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Spondylos
Medical Group
4130 La Jolla Village Drive: Suite 300
La Jolla, CA 92037
office
Effective
Date: April 14, 2003
THIS NOTICE
DESCRIBES HOW THE ABOVE INDEPENDENT PRACTICE MAY USE AND DISCLOSE YOUR
MEDICAL INFORMATION AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
We
understand the importance of privacy and are committed to maintaining the
confidentiality of your medical information. We make a record of the medical care we provide and may receive
such records from others. We
use these records to provide or enable other health care providers to
provide quality medical care, to obtain payment for services provided to
you as allowed by your health plan and to enable us to meet our
professional and legal obligations to operate this medical practice
properly. We are required by law to maintain the privacy of protected
health information and to provide individuals with notice of our legal
duties and privacy practices with respect to protected health information.
This notice describes how we may use and disclose your medical
information. It also
describes your rights and our legal obligations with respect to your
medical information. If you have any questions about this Notice, please contact
your treating physician’s Privacy Officer.
A. How this Medical Practice May Use or Disclose Your Health
Information
We
collect health information about you and store it in a chart and on a
computer. This is your
medical record. The medical
record is the property of the medical practice, but the information in the
medical record belongs to you. Each
of the above independent practices utilizes the Alteer system for storing
your medical record. Your
treating physician stores your record electronically. Alteer’s technology is designed to promote the highest level of
security and privacy protection, meeting the requirements of the HIPAA
mandate. The law permits us to use or disclose your health information for
the following purposes:
1. Treatment. We
use medical information about you to provide your medical care. We disclose medical information to our employees and others who are
involved in providing the care you need. For example, we may share your medical information with other
physicians or other health care providers who will provide services, which
we do not provide. Or we may
share this information with a pharmacist who needs it to dispense a
prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family
or others who can help you when you are sick or injured.
2. Payment. We
use and disclose medical information about you to obtain payment for the
services we provide. For
example, we give your health plan the information it requires before it
will pay us. We may also
disclose information to other health care providers to assist them in
obtaining payment for services they have provided to you.
3. Health Care Operations. We may use and disclose medical information about you to operate
this medical practice. For
example, we may use and disclose this information to review and improve
the quality of care we provide, or the competence and qualifications of
our professional staff. Or we
may use and disclose this information to get your health plan to authorize
services or referrals. We may
also use and disclose this information as necessary for medical reviews,
legal services and audits, including fraud and abuse detection and
compliance programs and business planning and management. We may also share your medical information with our "business
associates", such as our billing service, that perform administrative
services for us. We have a
written contract with each of these business associates that contains
terms requiring them to protect the confidentiality of your medical
information. Although federal
law does not protect health information, which is disclosed to someone
other than another healthcare provider, health plan or healthcare
clearinghouse, under California law all recipients of health care
information are prohibited from re-disclosing it except as specifically
required or permitted by law. We
may also share your information with other health care providers, health
care clearinghouses or health plans that have a relationship with you,
when they request this information to help them with their quality
assessment and improvement activities, their efforts to improve health or
reduce health care costs, their review of competence, qualifications and
performance of health care professionals, their training programs, their
accreditation, certification or licensing activities, or their health care
fraud and abuse detection and compliance efforts.
4. Appointment Reminders. We may use and disclose medical information to contact and remind
you about appointments. If
you are not home, we may leave this information on your answering machine
or in a message left with the person answering the phone.
5. Sign in sheet. We
may use and disclose medical information about you by having you sign in
when you arrive at our office. We
may also call out your name when we are ready to see you.
6. Notification and communication with family. We may disclose your health information to notify or assist in
notifying a family member, your personal representative or another person
responsible for your care about your location, your general condition or
in the event of your death. In
the event of a disaster, we may disclose information to a relief
organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with
your care or helps pay for your care. If you are able and available to agree or object, we will give you
the opportunity to object prior to making these disclosures, although we
may disclose this information in a disaster even over your objection if we
believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health
professionals will use their best judgment in communication with your
family and others.
7. Marketing. We
may contact you to give you information about products or services related
to your treatment, case management or care coordination, or to direct or
recommend other treatments or health-related benefits and services that
may be of interest to you, or to provide you with small gifts. We will not use or disclose your medical information without your
written authorization.
8. Required by law. As
required by law, we will use and disclose your health information, but we
will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic
violence, or respond to judicial or administrative proceedings, or to law
enforcement officials, we will further comply with the requirement set
forth below concerning those activities.
9. Public health. We
may, and are sometimes required by law to disclose your health information
to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting
child, elder or dependent adult abuse or neglect; reporting domestic
violence; reporting to the Food and Drug Administration problems with
products and reactions to medications; and reporting disease or infection
exposure. When we report
suspected elder or dependent adult abuse or domestic violence, we will
inform you or your personal representative promptly unless in our best
professional judgment, we believe the notification would place you at risk
of serious harm or would require informing a personal representative we
believe is responsible for the abuse or harm.
10. Health oversight activities. We may, and are sometimes required by law to disclose your health
information to health oversight agencies during the course of audits,
investigations, inspections, licensure and other proceedings, subject to
the limitations imposed by federal and California law.
