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HIPAA Information

Effective Date: April 1, 2025 Locations: Flower Mound & Northlake, TX

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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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1. Who We Are

Doctors Urgent Care of Northlake, PLLC and Doctors Urgent Care – Flower Mound, PLLC (collectively "we," "us," "our practice") is a covered entity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations. We are required by law to maintain the privacy of your Protected Health Information (PHI), provide you with this Notice of our privacy practices, and abide by the terms of this Notice.

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Protected Health Information (PHI) includes any individually identifiable health information we create, receive, maintain, or transmit, including information about your past, present, or future health condition, the healthcare we provide to you, and payment for that care.

This Notice applies to all locations operated by Doctors Urgent Care, including our Flower Mound and Northlake clinics.

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2. How We May Use & Disclose Your Health Information

The following describes the ways we may use and disclose health information about you. For uses and disclosures beyond those listed below, we will obtain your written authorization.

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Uses & Disclosures Permitted Without Your Authorization

Treatment We may use and share your PHI to provide, coordinate, or manage your healthcare. For example, we may share your information with specialists, hospitals, labs, or other providers involved in your care.

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Payment We may use and disclose your PHI to bill and collect payment for services. For example, we may submit a claim to your health insurance company, including information about the services we provided.

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Healthcare Operations We may use and disclose your PHI for internal business activities such as quality improvement, staff training, compliance audits, accreditation, and other administrative functions.

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Appointment Reminders We may contact you to remind you of upcoming appointments or provide information about your care.

Required by Law We will disclose your PHI when required to do so by federal, state, or local law, including public health reporting requirements.

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Health Oversight Activities We may disclose your PHI to government oversight agencies (e.g., the Texas Medical Board or the U.S. Department of Health and Human Services) for activities authorized by law.

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Judicial & Administrative Proceedings We may disclose your PHI in response to a court order, subpoena, or other lawful process.

Law Enforcement We may release your PHI to law enforcement officials in limited circumstances, including reporting certain wounds or injuries, or as required by law.

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Serious Threats to Health or Safety We may share PHI to prevent or lessen a serious threat to your health and safety or the health and safety of others.

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Workers' Compensation We may disclose PHI as authorized by and to the extent necessary to comply with workers' compensation laws.

Business Associates We may share your PHI with vendors and service providers (Business Associates) who help us operate our practice. These parties are required by law to protect your information under a signed Business Associate Agreement.

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Uses & Disclosures Requiring Your Written Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes not described above, including:

  • Most marketing communications

  • Sale of your PHI

  • Psychotherapy notes (where applicable)

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You may revoke any authorization you provide at any time by submitting a written request to our office. Revocation will not affect uses or disclosures already made in reliance on your authorization.

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3. Special Categories Requiring Additional Protection

Certain types of health information are afforded extra protection under federal and/or Texas state law. We will not use or disclose the following without your specific written consent or as otherwise permitted by law:

  • HIV/AIDS status or test results

  • Mental health and substance use disorder records

  • Genetic information

  • Reproductive healthcare information

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4. Your Rights Regarding Your Health Information

You have the following rights with respect to your Protected Health Information. To exercise any of these rights, please contact our front desk or Privacy Officer in writing.

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Right to Access & Copies You have the right to inspect and obtain a copy of your medical records. We may charge a reasonable fee for copies. We must respond within 30 days of your request.

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Right to Amend If you believe your health information is incorrect or incomplete, you may request that we amend it. We may deny the request under certain circumstances, and will explain any denial in writing.

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Right to an Accounting of Disclosures You may request a list of disclosures of your PHI made by us (other than for treatment, payment, or operations) for up to 6 years prior to your request.

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Right to Request Restrictions You may ask us to limit how we use or share your PHI. We are not required to agree, except when you have paid out-of-pocket in full and request that we not share that information with your health plan.

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Right to Confidential Communications You may request that we communicate with you in a specific way or at a specific location (e.g., only by mail, not by phone). We will accommodate reasonable requests.

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Right to a Paper Copy of This Notice You have the right to a paper copy of this Notice at any time, even if you agreed to receive it electronically. Ask our front desk staff at any visit.

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Out-of-Pocket Payment: If you pay in full out-of-pocket for a service and request that we not disclose that information to your health plan, we are required by law to honor that request.

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5. Our Duties

We are required by law to:

  • Maintain the privacy and security of your Protected Health Information

  • Provide you with notice of our privacy practices (this Notice)

  • Abide by the terms of the Notice currently in effect

  • Notify you in the event of a breach of your unsecured PHI

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We will not use or disclose your health information in a way that is not described in this Notice without your written authorization, except as required by law.

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6. How to Exercise Your Rights or File a Complaint

To exercise any of your rights, please contact our Privacy Officer:

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If you believe your privacy rights have been violated, you have the right to file a complaint with us or directly with the federal government. You will not be penalized or retaliated against for filing a complaint.

U.S. Department of Health & Human Services — Office for Civil Rights (OCR)

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7. Changes to This Notice

We reserve the right to change the terms of this Notice and to make new provisions effective for all PHI we maintain, including health information created or received before the change. If we make a material change, we will post the revised Notice at our clinics and on our website.

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The current effective version of this Notice is always available at our clinics and at www.drsurgentcare.com.

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