Privacy Policy


Protected Health Information           


Use and Disclosure of information

I understand that Patient’s medical records are confidential and cannot be disclosed without my written authorization except as authorized by law. Authorized disclosures are addressed in the Notice of Privacy Practices I have received. I understand that  Patient’s medical information includes past, present and future  information and may include genetic testing / counseling, communicable  disease information including Human Immunodeficiency Virus (HIV) and  Acquired Immune Deficiency Syndrome (AIDS), records related to mental health treatment / psychiatric care and alcohol / substance abuse  diagnosis or treatment (collectively, Medical Information). I authorize  release of that Medical Information, as part of Patient’s medical record. I understand that UHC must keep Patient’s medical records for a time period required by law and then may dispose of them  as permitted or required by law.             


Consent for Electronic Sharing and Health Information Exchange

I authorize Urgent House Calls (UHC) to use Patient’s Medical  Information for Patient’s treatment and related services. Unless I object below, I authorize UHC to release and send Patient’s Medical Information to Patient’s non-UHC health care providers electronically and/or through a Health Information Exchange, an organization that provides services to enable the electronic sharing of health-related information. Medical Information disclosed pursuant to this authorization may be used for treatment, payment and operational  purposes. The Medical Information disclosed may become part of my  non-UHC health care providers’ medical records and may be re-disclosed by the recipient and no longer protected by state or federal privacy laws. I understand that I can change my mind and withdraw this  authorization at any time, but UHC cannot take back information that has already been electronically shared. This consent is  valid unless I have withdrawn it.             


  • I do not authorize UHC to send text messages to my cell phone number.
  • I do not want Patient’s Medical Information shared electronically with non-UHC health care providers. I  understand, however, that if electronic sharing is required by law, UHC must act in compliance with the law.
  • I do not want Patient’s Medical Information shared with Health Information Exchanges. I understand, however, that if electronic sharing with a Health Information Exchange is required by law, UHC must act in compliance with the law. I further  understand that certain Medical Information may be shared with a Health Information Exchange in a manner that does not identify Patient

Patient Rights

I have been provided information regarding Patient Rights and Responsibilities. You may complain to us or to the Secretary of Health and Human Services  if you believe your privacy rights have been violated by us. You may  file a complaint with us by notifying our privacy officer of your complaint at our office and main telephone number. We will not retaliate against you for filing a complaint.