Notice of Privacy Practices

HIPAA Policy

What is HIPAA?

HIPAA is the acronym for the Health Insurance Portability and Accountability Act that was signed into law on August 21, 1996, Public Law 104-191. This law impacts all areas of the health care industry and was designed to provide insurance portability, to improve the efficiency of health care by standardizing the exchange of administrative and financial data, and to protect the privacy, confidentiality and security of health care information.

Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191)

The law is designed to improve portability and continuity of health insurance coverage, to combat waste, fraud and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify administration of health insurance, and for other purposes. [H.R. 3103]

Notice of Privacy Practices

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. Our staff is committed to protecting your health information, which is a right you have and one detailed in the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996. Listed on the back of this brochure are all the organizations and providers utilizing this Notice of Privacy Practices.

If you have any questions or requests, please contact the UCA offices at 15723 Tamiami Trail, Suite 106, Fort Myers, FL 33928:


We must protect the privacy of your protected health information or "PHI" for short. This Notice explains the ways that we will use your PHI. It also explains the ways that we will share, or disclose, PHI about you. In addition, we may make other uses and disclosures that occur as a result of the permitted uses and disclosures described in this Notice.

We must follow this Notice. We may change this Notice. We may make the changes apply to all PHI that we already have if we:

  • Post the new notice in our offices;
  • Make copies of the new notice available if someone asks for it (either at our offices); and
  • Post the new notice on our website:


  • We may use and disclose your PHI to provide health care treatment to you. 

EXAMPLE: A physician practicing in a UCA-affiliated urgent care center and treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Different facility departments may also need to share your PHI to coordinate services you may need. Such services include getting medicine, lab work, meals and x-rays. We may also disclose your PHI to people outside the center who may be involved in your medical care after you leave the facility.

We may use and disclose your PHI to obtain payment for services. 

Generally, we may use and give your PHI to others to bill and collect payment for services. Before we provide scheduled services, we may share information with your health plan(s) so that we can ask whether your plan or policy will pay for the service. We may also share PHI with: 
    Billing departments; 
    Collection departments or agencies; 
    Insurance companies, health plans and their agents who provide coverage; 
    Departments that review your care to see if the care and the costs were appropriate 
    Government agencies to try to get you qualified for benefits; 
    Consumer reporting agencies (such as credit bureaus); and;
    Other departments, agencies and/or companies to obtain payment.

EXAMPLE: Let's say you have a broken leg. We may need to give your health plan(s) information about your condition, supplies used (such as plaster for your cast or crutches), and services you received (such as x-rays or surgery).The information is given to our billing department and your health plan so we can be paid or you can be reimbursed. We may also send the same information to our hospital department that reviews our care. 

  • We may use and disclose your PHI for health care operations. 
  • 2.    Improving health care and lowering costs for groups of people who have similar health problems and to help manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar health problems to give them information about treatment choices, classes, or new procedures.
  • 3.    Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.
  • 4.    Training students, health care providers or other professionals (for example, billing clerks or assistants) to help them practice or improve their skills.
  • 5.    Working with outside organizations that assess the quality of the care that we and others provide. These organizations might include government agencies or accrediting bodies as may be appropriate for the urgent care setting. 
  • 6.    Helping people who review our activities. For example, PHI may be seen by doctors reviewing the services provided to you, and by accountants, lawyers, and others who help us in following the law.
  • 7.    Managing our business and performing general administrative activities related to our organization and the services we provide.
  • 8.    Solving problems or complaints within our organization.
  • 9.    Reviewing activities and using or disclosing PHI in the event that we sell our business or property, or give control of our business or property to someone else.
  • 10.  Complying with this Notice and with the law.


We may use and disclose PHI in other situations without your permission

We may use and/or disclose PHI about you without your permission. Those situations include when the use and/or disclosure: 
-  is required by law.
-  is needed for public health activities.
-  is about the abuse or neglect of a child or disabled adult.
-  is for health oversight activities.
-  is for legal proceedings.
-  is for police or other law enforcement purposes.
-  relates to a person who has died.
-  relates to organ, eye or tissue donation.
-  relates to medical research. In certain situations, we may share your PHI for medical research.
-  is to prevent a serious threat to health or safety.
-  relates to special government purposes.
-  relates to someone who is in jail, prison or police custody.

You can object to certain uses and disclosures. 

Unless you tell us not to, we may use or share your PHI as follows:

            • We may share your PHI with a family member, friend or other person identified by you.
            • We may share information directly related to that person's involvement in your care or payment for your care.
            • We also may share PHI needed to let these people know where you are, your general condition or your death.
            • We may share your PHI with a public or private agency (for example, American Red Cross) for disaster relief purposes. Even if you ask us not to, we may share your PHI, if we need to for an emergency. If you do not want us to use or disclose your PHI in the above situations, please tell the person who registered you or call the UCA Corporate Offices or any nearby affiliated UCA center. If you ask not to be included in the patient directory, you will not receive any cards or flowers that are sent to the facility for you. Also, we will not tell callers or visitors that you are here.

We may contact you to remind you of an appointment.

