Notice of Privacy Practice for Protected Health Information

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.

With your consent, the practice is permitted by federal privacy laws to make uses and disclosures of the health information for purposes of treatment, payment and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examinations and test results, diagnosis, treatment and applying for future care or treatment. It also includes billing documents for those services.

Example of Uses of Your Health Information:

1. For Treatment Purposes: 

A nurse obtains treatment information about you and records it in your health record. If the doctor determines a need to consult with a specialist, your information may be shared with the specialist for further input.

2. For Payment Purposes: 

We may submit a request for payment to your health insurance company, which may request additional information regarding the medical care received.

3. For Health Care Operations:

We may work with insurers or other business associates for quality assessment and improvement, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We may share your information with these professionals, as needed, to obtain these services.

Your Health Information Rights

The health record we maintain and billing records are physical property of the practice. The information in it, however, belongs to you. You have a right to:

  • Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office. We are not required to grant the request but we will comply with any request granted;
  • Request that you be allowed to inspect and copy your health record and billing record-you may exercise this right by delivering the request in writing to our office;
  • Appeal a denial of access to your protected health information except in certain circumstances;
  • Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office;
  • File a statement of disagreement if your amendment is denied and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
  • Obtain an accounting of disclosures of your health information be maintained by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment or operations, disclosures made to you or made at your request or disclosures made to family members or friends in the course of providing care;
  • Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office; and,
  • Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.

If you want to exercise any of the above rights, please contact our office manager in writing or in person during normal business hours. She will provide you with assistance on the steps to take to exercise your rights. Our address is 366 South Pierce Street, El Cajon, CA 92020. Additionally she can be reached at (619) 334-8880.

Our Responsibilities

The practice is required to:

  • Maintain the privacy of your health information as required by law;
  • Provide you with a notice of our duties and privacy practices as to the information we collect and maintain about you.
  • Abide by the terms of this Notice;
  • Notify you if we cannot accommodate a request restriction or request; and
  • Accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice.

You are entitled to receive a revised copy of Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.

To Request Information of file a Complaint

Additionally if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to our Office Manager. You may also file a complaint by contacting the Secretary of Health and Human Services: (877) 696-6775.

  • We cannot and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the practice.
  • We cannot and will not, retaliate against you for filing a complaint with the Secretary.

 

Other Disclosures and Uses

Notification
Unless you object, we may use or disclose your protected health information to notify or assist in notifying a family member, personal representative or other person responsible for your care, about your location and about your general condition or your death.

Communication with Family
Using our best judgment, we may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency.

Food and Drug Administration (FDA)
We may disclose to the FDA your protected health information relating to adverse events with respect to products and product defects or post-marketing surveillance information to enable product recalls, repairs or replacements.

Workers Compensation
If you seek compensation through Workers Compensation, we disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.

Public Health
As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Abuse & Neglect
We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.

Correctional Institutions
If you are an inmate of correctional institution, we may disclose to the institution or agents, your protected health information necessary for your health and the health and safety of other individuals.

Law Enforcement
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order or in cases involving felony prosecutions or to the extent and individual is in the custody of law enforcement.

Health Oversight
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.

Judicial/Administrative Proceeding
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent or as directed by a proper court order.

Other Uses
Other uses and disclosures besides those identified in the Notice will be made only as otherwise authorized by law or with your authorization and you may revoke the authorization as previously provided.

Effective Date: April 14, 2003

Privacy Policy Form

Please download and fill-out our Privacy Policy Form. After you have completed the form, please make sure to bring it on your first Get Adobe Readervisit to our office