Notice of Privacy Practices

Doctors' Only Urgent Care

Effective Date: November 6, 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.

Our Legal Duty

Doctors' Only Urgent Care is required by federal and state law (including the Health Insurance Portability and Accountability Act of 1996, "HIPAA," and the Health Information Technology for Economic and Clinical Health Act, "HITECH") to maintain the privacy and security of your Protected Health Information (PHI). We are also required to provide you with this Notice of Privacy Practices describing our legal duties and privacy practices regarding your medical information, to abide by the terms of this notice currently in effect, and to notify you following any breach of unsecured PHI.

How We May Use and Disclose Your Health Information

We may use and share your health information for the following purposes without your written authorization:

1. Treatment

We use and disclose your PHI to provide, coordinate, or manage your healthcare services and telemedicine consultations.

• Example: Our treating physician, Dr. Syed K. Raza, reviews your symptoms, medical history, and lab reports during your video or phone consultation and may electronically transmit a prescription to your designated pharmacy.
  

2. Payment

We use and disclose your PHI to bill and collect payment for services rendered, whether through private health insurance plans, Medicare, FSA/HSA programs, or self-pay card processing.

• Example: We submit required clinical diagnostic codes to your health insurer (e.g., Blue Cross Blue Shield of Illinois, UnitedHealthcare, Aetna, Cigna, or Medicare) to verify coverage and obtain reimbursement for your virtual visit.
  

3. Healthcare Operations

We use your PHI to support the business and quality improvement activities of our clinical practice.

• Example: We evaluate consultation quality, audit technical systems, conduct compliance training, and verify the performance and security of our telehealth software.
  

4. Telemedicine & Virtual Communications

As a telehealth practice, your PHI is created, received, transmitted, and maintained electronically.

• We transmit PHI across secure, encrypted audio and video consultation tools, patient portals, and electronic communication channels.
  

• We may send administrative appointment confirmations, consultation links, or billing notifications via secure email or SMS text message.
  

5. Business Associates

We contract with third-party vendors who provide services on our behalf (e.g., cloud-hosted electronic health record software, billing processors, and secure video servers). All business associates sign formal Business Associate Agreements (BAAs) binding them to the same strict privacy and security standards governing our practice.

Additional Disclosures Permitted or Required by Law

We may share your PHI without your authorization under specific statutory circumstances:

• Public Health & Safety: To report contagious diseases, adverse drug reactions, or suspected abuse,neglect, or domestic violence to state and public health authorities.
  

• Health Oversight Activities: To state medical boards, the Illinois Department of Public Health, or federal agencies conducting audits, investigations, and licensure oversight.
  

• Judicial and Administrative Proceedings: In response to a valid court order, subpoena, or administrative summons.
  

• Law Enforcement: When required by law or in limited emergency circumstances to report crimes or locate individuals.
  

• Preventing a Serious Threat to Health or Safety: When necessary to prevent or lessen an imminent threat to the health or safety of you, another individual, or the public.
  

• Workers’ Compensation: As authorized to comply with state workers' compensation laws.
  

Uses and Disclosures Requiring Your Written Authorization

Any use or disclosure not detailed in this notice requires your specific written authorization. In particular, we will never:

• Sell your PHI to third parties.
  

• Use or disclose your PHI for marketing purposes without your express authorization.
  

• Share your clinical documentation with unauthorized commercial tracking technologies or advertisers.
  

You may revoke any written authorization at any time in writing, except to the extent that our practice has already taken action in reliance on it.

Your Rights Regarding Your Health Information

You have the following rights under HIPAA regarding the medical records we maintain about you:

1. Right to Inspect and Obtain Copies

You have the right to inspect and obtain an electronic copy of your designated medical and billing records. You may request your records by contacting us at info@doctorsonlyurgentcare.com. We will provide access or electronic copies within 30 days.

2. Right to Amend Records

If you believe that your health record is incorrect or incomplete, you may submit a written request asking us to amend the record. We may deny your request under certain conditions (such as if we did not create the record or if it is currently accurate), but we will provide our reasoning in writing within 60 days.

3. Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or operations. While we are not required to agree to every restriction, we must agree if you request that we not disclose PHI to a health plan for payment or health care operations purposes, provided you have paid for the service in full out-of-pocket (e.g., our flat self-pay virtual visit).

4. Right to Confidential Communications

You have the right to request that we communicate with you via a specific method or at an alternative address or phone number (e.g., contacting you exclusively via a secondary email address rather than phone).

5. Right to an Accounting of Disclosures

You have the right to request a list (accounting) of instances where we shared your health information over the past six years, excluding disclosures made for treatment, payment, healthcare operations, or those made pursuant to your written authorization.

6. Right to Breach Notification

You have the right to be notified in writing if an unauthorized acquisition, access, use, or disclosure of your unsecured PHI occurs that compromises its security or privacy.

7. Right to a Copy of This Notice

You have the right to review, download, or print a copy of this notice from our website at any time, or request an electronic or paper copy sent to you directly.

Changes to This Notice

We reserve the right to revise this Notice of Privacy Practices at any time. Any changes will apply to all PHI we currently hold as well as any information received in the future. The updated notice will be posted promptly on our website at [https://doctorsonlyurgentcare.com](https://doctorsonlyurgentcare.com) with its revised effective date.

Questions and Complaints

If you have questions about this notice, believe your privacy rights have been violated, or wish to file a complaint, you may contact our Privacy Official:

Privacy Officer

Doctors' Only Urgent Care

Telephone: 844-318-5500

Email: info@doctorsonlyurgentcare.com

Website: doctorsonlyurgentcare.com

You may also file a formal written complaint with the U.S. Department of Health and Human Services Office for Civil Rights (OCR):

Office for Civil Rights (Region V - Illinois)

U.S. Department of Health and Human Services

233 N. Michigan Ave., Suite 240, Chicago, IL 60601

Online Portal: hhs.gov/ocr/privacy/hipaa/complaints

Phone: 1-800-368-1019 | TDD: 1-800-537-7697

We will not retaliate or penalize you in any way for filing a complaint.