Firebird Direct Primary Care LLC | Notice of Privacy Practices | Effective October 23, 2026
NOTICE OF PRIVACY PRACTICES
Your Information. Your Rights. Our Responsibilities.
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.
Effective Date: October 23, 2026
Privacy Contact: Mark Hagen, DO, Privacy Officer
Firebird Direct Primary Care LLC | 7100 N High Street, Suite 202, Worthington, Ohio 43085
Phone: (614) 259-7987 | Email: info@firebirddpc.com | Website: firebirddpc.com
This Notice applies to protected health information maintained by Firebird Direct Primary Care LLC. It explains
your privacy rights, how we may use and disclose your health information, and our responsibilities under
federal and applicable Ohio law.
Your Rights
When it comes to your health information, you have certain rights. We will help you exercise them.
Get an electronic or paper copy of your medical record
You may ask to see or obtain an electronic or paper copy of your medical record and other health
information we maintain about you.
We generally will provide a copy or summary within 30 days of your request. We may charge a reasonable,
cost-based fee when permitted by law.
Ask us to correct your medical record
You may ask us to correct health information that you believe is incorrect or incomplete.
We may deny the request in some circumstances, but if we do, we will explain the reason in writing,
generally within 60 days.
Request confidential communications
You may ask us to contact you in a particular way, such as by phone, secure message, email, or mail, or to
send communications to a different address.
We will accommodate reasonable requests. Secure messaging through AtlasMD is our preferred electronic
method for sensitive health information, although other methods may be used at your request when
appropriate.
Firebird Direct Primary Care LLC | Notice of Privacy Practices | Effective October 23, 2026
Ask us to limit what we use or share
You may ask us not to use or disclose certain health information for treatment, payment, or health care
operations. We are not always required to agree, but if we agree, we will follow the restriction except when
disclosure is needed for emergency treatment or otherwise permitted or required by law.
If you pay for a health care item or service out-of-pocket in full, you may ask us not to disclose information
about that item or service to your health plan for payment or health care operations. We will honor the
request unless disclosure is required by law.
Get a list of certain disclosures
You may request an accounting of certain disclosures of your health information made during the six years
before your request.
The accounting does not include every disclosure, such as many disclosures for treatment, payment, health
care operations, or disclosures you specifically authorized. One accounting in a 12-month period is generally
free; a reasonable, cost-based fee may apply to additional requests.
Get a copy of this Notice
You may ask for a paper copy at any time, even if you agreed to receive it electronically. We will provide a
copy promptly.
Choose someone to act for you
If a person has legal authority to act for you, such as a health care power of attorney or legal guardian, that
person may exercise your privacy rights. We will verify the person's authority before acting.
File a complaint if you believe your rights were violated
You may complain to Firebird Direct Primary Care by contacting the Privacy Officer listed on page 1.
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.
Your Choices
For certain health information, you may tell us your preferences about what we share. If you have a clear
preference, tell us what you want us to do.
You may tell us whether to share relevant information with family members, close friends, caregivers, or
others involved in your care or payment for your care.
You may tell us whether to share information in a disaster-relief situation.
If you cannot tell us your preference, such as when you are unconscious, we may disclose information if we
believe it is in your best interest and the law permits it. We may also disclose information when needed to lessen
a serious and imminent threat to health or safety.
Firebird Direct Primary Care LLC | Notice of Privacy Practices | Effective October 23, 2026
Uses that generally require your written authorization
Marketing purposes, except where the law allows communication without authorization.
Sale of your protected health information.
Most uses and disclosures of psychotherapy notes, if we maintain such notes.
Firebird Direct Primary Care does not sell your protected health information. We do not currently conduct
fundraising using patient health information.
How We Typically Use or Share Your Health Information
Treat you
We may use your health information and share it with other health professionals involved in your care. For
example, we may send relevant records to a specialist, laboratory, imaging facility, pharmacy, hospital, or other
clinician involved in your treatment.
Run our practice
We may use and disclose your health information for health care operations, such as managing your care,
improving quality, reviewing clinical services, training, compliance, scheduling, patient communication, and
operating the Practice. We may use electronic systems and vendors, including our electronic health record,
secure communication tools, and documentation technology, when appropriate safeguards and agreements are
in place.
Obtain payment
We may use and disclose health information as needed to collect payment from you or an authorized third party,
process payments, or address payment-related matters. Firebird Direct Primary Care generally does not submit
insurance claims for DPC membership services. Outside laboratories, imaging centers, specialists, pharmacies, or
other providers may have their own billing and privacy practices.
