2521 West Main Street
Norristown, PA 19403
Phone: (610) 539-3221
Fax: (610) 539-3222
E-Mail Us



This Notice Describes How Medical Information
About You May Be used and Disclosed And
How You Can Get Access to this Information.

Valley Forge Urgent Care values you as a customer and protection of your privacy is very important to us. In conducting our business, we will create and maintain records that contain protected health information about you and the health care provided to you.

“Protected health information” or “PHI” is information about you, including information about where you live, that can reasonably be used to identify you and that relates to your past, present or future physical or mental health condition, the provision of health care to you or the payment for that care.

We protect your privacy by:

  • Limiting who may see your PHI
  • Limiting how we may use or disclose your PHI
  • Informing you of our legal duties with respect to your phi
  • Explaining our privacy policies and
  • Adhering to the policies currently in effect

This notice describes our privacy practices, which include how we may use, disclose, collect, handle, and protect our members protected health information. We are required by certain federal ad state law to maintain the privacy of your

Protected health information. We also are required by the federal Health Insurance Portability and Accountability Act (or “HIPAA”) Privacy Rule to give you this Notice about our privacy practices, our legal duties, and your rights concerning your protected health information.

Copies of this Notice

You may request a copy of our Notice at any time. If you want more information about our private practices, or have questions or concerns, please contact Member Services by calling our telephone number, 610-539-3221. Contact us using the contact information at the end of this Notice.

Changes to this Notice

The terms of this Notice apply to all records that are created or retained by us which contain your PHI. We reserve the right to revise or amend the terms of this Notice. A revised or amended Notice will be effective for the entire PHI that we already have about you, as well as for any PHI we may create or receive in the future. We are required by law to comply with whatever Privacy Notice is currently in effect. We will Post any material change to our Privacy Notice before the change becomes effective, in our waiting room or you may request a copy. It will also be posted on our website.

Potential Impact of State Law

The HIPAA Privacy Rule generally does not “preempt” (or take precedence over) state privacy or other applicable laws that provide individuals greater privacy protections. As a result, to the extent state law applies, the privacy laws of a particular state, or other federal laws, rather than the HIPAA Privacy Rule, might impose a privacy standard under which we will be required to operate. For example, where such laws have been enacted, we will follow more stringent state privacy laws that relate to uses and disclosures of the protected health information concerning HIV or AIDS, metal health, substance abuse/chemical dependency, genetic testing, reproductive rights, etc.

How We May Use and Disclose Your Protected Health Information (PHI)

In order to administer our health care programs effectively, we will collect, use and disclose PHI for certain of our activities, including payment of covered services and health care operations.

The following categories describe the different ways in which we may use and disclose your PHI. Please note that every permitted use or disclosure of your Phi is not listed below. However, the different ways we will, or might, use or disclose your PHI do fall within one of the permitted categories described below.


We may use and disclose your PHI for all payment activities including, but not limited to, collecting payments from you or your medical insurance carrier. This may include coordinating benefits with other Health care programs, such as Medicare or Medicaid.

Health Care Operations:

We may use and disclose your PHI to conduct and support our business and management activities as a health care provider.

We may also use and disclose your PHI to provide you with reminders to obtain preventive health services, and to inform you of treatment alternatives and or health related benefits and services that may be of interest to you.


WE may use or disclose you PHI for research purposes if certain conditions are met. Before we disclose your PHI for research purposes without your written permission, an Institutional Review Board( a board responsible under federal law for reviewing and approving research involving human subjects) or Privacy Board reviews the research proposal to ensure that the privacy of your PHI is protected, and to approve the research.

Required by Law:

We may use disclose your PHI when required to do so by applicable law. For example, the law requires us to disclose your PHI:

  • When required by the Secretary of the U.S. department of health and human services to investigate our compliance efforts; and
  • To health oversight agencies, to allow them to conduct audits and investigations of the health care system, to determine eligibility for government program standards, and for certain civil rights enforcement actions.

Public Health Activities:

We may disclose your PHI to public health agencies for public health activities that are permitted or required by law, such as to:

  • Prevent or control disease, injury or disability
  • Maintain vital records , such as births and deaths
  • Report child abuse and neglect,
  • Notify a person about potential exposure to a communicable disease,
  • Notify a person about a potential risk for spreading or contraction a disease or condition
  • Report reactions to drugs or problems with products or devices,
  • Notify individuals if a product or device they may be using has been recalled
  • Notify appropriate government agency (ies) and authority (ies) about the potential abuse or neglect of an adult patient, including domestic violence

Health Oversight Activities:

We may disclose your PHI to a health oversight agency for activities authorized by laws such as audits, investigations, inspections, licensure or disciplinary actions or civil, administration, or criminal proceedings or actions. Health oversight agencies seeking this information included government agencies that oversee: (1) the health care system ;( 2) government benefit programs; (3) other government regulatory programs; and (5) compliance with civil rights laws.

Lawsuits and Other Legal Disputes:

We may disclose your PHI in response to a court or administration order, subpoena, discovery request, or other lawful process once we have met all administration requirements of the HIPAA Privacy Rule.

Law Enforcement:

We may disclose your PHI to law enforcement officials under certain conditions. For example, we may disclose PHI

  • To permit identification and location of witnesses, victims, and fugitives
  • In response to a search warrant or court order;
  • As necessary to report a crime on our premises;
  • To report a death that we believe may be the result of criminal conduct; or
  • In an emergency, to report a crime

Coroners, Medical Examiners, or Funeral Directors:

We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We also may disclose, as authorized by law, information to funeral directions so that they may carry out their duties.

Organ and Tissue Donations:

We may use or disclose your PHI to organizations that handle organ and tissue donation and distribution, banking or transplanting.