We may use and/or disclose PHI to contact you to remind you about an appointment you have for treatment or medical care. 

We may contact you with information about treatment, services, products or health care providers.

We may use and/or disclose PHI to manage or coordinate your health care. This may include telling you about treatments, services, products and/or other health care providers. We may also use and/or disclose PHI to give you gifts of a small value. 

    EXAMPLE: If you learn that you have diabetes, we may tell you about nutritional and other counseling services that may help you. 

We may contact you to raise money for our organization. 

    We may use and/or disclose PHI about you, including disclosure to a foundation, to contact you to raise money. We will only share your name, address, telephone number and the dates you received treatment or services at the hospital, unless you give us written permission to share more information. If you do not want to be contacted in this way, you must write to UCA Corporate Privacy Official.


In any situations other than those listed above, we will ask for your written permission before we use or disclose your PHI. If you sign a written authorization allowing us to disclose PHI about you in a specific situation, you can later cancel your authorization in writing. We will not disclose PHI about you after we receive your cancelation, except for disclosures that were made before we got your cancelation.


    1. You have the right to ask us to restrict the uses and disclosures of your PHI. 

    You have the right to ask that we restrict the use and disclosure of your PHI. You must ask us in writing. We do not have to agree to your request. Even if we agree to your request, in certain situations your restrictions may not be followed. You may ask for a restriction by filling out a form that you can get from the registration desk or your care giver. We will write to you to tell you if your request was granted. 

    2. You have the right to ask for different ways to communicate with you. 

    You have the right to ask how and where we contact you about PHI. For example, you may ask that we contact you at your work address or phone number instead of contacting you at home. If your request is reasonable, then we must do what you ask, if we can. In order for us to do this, you must give us information about how payment, if any, will be handled. You also must give us another address or other way to reach you. 

    3. You have the right to see and copy your PHI. 

    You have the right to see and get a copy of your PHI. You must ask us in writing by filling out a form that you may get from the UCA Corporate Headquarters or any UCA affiliated center. We may charge you a fee to do this. There are some situations where we do not have to do what you ask. 

    4.  You have the right to ask for changes to your PHI 

    You have the right to ask us to make changes to your PHI. You must ask us in writing by filling out a form that you can get from the UCA Corporate Headquarters or any UCA affiliated center. You must tell us why you want us to make the change. We do not have to make the change. 

    5. You have the right to a list of certain people or organizations who have gotten your PHI from us. 

    If you ask in writing, you can get a list of certain of our disclosures of your PHI. You may ask for disclosures made in the last six (6) years. We cannot give you a list of any disclosures made before April 14, 2003. We must give you a list of only certain disclosures. If you ask for a list of disclosures more than once in 12 months, we can charge you a reasonable fee. You may ask for a listing of disclosures by filling out a form that you can get from our Department of Health Information Services or the registration desk. 

    6. You have the right to a copy of this Notice.

You can get a copy of this Notice by asking the UCA Corporate office to supply it. We will give patients a copy of this Notice on the encounter at any UCA affiliated center and after that notice is implied all others.  


Some individual state laws give greater protection of privacy than federal laws. We must follow both federal and state law. These North Carolina laws may apply to our treatment of you:

  • Each state has applicable laws that protect the privacy of PHI about mental health treatment. Before sharing mental health information about you with others for treatment, payment or health care operations, we will ask that you sign a form giving us permission to share that information.
  • If you ask for treatment and rehabilitation for drug abuse, your request will be confidential. We will not give your name to any police officer or other law enforcement officer unless you give us permission to do so. Even if we refer you to another person for help, we will keep your name confidential.
  • If you have a communicable disease (for example, tuberculosis, syphilis or HIV/AIDS), information about your disease will be kept confidential, and will not be shared without your written permission except in limited situations. For example, we will get your permission to share this information for payment purposes. However, we do not need to get your permission to report information about your disease to state and local health officials or to prevent the spread of the disease.

Special provisions for persons under the age of 18: Under most state laws, persons under the age of 18 may give permission for services to prevent, diagnose and/or treat certain illnesses including: sexually transmitted diseases and other diseases that must be reported to the state (such as HIV); pregnancy; abuse of drugs or alcohol; and emotional disturbances. In general, a person under the age of 18 cannot terminate a pregnancy unless she has permission from a parent, guardian or a grandparent with whom she has been living for at least six (6) months. The only way to terminate a pregnancy without this permission is if a court orders that the person under age 18 can make this decision for herself. If you are under the age of 18 and you give permission for one of these services, you have all the rights stated in this Notice relating to that service. If you are under the age of 18 and you have been married; are a member of the armed services or have been "emancipated" by a judge, then you have the right to be treated as an adult for all purposes. This means that you have all the rights stated in this Notice for all services.


If you think we have violated your privacy rights, or you want to complain to us about our privacy practices, you may contact the UCA Privacy Official. You also may write to the United States Secretary of the Department of Health and Human Services. If you file a complaint, we will not take any action against you or change our treatment of you in any way.


This Notice of Privacy Practices is effective on April 1, 2008.