11. Judicial and administrative proceedings. We may, and are sometimes required by law, to disclose your health
information in the course of any administrative or judicial proceeding to
the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a
subpoena, discovery request or other lawful process if reasonable efforts
have been made to notify you of the request and you have not objected, or
if your objections have been resolved by a court or administrative order.
12. Law enforcement. We
may, and are sometimes required by law, to disclose your health
information to a law enforcement official for purposes such as identifying
of locating a suspect, fugitive, material witness or missing person,
complying with a court order, warrant, grand jury subpoena and other law
enforcement purposes.
13. Coroners. We
may, and are often required by law, to disclose your health information to
coroners in connection with their investigations of deaths.
14. Organ or tissue donation. We may disclose your health information to organizations involved
in procuring, banking or transplanting organs and tissues.
15. Public safety. We
may, and are sometimes required by law, to disclose your health
information to appropriate persons in order to prevent or lessen a serious
and imminent threat to the health or safety of a particular person or the
general public.
16. Specialized government functions. We may disclose your health information for military or national
security purposes or to correctional institutions or law enforcement
officers that have you in their lawful custody.
17. Worker’s compensation. We may disclose your health information as necessary to comply with
worker’s compensation laws. For example, to the extent your care is covered by workers'
compensation, we will make periodic reports to your employer about your
condition. We are also
required by law to report cases of occupational injury or occupational
illness to the employer or workers' compensation insurer.
18. Change of Ownership. In
the event that any of the above independent medical practices is sold or
merged with another organization, your health information/record will
become the property of the new owner, although you will maintain the right
to request that copies of your health information be transferred to
another physician or medical group.
19. Research. We
may disclose your health information to researchers conducting research
with respect to which your written authorization is not required as
approved by an Institutional Review Board or privacy board, in compliance
with governing law.
20. Fundraising. We
may use or disclose your demographic information and the dates that you
received treatment in order to contact you for fundraising activities. If you do not want to receive these materials, notify your treating
physician’s Privacy Officer. We
will obtain your written authorization prior to such disclosure.
B. When This Medical Practice May Not Use or Disclose Your Health
Information
Except
as described in this Notice of Privacy Practices, we will not use or
disclose health information which identifies you without your written
authorization. If you do
authorize us to use or disclose your health information for another
purpose, you may revoke your authorization in writing at any time.
C. Your Health Information
Rights
1. Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and
disclosures of your health information, by a written request specifying
what information you want to limit and what limitations on our use or
disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request, and will
notify you of our decision.
2. Right to Request Confidential Communications. You have the right to request that you receive your health
information in a specific way or at a specific location. For example, you may ask that we send information to a particular
e-mail account or to your work address. We will comply with all reasonable requests submitted in writing
which specify how or where you wish to receive these communications.
3. Right to Inspect and Copy. You have the right to inspect and copy your health information,
with limited exceptions. To
access your medical information, you must submit a written request
detailing what information you want access to and whether you want to
inspect it or get a copy of it. We
will charge a reasonable fee, as allowed by California law. We may deny your request under limited circumstances. If we deny your request to access your child's records because we
believe allowing access would be reasonably likely to cause substantial
harm to your child, you will have a right to appeal our decision. If we deny your request to access your psychotherapy notes, you
will have the right to have them transferred to another mental health
professional. Your request
may take up to 15 days to process after receipt of your payment.
4. Right to Amend or Supplement. You have a right to request that we amend your health information
that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the
reasons you believe the information is inaccurate or incomplete. We are not required to change your health information, and will
provide you with information about this medical practice's denial and how
you can disagree with the denial. We
may deny your request if we do not have the information, if we did not
create the information (unless the person or entity that created the
information is no longer available to make the amendment), if you would
not be permitted to inspect or copy the information at issue, or if the
information is accurate and complete as is. You also have the right to request that we add to your record
a statement of up to 250 words concerning any statement or item you
believe to be incomplete or incorrect.
5. Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your
health information made by us, except that we do not have to account for
the disclosures provided to you or pursuant to your written authorization,
or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care
operations), 6 (notification and communication with family) and 16
(specialized government functions) of Section A of this Notice of Privacy
Practices or disclosures for purposes of research or public health which
exclude direct patient identifiers, or which are incident to a use or
disclosure otherwise permitted or authorized by law, or the disclosures to
a health oversight agency or law enforcement official to the extent this
medical practice has received notice from that agency or official that
providing this accounting would be reasonably likely to impede their
activities.
6. You have a right to a paper copy of this Notice of Privacy
Practices.
If
you would like to have a more detailed explanation of these rights or if
you would like to exercise one or more of these rights, contact your
treating physician’s Privacy Officer.
D. Changes
to this Notice of Privacy Practices
We
reserve the right to amend this Notice of Privacy Practices at any time in
the future. Until such
amendment is made, we are required by law to comply with this Notice. After an amendment is made, the revised Notice of Privacy
Protections will apply to all protected health information that we
maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception
area, and will offer you a copy at each appointment. We will also post the current notice on our website.
E. Complaints
Complaints
about this Notice of Privacy Practices or how we handle your health
information should be directed to your treating physician’s Privacy
Officer.
If
you are not satisfied with the manner in which we handle a complaint, you
may submit a formal complaint to:
Department
of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You
will not be penalized for filing a complaint.
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