Notice of Privacy Practices (HIPAA)

Notice of Privacy Practices (NPP)

Effective Date: 12/02/2025
MD Urgent Care Clinic
Merrillville • Highland • Hammond

Your Information. Your Rights. Our Responsibilities.

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.

YOUR RIGHTS

You have the right to:

• Request a copy of your medical record

You can ask to see or receive a copy of your health records. We will provide these within a reasonable time and cost-based fee.

• Request corrections to your record

If you believe information is incorrect or incomplete, you may request an amendment.

• Request confidential communication

You may ask us to contact you in a specific way (e.g., phone only, mailing address).

• Ask us to limit what we use or share

You may request restrictions, but we are not required to agree if it affects your care.

• Receive a list of disclosures

You may ask for a list of times we shared your PHI for purposes other than treatment, payment, or operations.

• Receive a copy of this Notice

You can request a paper or electronic version at any time.

• Choose someone to act for you

If a legal guardian or medical representative is authorized, they may exercise your rights.

• File a complaint

You may file a complaint if you feel your privacy rights were violated.
We will not retaliate.

YOUR CHOICES

You may tell us your preferences on how we:

  • Share information with family members
  • Share information for disaster relief
  • Include your information in facility directories
  • Provide mental health notes (requires authorization)
  • Use photographs or marketing content

OUR USES AND DISCLOSURES

We typically use or share your health information to:

• Treat you

Information is shared among clinical staff to manage your care.
Example: A provider reviews your medical history to diagnose or treat you.

• Bill for services

Information may be shared with insurance companies or third-party payers.

• Operate our clinic

We use your information to improve quality of care, training, and operations.

We may also use or share information when:

  • Required by law
  • Responding to public health and safety issues
  • Addressing workers’ compensation claims
  • Responding to law enforcement
  • Assisting medical examiners or funeral directors
  • Preventing serious threats to health or safety
  • Complying with health oversight investigations

Any use or disclosure not listed above requires written authorization.

OUR RESPONSIBILITIES

MD Urgent Care Clinic is legally required to:

  • Maintain the privacy and security of your protected health information (PHI)
  • Notify you in case of a breach involving your PHI
  • Follow the duties and privacy practices described in this Notice
  • Provide updates if our privacy policies change

We will never use your information:

  • For marketing without written permission
  • For selling your information
  • For sharing psychotherapy notes without authorization

CONTACT INFORMATION

Privacy Officer – MD Urgent Care Clinic
Phone: 219-487-5773
Email: info@mdurgentcare.us
Address: 5304 Broadway, Merrillville, Indiana 46410

You may also file a complaint with:

U.S. Department of Health & Human Services
Office for Civil Rights
Website: www.hhs.gov/ocr/privacy/
Phone: 1-877-696-6775