NOTICE OF PRIVACY PRACTICES
Effective Date: 4/6/2026
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
Prime Form Care, LLC is committed to protecting the privacy and confidentiality of your protected health information (“PHI”). This Notice describes how we may use and disclose your health information and outlines your rights under applicable federal and state laws, including HIPAA.
How We May Use and Disclose Your Information
We may use and disclose your PHI for the following purposes:
Treatment
We may use your information to provide, coordinate, and manage your care, including communication with pharmacies, laboratories, and other healthcare providers.
Payment
We may use your information to bill and collect payment for services rendered.
Healthcare Operations
We may use your information for administrative, quality assurance, and operational purposes.
We limit uses and disclosures to the minimum necessary where applicable under law.
Other Uses and Disclosures
We may also disclose your information:
- To comply with applicable laws and regulations
- In response to legal processes (e.g., subpoenas)
- To prevent or reduce a serious threat to health or safety
- For public health reporting
- For health oversight activities
Uses not described in this Notice will be made only with your written authorization, which you may revoke at any time in writing.
Telehealth Services
Services may be provided via telehealth using secure, HIPAA-compliant platforms. Reasonable safeguards are used to protect your information.
Third-Party Services
We may share your information with Business Associates who assist in operations, including:
- Electronic health record systems
- Laboratories
- Pharmacies (including compounding pharmacies)
- Other healthcare-related service providers
- Payment processors
These entities are contractually required to safeguard your information.
Your Rights
You have the right to:
- Access and obtain a copy of your records
- Request corrections
- Request restrictions on certain disclosures
- Request confidential communications
- Receive an accounting of disclosures
- File a complaint
- Receive a paper copy of this Notice upon request
- Provide authorization for certain uses and disclosures and revoke that authorization in writing
How to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with:
Privacy Officer
Prime Form Care, LLC
Email: contact@primeformcare.com
You may also file a complaint with the
U.S. Department of Health and Human Services Office for Civil Rights.
We will not retaliate against you for filing a complaint.
Our Responsibilities
We are required to:
- Maintain the privacy of your information
- Provide this Notice
- Notify you of breaches
- Follow the terms of this Notice
Changes to This Notice
We reserve the right to update this Notice. Updates will be posted on our website with a revised effective date.