Notice of Privacy Practices

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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 contains a summary of our health information privacy practices and of your rights relating to your health information.  In the absence of an express statement to the contrary, this notice is not intended to preclude or restrict uses or disclosures of health information that are otherwise permitted by law, or to give you rights that we are not required by law to give you.

If you have any questions about this notice, please contact the privacy officer at

 (925) 201-6048

 Who Will Follow This Notice:

 This notice describes our health center’s practices and that of: 

• All employees, staff, and other health center personnel.

• All departments and units of the health center.

• Any independent health care professional who provides services to you within our facilities.

• Any member of a volunteer group we allow to help you while you are in the health center.

All these individuals, sites and locations follow the terms of this notice.  In addition, these individuals, sites and locations may share medical information with each other for treatment, payment, or health center operations purposes described in this notice. 

Our Pledge Regarding Medical Information: 

We understand that medical information about you and your health is personal.  We are committed to protecting medical information about you.  We create a record of the care and services your receive at the health center.  We need this record to provide you with quality care and to comply with legal requirements.  This notice applies to all of the records of your care maintained by the health center, whether made by the health center personnel or your personal doctor.

This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. 

We are required by law to:

• make sure that medical information that identifies you is kept private;

• give you this notice of our legal duties and privacy practices with respect to medical information about you; and

• follow the terms of this notice, as currently in effect. 

How We May Use and Disclose Medical Information About You: 

The following categories describe different ways that we use and disclose medical information.  For each category of uses or disclosures we will explain what we mean and try to give some examples.  Not every use or disclosure in a category will be listed. 

For Treatment.  We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, medical students, or other health center personnel who are involved in taking care of you at the health center.  For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.  Different departments of the health center also may share medical information about you in order to coordinate the different services you need, such as prescriptions, lab work and x-rays.  We also may disclose medical information about you to people outside the health center who may be involved in your medical care after you leave the health center, such as family members, social services agencies, health care facilities, and providers that we use to provide services for part of your care. 

For Payment.  We may use and disclose medical information about you to bill and collect payment from you or another source, such as an insurance company or a relative who has financial responsibility for you.  For example, we may need to give your health plan information about medical care you received at the heath center so your health plan will pay us or reimburse you for the medical care.  We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover treatment. 

For Health Care Operations.  We may use and disclose medical information about you for health center operations, and in limited circumstances to enable the recipient of the information to carry out its operations.  These uses and disclosures are necessary to run the health center and make sure that all of our patients receive quality  care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine medical information about many health center patients to decide what additional services the health center should offer, what services are not needed, and whether certain new treatments are effective.  We may also disclose information to doctors, nurses, technicians, medical students, and other health center personnel for review and learning purposes. 

Quality of Care Improvement Activities.  We may use and disclose medical information about you for reviews of the quality of  care we are providing.  For example, our health center works with the Community Health Center Network, a local group who has reviewed the quality of diabetes care being provided to patients in our area. 

Appointment Reminders.  We may use and disclose medical information to  contact you as a reminder that you have an appointment for treatment or medical care at the health center. 

Treatment Alternatives.  We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. 

 Health-Related Benefits and Services.  We may use and disclose medical information to tell you about health-related benefits or services that we provide and that may be of interest to you. 

Fundraising Activities.  We may use medical information about you to contact you in an effort to raise money for the health center and its operation.  We may disclose medical information to a foundation related to the health center so that the foundation may contact you in raising money for the health center.  We would only release contact information, such as your name, address and phone number.  If you do not want the health center to contact you for fundraising efforts, you must notify the privacy officer in writing. 

Payment for Your Care.  We may also give information to someone who helps pay for your care. 

Contractors.  We may disclose your health information to our contractors who assist us with our operations.  Our contractors agree in writing to keep the health information provided to them confidential and secure, and not to use it except to assist us. 

Research.  Under certain circumstances, we may use and disclose medical information about you for research purposes.   For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition.  Where feasible, research information will not include information that could identify you as an individual.  If research projects can identify you, those projects are subject to a special approval process.  This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with the patients’ need for privacy of their medical information.  Before we use or disclose medical information for research, the project will have been approved through this research approval process. 

As required By Law.  We will disclose medical information about you when required to do so by federal, state, or local law. 

