Clinic: Wild Prairie Primary Care

Effective Date: 09/01/2025

Notice of Privacy Practices

Note: This Notice of Privacy Practices is generated by the clinic's EHR system and presented to patients electronically for acknowledgment (via iPad). This paper copy is provided upon request.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Legal Duties

Wild Prairie Primary Care is required by law to maintain the privacy of your protected health information (PHI) and to provide you with this notice of our legal duties and privacy practices. We must abide by the terms of this Notice for as long as it remains in effect.

We reserve the right to change this Notice and make the new provisions effective for all PH| that we maintain. If changes occur, we will make the revised Notice available.

Uses and Disclosures of Your Protected Health Information

Authorization and Consent

We will not use or disclose your PHI for purposes other than treatment, payment, or healthcare operations unless you have provided written authorization. You may revoke your authorization at any time in writing, except where we have already relied on it or where authorization was a condition of obtaining insurance coverage.

For Treatment

We may use and disclose your PHI to provide you with medical treatment and coordinate your care. For example, doctors and nurses may share information in your record to manage your care, prescribe medications, or order tests.

For Payment

We may use and disclose your PHI as necessary to obtain payment for services rendered. This may include sending information to your insurance company so they can reimburse us for your care.

For Healthcare Operations

We may use and disclose your PHI as necessary for our healthcare operations. This includes quality improvement activities, reviewing staff performance, and training purposes.

Your Rights

You have the right to:

• Request a copy of this Notice at any time.

• Inspect and request a copy of your medical record.

• Request an amendment to your record if you believe it is incorrect.

• Request restrictions on certain uses and disclosures of your PHI.

• Request confidential communication methods (e.g., only calling a specific phone

number).

• File a complaint if you believe your privacy rights have been violated.

Contact Information

If you have questions about this Notice, or if you wish to exercise your rights under HIPAA, please contact:

Privacy Officer: Juniper Vale, MD

Wild Prairie Primary Care

603-727-9175