NOTICE: PATIENT PRIVACY

We are committed to preserving the privacy of your personal health information. In fact, we are required to protect the privacy of your medical information and to provide you with a Notice describing:

HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THE INFORMATION.

We use the health information about you for treatment, to obtain payment for the treatment, for administrative purposes, and to evaluate the quality of care that you receive.

We may be required or permitted by certain laws to use and disclose your medical information for other purposes without your consent or authorization.

As our patient, you have important rights relating to inspecting and copying your medical information that we maintain, amending or correcting that information, obtaining an accounting of your disclosures of your medical information, requesting that we restrict certain uses and disclosures of your health information, and complaining if you think your rights have been violated.

We have available a detailed Notice of Privacy Practices which fully explains your rights and our obligations under the law. We may revise our Notice from time to time. The effective date at the top right hand side of this page indicates the date of the most current Notice in effect.

You have the right to receive a copy of our most current Notice in effect. If you have not yet reserved a copy of our current Notice, please ask a ProvidaCare employee and we will provide you with a copy.

If you have any questions, concerns or complaints about the Notice or your medical information, please contact us at (512) 733 – 6518 or stop by one of our offices between the hours of 9:00 am – 3:00 pm Monday through Friday or call the numbers listed below after hours.

•21 Cypress Blvd Suite 1150 Round Rock, TX 78664 512 – 733 – 6500
•3724 Executive Ctr Dr Ste 250 Austin, TX 78731 512 – 326 – 9898
•3453 IH 35 North Suite 210 San Antonio, TX 78219 210 – 226 – 8700
•1300 Hwy 281 Marble Falls, TX 78654 830 – 693 – 7363
•1514 South 31st Street Temple, TX 76504 254 – 778 – 2727
•831 E. 2nd St Duluth MN 55805 218 – 727 – 5555
•414 Great Oak Dr Waite Park MN 56387 320 – 257 – 7000
•601 Hwy 10 East Detroit Lakes, MN 56501 218 – 844 – 2273