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.
If you have any questions about this notice, please contact Dehn@elcaminowomen.com.
I understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. I make a record of the medical care we provide and may receive such records from others. I 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 me to meet my professional and legal obligations to operate this healthcare practice properly. I am required by law to maintain the privacy of protected health information and to provide individuals with notice of my legal duties and privacy practices with respect to protected health information. This notice describes how I may use and disclose your medical information. It also describes your rights and my legal obligations with respect to your medical information. If you have any questions about this Notice, please contact my Privacy Officer listed above.
How this Healthcare Practice May Use or
Disclose Health Information
This healthcare practice collects medical and related identifiable patient information (such as demographics, billing information, claims information, referral and health plan information) and stores it in a chart, in administrative or billing files, and on a computer. The medical record is the property of this medical practice, but the information in the medical record is accessible to the patient. This information is considered “protected health information” (PHI) under the HIPAA Privacy Rule. The law permits me to use or disclose health information for the following purposes without the patient’s written authorization:
- Treatment. I use medical information to provide medical care. I disclose medical information to the staff, employees of El Camino Women’s Medical Group and others who are involved in providing the care my patients need. For example, I may share medical information with other physicians or other health care providers who will provide services that I do not provide or I may share this information with a pharmacist who needs it to dispense a prescription, or a laboratory that performs a test. I may also disclose medical information to members of patients’ families or others who can help them, when they are sick or injured or following the patient’s death.
- Payment. I use and disclose PHI to obtain payment for the services I provide. For example, I give patients a superbill to submit to their health plan, which includes the information they require for payment and reimbursement to the patient. I may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to my patients.
- Health Care Operations. I may use and disclose PHI to operate this healthcare practice. For example, I may use and disclose this information to review and improve the quality of care I provide, or the competence and qualifications of the professional staff. Or I may use and disclose this information to assist in having your health plan authorize services, medications, or referrals. I 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. I may also share PHI with our “business associates,” such as the billing service, that perform administrative services for me. I have a written contract with each of these associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of this PHI.Although federal law does not protect health information which is disclosed to someone other than another health care provider, health plan, health care clearinghouse, or one of their business associates, California law prohibits all recipients of healthcare information from further disclosing it except as specifically required or permitted by law.
- I may also share PHI with other health care providers, health care clearinghouses, or health plans that have a relationship with my patients when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health care costs, protocol development, case management or care coordination activities, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, their activities related to contracts of health insurance or health benefits, or their health care fraud and abuse detection and compliance efforts.
- I may also share PHI with the other health care providers, health care clearinghouses, and health plans that participate with us in “organized health care arrangements” (OHCAs) for any of the OHCAs’ health care operations. OHCAs include hospitals, physician organizations, health plans, and other entities that collectively provide health care services. A listing of the OHCAs I participate in is available from the Privacy Official.
- Check in. I may use and disclose medical information about my patients by having them check in when they arrive at our office. The staff may also call out their names when their appointment time arrives and they are ready to be seen.
- Notification and Communication with Family. I may disclose my patients’ health information to notify or assist in notifying a family member, personal representative or another person responsible for their care about their location or general condition in the event of they are incapacitated, unconscious or in the event of death, unless a patient had instructed us otherwise. In the event of a disaster, I may disclose information to a relief organization so that they may coordinate these notification efforts. I may also disclose information to someone who is involved with our patient’s care or helps pay for that care. If a patient is able and available to agree or object, I will give the patient the opportunity to object prior to making these disclosures, although I may disclose this information in a disaster even over the patient’s objection if I believe it is necessary to respond to the emergency circumstances. If a patient is unable or unavailable to agree or object, the health professionals in the office will use their best judgment in communication with the patient’s family.
- Marketing. Provided I do not receive any payment for making these communications, I may contact patients to encourage them to purchase or use products or services related to their treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may be of interest to them. I may similarly describe products or services provided by this practice and tell patients which health plans other providers in the office participate in. I may receive financial compensation to talk with patients face-to-face, to provide them with small promotional gifts, or to cover our cost of reminding them about treatment options.
- Sale of Health Information. I will not sell patients’ health information without their prior written authorization. The authorization will disclose that I will receive compensation for PHI if the patient authorizes me to sell it, and I will stop any future sales of information to the extent that the patient revokes that authorization.
- Required by Law. As required by law, I will use and disclose patients’ health information, but I will limit the use or disclosure to the relevant requirements of the law. When the law requires me to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, I will further comply with the requirement set forth below concerning those activities.
- Public Health. I may, and are sometimes required by law, to disclose patients’ 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 I report suspected elder or dependent adult abuse or domestic violence, I will inform our patients or their personal representative promptly unless in my best professional judgment, I believe the notification would place a patient at risk of serious harm or would require informing a personal representative I believe is responsible for the abuse or harm.
- Health Oversight Activities. I may, and am sometimes required by law, to disclose patients’ 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.
- Judicial and Administrative Proceedings. I may, and am sometimes required by law, to disclose patients’ health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. I may also disclose information about patients in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify them of the request and they have not objected, or if their objections have been resolved by a court or administrative order.
- Law Enforcement. I may, and am sometimes required by law, to disclose patients’ health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
- Coroners. I may, and am often required by law, to disclose our patients’ health information to coroners in connection with their investigations of deaths.
- Organ or Tissue Donation. I may disclose patients’ health information to organizations involved in procuring, banking or transplanting organs and tissues.
- Public Safety. I may, and am sometimes required by law, to disclose our patients’ 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.
- Proof of Immunization. I will disclose proof of immunization to a school where the law requires the school to have such information prior to admitting a student if the patient has agreed to the disclosure on behalf of themselves or their dependent.
