HIPAA Notice

Understanding how your protected health information is used, disclosed, and safeguarded.

Privacy Commitment

Our Commitment

Effective Date: April 21, 2026

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.

Prime Form Care is committed to protecting the privacy of your protected health information (PHI). We are required by law to maintain the privacy of your PHI, provide you with this notice of our legal duties and privacy practices, and follow the terms of this notice.

Your Information

Use, Disclosure & Your Rights

How We May Use Your PHI

  • •Treatment: To provide, coordinate, or manage your healthcare and related services.
  • •Payment: To obtain payment for services, including billing and collections.
  • •Healthcare Operations: For quality assessment, compliance activities, and administrative functions.
  • •As Required by Law: When required by federal, state, or local law.
  • •Public Health: For reporting diseases or adverse reactions to medications.

Your Rights

  • •Access: Request access to your PHI maintained by us.
  • •Amend: Request amendments if you believe information is inaccurate.
  • •Accounting: Request an accounting of certain disclosures.
  • •Restrict: Request restrictions on certain uses and disclosures.
  • •Confidential Communications: Request specific communication methods.
  • •Copy: Request a paper copy of this notice at any time.

Complaints & Contact

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Prime Form Care — Privacy Officer
11166 Fairfax Blvd, Suite 500, Fairfax, VA 22030
contact@primeformcare.com · 703-688-8426

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