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.
This
Notice of Privacy Practices describes how we may use and
disclose your protected health information (PHI) to carry
out treatment, payment or health care operations (TPO) and
for other purposes that are permitted or required by law.
It also describes your rights to access and control your
protected health information. "Protected health information"
is information about you, including demographic information
that may identify you and that relates to your past, present
or future physical or mental health or condition and related
health care services.
1.
Uses and Disclosures of Protected Health Information.
Uses
and Disclosures of Protected Health Information
Your protected health information may be used and disclosed
by your physician, our office staff and others outside of
our office that are involved in your care and treatment
for the purpose of providing health care services to you,
to pay your health care bills, to support the operation
of the physician's practice and any other use required by
law.
Treatment:
We will use and disclose your protected health information
to provide, coordinate, or manage your health care and any
related services. This includes the coordination or management
of your health care with a third party. For example, we
would disclose your protected health information, as necessary,
to a home health agency that provides care to you. For example,
your protected health information may be provided to a physician
to whom you have been referred to ensure that the physician
has the necessary information to disagnose or treat you.
Payment:
Your protected health information will be used, as needed,
to obtain payment for your health care services. For example,
obtaining approval for a hospital staff may require that
your relevant protected health information be disclosed
to the health plan to obtain approval for the hospital admission.
Healthcare
Operations: We may use or disclose, as needed, your protected
health information in order to support the business activities
of your physician's practice. These activities include,
but are not limited to, quality assessment activities, employee
review activities, training of medical students, licensing,
and conducting or arranging for other business activities.
For example, we may disclose your protected health information
to medical school students that see patients at our office.
In addition, we may use a sign-in sheet at the registration
desk, where you will be asked to sign your name and indicate
your physician. We may also call you by name in the waiting
room when your physician is ready to see you. We may use
or disclose your protected health information, as necessary,
to contact you to remind you of your appointment.
We
may use or disclose your protected health information in
the following situations without your authorization. These
situations include: as Required By Law, Public Health issues
as required by law, Communicable Diseases, Health Oversight,
Abuse or Neglect, Food and Drug Administration requirements,
Legal Proceedings, Law Enforcement, Coroners, Funeral Directors
and Organ Donation Research, Criminal Activity, Military
Activity and National Security, Workers' Compensation, Inmates,
Required Uses and Disclosures. Under the law, we must make
disclosures to you and when required by the Secretary of
the Department of Health and Human Services to investigate
or determine our compliance with the requirements of Section
164.500.
Other
Permitted and Required Uses and Disclosures Will Be Made
Only With Your Consent, Authorization or Opportunity to
Object unless required by law.
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You
may revoke this authorization, at any time, in writing, except
to the extent that your physician or the physician's practice
has taken an action in reliance on the use or disclosure indicated
in the authorization.
Your
Rights
Following is a statement of your rights with respect to your
protected health information.
You
have the right to inspect and copy your protected health information.
Under federal law, however, you may not inspect or copy the
following records, psychotherapy notes, information compiled
in reasonable anticipation of, or use in, a civil, criminal,
or administration action or proceeding, and protected health
information that is subject to law that prohibits access to
protected health information.
You
have the right to request a restriction of your protected
health information. This means you may ask us not to use or
disclose any part of your protected health information for
the purposes of treatment, payment or healthcare operations.
You may also request that any part of your protected health
information not be disclosed to family members or friends
who may be involved in your care or for notification purposes
as described in this Notice of Privacy Practices. Your request
must state the specific restriction requested and to whom
you want the restriction to apply.
Your
physician is not required to agree to a restriction that you
may request. If physican believes it is in your best interest
to permit use and disclosure of your protected health information,
your protected health information will not be restricted.
You then have the right to use another Healthcare Professional.
You
have the right to request to receive confidential communications
from us by alternative means or at an alternative location.
You have the right to obtain a paper copy of this notice from
us, upon request, even if you have agreed to accept this notice
altenatively, i.e. electronically.
You
may have the right to have your physican amend your protected
health information. If we deny your request for amendment,
you have the right to file a statement of disagreement with
us and we may prepare a rebuttal to your statement and will
provide you with a copy of any such rebuttal.
You
have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information.
We
reserve the right to change the terms of this notice and will
inform you by mail of any changes. You then have the right
to object or withdraw as provided in this notice.
Complaints
You may complain to us or to the Secretary of Health and Human
Services if you believe your privacy rights have been violated
by us. You may file a complaint with us by notifying our privacy
contact of your complaint. We will not retaliate against you
for filing a complaint.
This
notice was published and becomes effective on/or before April
14, 2003.
We are required by law to maintain the privacy of, and provide
individuals with, this notice of our legal duties and privacy
practices with respect to protected health information. If
you have any objections to this form, please ask to speak
with our HIPAA Compliance Officer in person or by phone at
our Main Phone Number.
Call
(559) 638-2246 for our HIPAA Compliance Officer or for any
questions you might have.
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