University Hospitals Urgent Care is committed to protecting your health information. This Notice applies to all University Hospitals Urgent Care sites. State and Federal laws require us to maintain the privacy of your health information and to inform you about our privacy practices by providing you with this Notice. We must follow the privacy practices as described below. This Notice will take effect on February 14, 2023, and will remain in effect until it is amended or replaced by us.

We reserve the right to make any changes in our privacy practices and the updated terms of our Notice effective for all health information maintained, created, and/or received by us before the date changes were made. Before we make a significant change, this Notice will be amended to reflect the changes and we will make the new Notice available upon request. We will post the Notice on our website. You may request a copy of our Privacy Notice at any time by contacting our Privacy Officer, Ty Houston at [email protected]

Availability of your health information to providers outside University Hospitals Urgent Care

Your medical records at University Hospitals Urgent Care are primarily maintained in an electronic medical record system called Agility; however, there may also be legacy systems that house your medical records from previous sites. Your health information may be available to other healthcare providers.


The following categories describe different ways that we use and disclose Health Information without your written permission. A “use” of your Health Information means sharing, accessing, or analyzing Health Information within the University Hospitals Urgent Care System. A “disclosure” of your Health Information means sharing, releasing, or giving access to your Medical Information to a person or company outside University Hospitals Urgent Care System. Not every use or disclosure in a category will be listed. However, all of the ways that we are allowed to use or disclose your Health Information should fall within one of these categories:

Treatment: We may use your health information to provide you with our professional services. We have established “minimum necessary or need to know” standards that limit various staff members’ access to your health information per their primary job functions. Everyone on our staff is required to sign a confidentiality statement.

Disclosure: We may disclose and/or share your healthcare information with other health care professionals who provide treatment and/or service to you either by fax or electronically through electronic medical records. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends, and/or other persons you choose to involve in your care, only if you agree that we may do so. The uses and disclosures that constitute the sale of Personal Health Information and other uses and disclosures not described in the notice will be made only with authorization from the individual.

Payment: We may use and disclose your health information to seek payment for services we provide to you. This disclosure involves our business office staff and may include insurance organizations or other businesses that may become involved in the process of mailing statements and/or collecting unpaid balances.

Emergencies: We may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition, or death. If possible we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated, we will use our professional judgment to disclose only that information directly relevant to your care. We will also use our professional judgment to make reasonable inferences of your best interest by allowing someone to pick up filled prescriptions, x-rays or other similar forms of health information and/or supplies unless you have advised us otherwise.

Healthcare Operations: We will use and disclose your health information for health care operations. These uses and disclosures are necessary to make sure that all of our patients receive quality care and for management purposes  Examples of personnel who may have access to this information include, but are not limited to, our medical records staff, outside health or management reviewers and individuals performing similar activities.

Business Associates: We may disclose Health Information to third parties so that they can perform a job we have asked them to do. For example, we may use another company to perform billing services on our behalf. All of these third parties are required to protect the privacy and security of your Health Information.

Required by Law: We may use or disclose your health information when we are required to do so by law. (Court or administrative orders, subpoena, discovery request or other lawful process.) We will use and disclose your information when requested by national security, intelligence and other State and Federal officials and/or if you are an inmate or otherwise under the custody of law enforcement.

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others.

Public Health Activities: We may disclose your health care information for public health, including to report problems with products, reactions to medications, product recalls, disease/infection exposure, vaccinations/immunizations, and to prevent and control disease, injury and/or disability. We may electronically report as permitted by law for tracking and quality/payment purposes.

Workers Compensation: We may disclose Health Information for Workers’ Compensation or similar programs that provide benefits for work related injuries or illnesses.

Marketing Health-Related Services: We may use your information to contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. From time to time, your healthcare provider or designee may contact you to request your permission to take part in health education and/or promotion. If University Hospitals Urgent Care receives compensation for a marketing-related activity, your authorization is required.

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.

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders, including, but not limited to, voicemail messages, postcards, or letters.