- Specialized Government Functions. I may disclose patients’ health information for military or national security purposes or to correctional institutions or law enforcement officers that have the patient in lawful custody.
- Workers’ Compensation. I may disclose patients’ health information as necessary to comply with workers’ compensation laws.For example, to the extent the patients’ care is covered by workers’ compensation, I will make periodic reports to their employer about their conditions. I am also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.
- Change of Ownership. In the event that this healthcare practice is sold or merged with another organization, the patients’ health information/record will become the property of the new owner, although the patients will maintain the right to request that copies of their health information be transferred to another healthcare practice, physician or medical group.
- Breach Notification. In the case of a breach of unsecured protected health information, I will notify patients as required by law. If they have provided us with a current email address, I may use email to communicate information related to the breach. In some circumstances a business associate may provide the notification. I may also provide notification by other methods as appropriate.
- Other disclosures specified in our Notice of Privacy Practices. I may disclose patients’ health information as otherwise described in our Notice of Privacy Practices.
- Psychotherapy Notes. I will not use or disclose patients’ psychotherapy notes without their prior written authorization except for the following: (1) treatment, (2) for training of staff, students and other trainees, (3) to defend myself if the patient sues or brings some other legal proceeding, (4) if the law requires me to disclose the information to the patient or the Secretary of HHS or for some other reason, (5) in response to health oversight activities concerning the patient’s psychotherapist, (6) to avert a serious threat to health or safety, or (7) to the coroner or medical examiner following the patient’s death. To the extent the patient revokes an authorization to use or disclose their psychotherapy notes, I will stop using or disclosing these notes.
- Research. I may disclose patients’ health information to researchers conducting research with respect to which their written authorization is not required as approved by an Institutional Review Board (IRB) or privacy board, in compliance with governing law.
When this Healthcare Practice May Not Use or
Disclose Health Information
Except as described in this Notice of Privacy Practices, this healthcare practice will, consistent with its legal obligations, not use or disclose health information which identifies individual patients without their written authorization. If a patient authorizes this healthcare practice to use or disclose health information for another purpose, the patient may revoke the authorization in writing at any time.
Patients’ Health Information Rights
- Right to Request Special Privacy Protections. Patients have the right to request restrictions on certain uses and disclosures of their health information by a written request specifying what information they want to limit, and what limitations on the use or disclosure of that information they wish to have imposed. If patients communicate to me not to disclose information to their commercial health plan concerning health care items or services for which they paid for in full out-of-pocket, I will abide by their request, unless I must disclose the information for treatment or legal reasons. I reserve the right to accept or reject any other request and will notify patients of this decision.
- Right to Request Confidential Communications. Patients have the right to request that they receive their health information in a specific way or at a specific location. For example, they may ask that I send information to a particular email account or to their work address. I will comply with all reasonable requests submitted in writing which specify how or where they wish to receive these communications.
- Right to Inspect and Copy. Patients have the right to inspect and copy their health information, with limited exceptions. To access their medical information, patients must submit a written request detailing what information they want access to, whether they want to inspect it or get a copy of it, and if they want a copy, their preferred form and format. I will provide copies in the requested form and format if it is readily producible, or I will provide patients with an alternative format they find acceptable.
If we can’t agree and their medical records are maintained in an electronic format, their choice of a readable electronic or hardcopy format will be provided. I will also send a copy to any other person our patients designate in writing. I will charge a reasonable fee which covers the costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary, as allowed by federal and California law. I may deny a patients’ request under limited circumstances. If I deny a request to access a child’s records or the records of an incapacitated adult because I believe allowing access would be reasonably likely to cause substantial harm to the patient, the guardian or legal representative will have a right to appeal that decision. If I deny a patient’s request to access their psychotherapy notes, patients will have the right to have them transferred to another mental health professional.
- Right to Amend or Supplement. Patients have a right to request that I amend their health information if they believe it is incorrect or incomplete. Patients must make a request to amend in writing and include the reasons they believe the information is inaccurate or incomplete. I am not required to change patients’ health information and will provide them with information about this healthcare practice’s denial and how they can disagree with the denial. I may deny their request if I do not have the information, if I did not create the information (unless the person or entity that created the information Is no longer available to make the amendment}, if they would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. If I deny a request, patients may submit a written statement of their disagreement with that decision, and I may, in turn, prepare a written rebuttal. Patients also have the right to request that I add to their record a statement of up to 250 words concerning anything in the record they believe to be incomplete or incorrect. All information related to any request to amend or supplement will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
- Right to an Accounting of Disclosures. Patients have a right to receive an accounting of disclosures of their health information made by this healthcare practice, except that this healthcare practice does not have to account for the disclosures provided to them or pursuant to their written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notification and communication with family) and 18 (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 healthcare practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities.
- Right to Paper Copy of Notice of Privacy Practices. Patients have a right to the notice of our legal duties and privacy practices with respect to their health information, including a right to a paper copy of this Notice of Privacy Practices, even if they have previously requested its receipt by email. If I have a website, we must post our current Notice of Privacy Practices on our website.
Changes to this Notice of Privacy Practices
I reserve the right to amend these privacy practices and the terms of this Notice of Privacy Practices at any time in the future. Until such amendment is made, I am 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 I maintain, regardless of when it was created or received. I will keep a copy of the current notice posted in the reception area, and a copy will be available upon request at each appointment.
Complaints about this Notice of Privacy Practices or how this healthcare practice handles patients’ health information should be directed to the Privacy Officer listed at the top of this Notice of Privacy Practices.
If patients are not satisfied with the way this office handles a complaint, they may submit a formal complaint to:
Region IXOffice for Civil Rights
U.S. Department of Health & Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
(800) 368-1019; (800) 537-7697 (TDD)
(202) 619-3818 (fax)