To Prevent a Serious Threat to Health or Safety:

As permitted by law, we may disclose your PHI if we believe that the disclosure is necessary to prevent or lesser a section and imminent threat to the health or safety of a person or the public.

Military and National Security:

We may disclose to military authorities the PHI of Armed Forces personnel under certain circumstances. We may disclose to authorize federal officials PHI required for lawful intelligence, counter-intelligence, and other national security activities.


If you are a prisons inmate, we may disclose you PHI to the prison or to a law enforcement official for: (1) the prison to provide health care for you; (2) your health and safety, and health and safety of others; or (3) the safety and security of the prison.

Workers’ Compensation:

As part of your workers’ compensation claim, we may have to disclose your PHI to a worker’s compensation carrier.

To You:

When you ask us to, we will disclose to you your PHI that is in a “designated record set.” Generally, a designated record set contains medical records claims and billing records we may have about you, as well as other records that we use to make decisions about health care. You can request the PHI from your designated record set as described below called “You’re Privacy Rights concerning your Protected Health Information.”

To Your Personal Representative:

If you tell us to, we will disclose your PHI to your personal representative according to any relevant state laws. In order for us to disclose your PHI to your personal representative you must send us documentation that supports the person’s qualification according to state law (such as a power of attorney or guardianship). However, the HIPAA Privacy rule permits us to choose not to treat that person as your personal representative when we have a reasonable belief that (1) you have been, or may be, subjected to domestic violence, abuse or neglect by the person; (2) treating the person as your personal representative could endanger you; or (3) in our professional judgment, it is not in your best interest to treat the person as your personal representative

To Family and Friends:

Unless you object we may disclose your PHI to a friend or family member who has been identified as being involved in your health care. We also may disclose your PHI to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. If you neither are nor present or able to agree to these disclosures of your PHI, then we may, using our professional judgment, determine whether the disclosure is in your best interest.

Parents as Personal Representatives of Minors:

In most cases, we may disclose your minor child’s PHI to you. However, we may be required to deny a parent’s access to a minor’s PHI according to applicable state law

Right to Provide an Authorization for Other Uses and Disclosures
  • Other uses and disclosures of your PHI that are described above will be made only with your written authorization.
  • You may give us written authorization for uses and disclosures of your PHI that are not identified by this Notice, or are not otherwise permitted by applicable law.

Any authorization that you provide to us regarding the use and disclosure of your PHI may be revoked by you writing at any time. After you revoke your authorization, we will no longer use or disclose your PHI for the reason described in the authorization. Of course, we are unable to take back any disclosures that we have already made with your authorization. We may also be required to disclose PHI as necessary for purposes of payment for services received by you prior to the date when you revoke your authorization.

Your authorization must be in writing and contain certain elements to be considered a valid authorization. For your convenience, you may use our approved Authorization form.

Your Privacy Rights Concerning Your Protected Health Information:

You have the following rights regarding the PHI that we maintain about you. Requests to exercise your rights as listed below must be in writing.

Rights to Access Your PHI:

You have the right to inspect or get copies of your PHI contained in a designated record set. Generally, a “designated record set” contains medical, and billing records we may have about you, as well as other records that we may use to make decisions about your health cares. However, you may not inspect or copy psychotherapy notes or certain other information that may be contained in a designated record set.

You may request that we provide copies of your PHI. We may charge a reasonable fee for copies of PHI (based on our costs), for postage, and for a custom summary or explanation of PHI. You will receive notification of any fee(s) to be charged before we release your PHI, and you will have the opportunity to modify your request in order to avoid or reduce the fee. In certain situations we may deny your request for access to your PHI. If we do, we will tell you our reasons in writing, and explain your rights to have the denial reviewed.

Right to Amend Your PHI:

You have the right to request that we may amend your PHI if you believe there is a mistake in your PHI, or that important information is missing. Approved amendments made to your PHI will also be sent to those who need to know. We may also deny your request if, for instance, we did not create the information you wanted amended. If we deny your request to amen your PHI, we will tell you our reasons in writing, and explain your right to file a written statement of disagreement.

Right to Request Restrictions:

You have the right to request, in writings, that we place additional restrictions on our use or disclosure of your PHI. We are not required to agree to your request. However, if we do agree, we will bound by our agreement except when required by law, in emergencies, or when information is necessary to treat you. An approved restriction continues until you revoke it in writing, or until we tell you that we are terminating our agreement to a restriction.

Right to Request Confidential Communications:

You may have the right to request, in writing, that we may use alternate means or an alternative location to communicate with you in confidence about your PHI. For instance, you may ask us if we contact you by mail, rather than by telephone, or at work, rather than at home. Your written request must clearly state that the disclosure of all or part of your PHI at your current address or method of contact we have on record could be an endangerment to you. We will require that you will provide a reasonable alternate address or other method of contact for the confidential communications. In assessing reasonableness, we will consider our ability to continue to receive payment and conduct health care operations effectively, and the subscriber’s right to payment information. We may exclude certain communications that are commonly provided to all members from confidential communications. Examples of such communications include benefit booklets and newsletters.

Right to a Paper Copy of this Notice:

You have the right to receive a paper copy of our Notice of Privacy Practices. You can request a copy at any time, even if you have agreed to receive this notice electronically.

Your Right to File A Privacy Complaint:

If you believe your privacy rights have been violated, or if you are dissatisfied with Valley Forge Urgent Care practices or procedures, you may file a compliant. You will not be penalized for filing a complaint.

To file a privacy complaint with us, you may contact Medical Director’s telephone number.

Radha K. Mahajan, M.D.

2521 West Main Street

Norristown, Pa 19403