Telemedicine: Telemedicine Healthcare services may be provided via telemedicine, which means an image, video recording and/or audio of you may be used to allow healthcare providers at different locations to see you on a computer screen or view your medical records. Telemedicine may be used for diagnosis, therapy, follow-up and/or education, and may include: your medical records, medical images, live two-way audio and video, output data from medical devices, and sound and video files. Electronic systems used will incorporate network and software security protocols to help protect the confidentiality and integrity of your identity and imaging data.

University Hospitals Urgent Care participates in the Ohio Health Information Partnership: University Hospitals Urgent Care participates in CliniSync, a Health Information Exchange operated by the Ohio Health Information Partnership. Through CliniSync, participating UH providers may exchange the Health Information of patients with other healthcare providers throughout the State of Ohio that also participate in CliniSync. Patients may withdraw from participation in the Health Information Exchange by contacting the Privacy Officer at 404-996-0125. University Hospitals Urgent Care participates in CliniSync voluntarily and does not warrant or guarantee that any particular Health Information will be accessible via CliniSync.


Access: Upon written request, you have the right to inspect and get copies of your health information (and that of an individual for whom you are a legal guardian.) There will be some limited exceptions. If you wish to examine your health information, you will need to complete and submit an appropriate request form. Contact our Privacy Officer for a copy of the Request Form. You may also request access by sending us a letter. Once approved, an appointment can be made to review your records. Medical records can also be requested online or at one of our University Hospitals Urgent Care facilities.

Amendment: You have the right to amend your healthcare information, if you feel it is inaccurate or incomplete. Your request must be in writing and must include an explanation of why the information should be amended. Under certain circumstances, your request may be denied.

Non-routine Disclosures: You have the right to receive a list of non-routine disclosures we have made of your health care information. You have the right to a list of instances in which we, or our business associates, disclosed information for reasons other than treatment, payment, or healthcare operations. You can request non-routine disclosures going back 6 years prior to the date of your request.

Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We do not have to agree to these additional restrictions, but if we do, we will abide by our agreement. (Except in emergencies.) Please contact our Privacy Officer if you want to further restrict access to your health care information. This request must be submitted in writing.

Breach: An individual has the right to notice in the event of a breach. If a breach does occur, our privacy officer will contact you directly to inform you.

Access to Care: You have the right to access, and request for, and an amendment of your medical records.

Safety: You have a right to receive safe, high-quality care.

Respect: You have a right to be shown respect, dignity, and consideration regarding your healthcare. Communication: You have a right to be informed about services, treatment options, and costs in a clear and susceptible way.

Participation: You have a right to be included in decisions and choices regarding your care.

Privacy: You have a right to privacy and confidentiality of your personal information.

Comment: You have a right to comment on your care and to have your concerns addressed.

Health Records: You have the right to refuse the release of your personal health information (except when permitted by law).

Interpreter: You have the right to have clinic personnel or a language line available for patient/family members with a language barrier.


Advance Care Directive / Power of Attorney / Guardianship: Please inform your health care professional if you have a current Advance Care Directive or Power of Attorney for any health or personal matters, or if you are subject to a guardianship order.

Safety: Tell us your safety concerns.

Respect: Consider the wellbeing and rights of others.

Communication: Provide information regarding your medical history and ask questions.

Participation: Follow your treatment plan, cooperate, and participate where able.

Services: You have the right to refuse care or services.

Complain / Feedback: You should direct any complaint to a staff member or member of management so that immediate and appropriate action can be taken to remedy your concern.


You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. Your complaint should be directed to our Privacy Officer or Security Officer. If you feel we may have violated your privacy rights, or if you disagree with a decision, we made regarding your access to your health information, you can complain to us. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. The toll-free number for the U.S. Department of Health and Human Services at 1-877-696-6775.


Privacy Officer: Ty Houston
Telephone: (404) 382-9890
E-Mail Address: [email protected]

Security Officer: Chase Holcombe
Telephone: (404) 994-4159
E-Mail Address: [email protected]

HIPAA Notice of Privacy Practices

This form does not constitute legal advice and covers only federal, not state, law.