FAMILY PRACTICE & URGENT CARE

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 Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that all
medical records and other individually identifiable health information used or disclosed by
us, whether electronically, on paper, or orally, are kept confidential. HIPAA gives you
important rights regarding the understanding and control of how your health information is
used. It also provides penalties for misuse of Protected Health Information (PHI).
This Notice explains how we may use and disclose your PHI for treatment, payment, health
care operations, and other purposes permitted or required by law. It also explains your
rights to access and control your PHI.
PHI Definition
Protected Health Information is any information that can identify you and that relates to
your past, present, or future physical or mental health condition and related health care
services.
How We May Use and Disclose Your PHI
Your PHI may be used or disclosed by your physician, our staff, and others outside our
office involved in your care. Common examples include:
Treatment
We may use and share your PHI to coordinate and manage your health care services. For
example, we may share information with a specialist involved in your treatment, so they
have the information necessary for your care.
Payment
We may use and disclose PHI to obtain payment for services, including billing and claims
processing.
Healthcare Operations
We may use your PHI to support business activities such as quality assessment, staff
review, and training.
Examples may include:
• Using a sign-in sheet at the front desk
• Calling your name in the waiting room
• Leaving appointment reminders on voicemail or by mail
If you prefer alternative communication methods, please let us know.
Other Uses and Disclosures Without Authorization
We may disclose your PHI without your written authorization in certain situations including:
• When required by law
• Public health reporting
• Cases of abuse or neglect
• Legal proceedings and law enforcement
• FDA reporting obligations
• Coroners, funeral directors, and organ donation
• Research under approved protocols
• Criminal activity and national security
• Workers’ compensation
• For health oversight activities
• To comply with requests from the U.S. Department of Health and Human Services
Any other uses or disclosures require your written authorization. You may revoke an
authorization in writing at any time, except when action has already been taken in reliance
on it.
Your Rights Regarding Your PHI
You have the following rights:
Inspect and Copy
You may review and request copies of your health information, with some legal restrictions
including psychotherapy notes and information prepared for legal proceedings.
Request a Restriction
You may ask us not to use or disclose certain information for treatment, payment, or
operations, or to specific individuals. We are not required to agree to all requests but will
consider them carefully.
Confidential Communication
You may request that we contact you using a specific method or at a different location.
Paper Notice
You may request a paper copy of this Notice at any time, even if received electronically.
Accounting of Disclosures
You may request a list of certain disclosures we have made of your PHI.
We reserve the right to change this Notice at any time. Changes will apply to PHI we already
hold and any future information. Updated notices will be available upon request.
Mobile and Electronic Communications
If you provide your mobile number or opt in to receive text messages, we may use your
mobile contact information to communicate about appointments, reminders, or other
healthcare-related updates.
No mobile opt-in data, text messaging originator opt-in data, or personal contact
information will be shared with or sold to third parties or affiliates for marketing or
other promotional purposes.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us.
You will not face retaliation for filing a complaint.
Effective Date: October 27, 2025
Contact for Questions and Concerns:
Privacy Officer
Emilia Rivas, Office Manager
655 Street Ste. 201
Providence, RI 02907
Phone: 401-642-0100

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