For Public Health Activities.  We may disclose health information about you for public health purposes, if we are required or permitted to do so by law.  The following are examples of circumstances in which we may be mandated or permitted by law to make a report:

• to prevent or control disease, injury, or disability;

• to report births and deaths;

• to report the abuse or neglect of children, elders, and dependent adults;

• to report reactions to medications or problems with products;

• to notify people of recalls of products they may be using;

• to public health registries such as a breast cancer registry;

• to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and

• to notify the appropriate authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. 

To Avert a Serious Threat to Health or Safety.  We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would only be to someone able to help prevent the threat. 

Special Situations 

In addition to the practices described above, there are other situations in which we may be required or permitted to disclose our patients’ health information.  These include the following: 

Disasters.  We may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. 

Organ and Tissue Donation.  If you are an organ donor or a prospective donor, we may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. 

Military and Veterans.  If you are a member of the armed forces or a veteran, we may release medical information about you as required by military command authorities or to assist in determining your eligibility for veterans’ benefits.  We may also release medical information about foreign military personnel to the appropriate foreign military authority. 

Workers’ Compensation.  We may release medical information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness. 

Health Oversight Activities.  We may disclose information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, Medi-Cal audits, investigations of Medicare claims, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. 

Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order.  We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you). 

Law Enforcement.   We may release medical information if asked to do so by a law enforcement official:

• In response to a court order, subpoena, warrant, summons, or similar process;

• To identify or locate a suspect, fugitive, material witness, or missing person;

• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;

• About a death we believe may be the result of criminal conduct;

• About criminal conduct at the health center; and

• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. 

Coroners, Medical Examiners and Funeral Directors.   We may release medical information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release medical information about patients of the health center to funeral directors as necessary to carry out their duties. 

National Security and Intelligence Activities.   We may release medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.  We may also disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or conduct special investigations. 

Inmates.   If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.  This release would be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. 

De-Identified Information.  We may remove information that identifies you from your health information, so others may use it without learning who you are.  Once your health information has been de-identified, we may use or disclose it. 

Limitations  In some circumstances, your health information may be subject to restrictions that may limit or preclude some uses or disclosures described above.  For example, government health benefit programs may limit the disclosure of members’ health information for purposes unrelated to the program.  In addition, there are special restrictions on the disclosure of health information relating to HIV/AIDS status, mental health treatment, developmental disabilities, and drug and alcohol abuse treatment.  We comply with these restrictions in our use of your health information. 

Your Rights Regarding Medical Information About You:

 You have the following rights regarding medical information we maintain about you: 

Right to Inspect and Copy.  You have the right to inspect and copy medical information that may be used to make decisions about your care.  Usually, this includes medical and billing records, but may not include some mental health information. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the medical records department.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. 

We may deny your request to inspect and copy in certain very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.   Another licensed health care professional chosen by the health center will review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review. 

Right to Amend.   If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for the health center. 

To request an amendment, your request must be made in writing and submitted to the medical record department.  In addition, you must provide a reason that supports your request. 

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  In addition, we may deny your request if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

• Is not part of the medical information kept by or for the health center;

• Is not a part of the information which you would be permitted to inspect and copy; or

• Is accurate and complete. 

Right to an Accounting of Disclosures.  You have the right to request an “accounting of disclosures.”  This is a list of the disclosures we made of medical information about you other than our own uses for treatment, payment, and health care operations, and disclosures you have authorized. 

To request this list of accounting of disclosures, you must submit your request in writing to the medical record department.  Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003.  The first list you request within a 12 month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. 

Right to Request Restrictions.  You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations.  You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  For example, you could ask that we not use or disclose information about a test you had. 

We are not required to agree to your request.  If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. 

To request restrictions, you must make your request in writing to the privacy officer.  In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

 Right to Request Confidential Communications.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail. 

To request confidential communications, you must make your request in writing at time of registration.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted. 

Right to a Paper Copy of This Notice.  You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

 Changes to This Notice:

 We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for all medical information we already have about you as well as any information we receive in the future.  We will post a copy of the current notice in the health center.  This notice will contain the effective date on the first page, in the top right-hand corner.

 Complaints:

 If you believe your privacy rights have been violated, you may file a complaint with the health center or with the Secretary of the Department of Health and Human Services.  To file a complaint with the health center, contact the privacy officer at (925) 201-6048.  All complaints must be submitted in writing.

 We will not retaliate against you for filing a complaint.

 Other Uses of Medical Information:

 Other uses and disclosures of medical information not covered by this notice or otherwise permitted by the laws that apply to us will be made only with your written authorization.  If you provide us with authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time.  If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.

 

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