment to PHI by contacting the miCare HIPAA Privacy Officer at 800-777-3575.
To receive an accounting of disclosures of your PHI: You have the right to receive an accounting of certain disclosures of your PHI made by the clinic. You may submit a Request for Accounting of Disclosures by contacting the miCare HIPAA Privacy Officer at 800-777-3575. Any accounting we provide will include the disclosures we have made of your PHI but will exclude disclosures made for the purposes of treatment, payment, health care operations, disclosures required by law, and certain other disclosures (such as those you asked us to make). Your request must be in writing and state the period for which you are requesting the accounting (not to exceed six (6) years prior to the request date).
To be notified of a breach of your unsecured PHI: You have the right to receive notification of a breach that may have compromised the privacy or security of your PHI.
To receive additional copies of this Notice: You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically. If you wish to receive a paper copy of this request, please ask a clinic workforce member, and they will provide you with a copy.
REVISIONS TO THE NOTICE OF PRIVACY PRACTICES
The clinic reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The revised Notice will be available, upon request, to all individuals. The clinic will also post the revised version of the Notice in the clinic and online.COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the clinic and/or to the Secretary of HHS, or his designee. If you wish to file a complaint with the clinic, please contact the miCare HIPAA Privacy Officer. If you wish to file a complaint with the Secretary, please write to:The U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Ave, S.W.
Washington, D.C. 20201You may also call 1-877-696-6775 or submit a complaint online at: www.hhs.gov/ocr/privacy/hipaa/complaints/.
The clinic will not take any adverse action against you as a result of your filing of a complaint.
CONTACT INFORMATION
If you have any questions about the clinic’s privacy practices or need clarification on anything contained within the Notice, please contact:miCare LLC
HIPAA PRIVACY OFFICER
1550 Liberty Bridge Drive, Suite 330Wayne, PA 19087
(800) 777-3575