Other Uses and Disclosures Permitted or Required by Law
We may use or disclose your information in other circumstances permitted or required by law. Applicable
conditions and limitations must be met before we make these disclosures.
Public health and safety activities, such as disease reporting, product recalls, adverse-event reporting,
reporting suspected abuse or neglect, or preventing or reducing a serious threat to health or safety.
Health research when the requirements of applicable law are satisfied.
Compliance with federal or state law, including disclosures to the U.S. Department of Health and Human
Services when it is reviewing our compliance with federal privacy law.
Organ and tissue donation activities.
Coroners, medical examiners, and funeral directors as permitted by law.
Firebird Direct Primary Care LLC | Notice of Privacy Practices | Effective October 23, 2026
Workers' compensation matters.
Certain law-enforcement requests and health-oversight activities as permitted or required by law.
Special government functions, such as certain military, national-security, or protective-service activities.
Court or administrative proceedings, including disclosures made in response to qualifying court orders,
subpoenas, or other lawful process.
Specially Protected Information
Substance Use Disorder Records
If Firebird Direct Primary Care receives or maintains substance use disorder (SUD) patient records protected by 42 CFR Part 2, special federal rules apply. A Part 2 program may obtain a single written consent for future uses and disclosures for treatment, payment, and health care operations. When we receive Part 2 records pursuant to valid consent for those purposes, we may use or disclose them for those purposes as permitted by HIPAA and Part 2. Certain disclosures are permitted without patient consent under limited Part 2 exceptions. A HIPAA-covered recipient may redisclose records received under a valid treatment, payment, or operations consent as HIPAA permits, subject to Part 2 restrictions on use in proceedings against the patient. We will not use or disclose Part 2 records, or testify about them, in civil, criminal, administrative, or legislative proceedings against you except as permitted by Part 2, including where applicable your specific written consent or a qualifying Part 2 court order accompanied by a subpoena or similar legal mandate. If fundraising communications would use Part 2 information, we will provide clear advance notice and a choice about whether to receive them.
Ohio and Other More Protective Laws
Some health information may receive additional protection under Ohio or other applicable law. For example,
Ohio law places specific limits on disclosure of identifiable HIV test results and HIV/AIDS-related information.
Certain behavioral-health records may also be subject to additional confidentiality requirements when those
laws apply. When another applicable law provides greater privacy protection than HIPAA, Firebird Direct
Primary Care will follow the more protective requirement.
Electronic Communications and Technology
Firebird Direct Primary Care may communicate with you by telephone, secure AtlasMD messaging, email, text
message, telehealth, facsimile, or other methods appropriate to your care. Secure channels are preferred for
sensitive information. If you request communication through a method that may carry additional privacy or
security risk, we may honor that request when permitted by law after considering the circumstances.
The Practice may use technology vendors and business associates to support electronic health records, secure
communications, scheduling, payment processing, laboratory coordination, telehealth, document management,
and AI-assisted clinical documentation. When HIPAA requires a business associate agreement or other safeguard,
we require the appropriate protections.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will notify you as required by law if a breach occurs that may have compromised the privacy or security
of your information.
Firebird Direct Primary Care LLC | Notice of Privacy Practices | Effective October 23, 2026
We must follow the duties and privacy practices described in the Notice that is currently in effect.
We will not use or disclose your information other than as described in this Notice unless you authorize us in
writing or the law otherwise permits or requires the use or disclosure.
If you give us a written authorization, you may revoke it in writing at any time, except to the extent we
already acted in reliance on it.
Changes to This Notice
We may change the terms of this Notice, and the changes may apply to all health information we maintain about
you, including information created or received before the change. If we materially revise this Notice, the current
version will be available upon request, in our office, and on our website.
Questions, Requests, or Complaints
Contact our Privacy Officer if you have questions about this Notice, want to exercise a privacy right, or wish to
make a privacy complaint.
Privacy Officer Mark Hagen, DO
Practice Firebird Direct Primary Care LLC
Address 7100 N High Street, Suite 202, Worthington, Ohio
43085
Phone / Email / Website (614) 259-7987 | info@firebirddpc.com | firebirddpc.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200
Independence Avenue, S.W., Washington, D.C. 20201; phone 1-877-696-6775; or through the HHS Office for Civil Rights
complaint process. Firebird Direct Primary Care will not retaliate against you for filing a complaint.