Your first visit
On your first visit, you will be asked to give us a photo identification card, your insurance card (if you have coverage) and some basic demographic information. For a faster first visit, bring in your filled-out paperwork. Just download this forms, print it, fill in your information and give it to the receptionist.
New Patient, Patient Rights and Responsibilities and Registration (PDF)
We will also take your medical history during your first visit to ensure that you are given the best treatment plan possible. It is also important to bring in a list of medications you are currently taking, as well as a list of allergies you may have.
How We Collect Information About You
Urgent Care of Mountain View (UCMV) and its employees and volunteers collect data through a variety of means including, but not necessarily limited to, letters, phone calls, emails, voice mails, and from the submission of applications that is either required by law, or necessary to process applications or other requests for treatment through our organization.
What We Do Not Do With Your Information
Information about your financial situation, medical conditions and care that you provide to us in writing, via email, on the phone(including information left on voicemails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence. We do not give out, exchange, barter, rent, sell, lend, or disseminate any information about applicants, or clients who apply for or actually receive our services, that is considered patient confidential, is restricted by law, or has been specifically restricted by a patient/client in a signed HIPAA consent form.
How We Do Use Your Information
Information is only used as is reasonably necessary to process your insurance claims or to provide you with health or counseling services which may require communication between UCMV and health care providers, medical product or service providers, pharmacies, insurance companies, and other providers necessary to: verify your medical information is accurate; determine the type of medical supplies or any health care services you need including, but not limited to; or to obtain or purchase any type of medical supplies, devices, medications and insurance.
If you receive treatment through us and provide information with the intent or purpose of fraud or that results in either an actual crime of fraud for any reason including willful or un-willful acts of negligence, whether intended or not, or in any way demonstrates or indicates attempted fraud, your non-medical information can be given to legal authorities including police, investigators, courts, and/or attorneys or other legal professionals, as well as any other information as permitted by law.
Notice Privacy Practices (PDF)