NOTICE OF PRIVACY PRACTICES
This notice is effective April 14, 2003
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.
Your medical information is personal and private. We are committed to protecting medical information about you. This notice tells you about the ways in which we may use and disclose medical information about you. Generally, we are required by law to ensure that medical information that identifies you is kept private. We are required to give you this notice of our legal duties and privacy practices with respect to medical information about you and we are required to follow the terms of the notice that is currently in effect.
Except for specific circumstances, federal and/or state law require special protections for medical information related to mental health, alcohol and drug abuse, HIV/AIDS, Sexually Transmitted Disease, and California Children’s Services. According to applicable law, we will not use or disclose these or other specially protected medical information without your written authorization.
Your medical information may be used for:
Ø Treatment – Information obtained by health care providers will be recorded in your medical record and may be used by other health care providers to determine your plan of care. .
Ø Payment – We may release medical information to your health plan or health insurance carrier to obtain payment for health services that you receive. For example, we may need to give your health plan information about a clinical exam or vaccinations that you or your child receive so your health plan will pay us for services provided. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval for the treatment.
Ø Health Care Operations – We may use your medical information for health care operations to make sure that the services and care provided to you are appropriate and of high quality. For example, we may combine medical information about many individuals to research health trends or to determine what service and programs we should offer. We may share your medical information with other providers who perform case management, coordination of care or other assessment activities.
We may share your medical information with public agencies or other organizations in instances in which we are required or permitted by law, such as:
Ø Health Oversight Activities – For activities authorized by law; for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights and privacy laws.
Ø Public Health Activities – To prevent or control disease, injury or disability; to notify an individual who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; 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.
Ø Victims of Abuse, Neglect or Domestic Violence – To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Ø 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 or to obtain an order protecting the information requested.
Ø Law Enforcement – If asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process for purposes that are required by law.
Ø Coroners, Medical Examiners and Funeral Directors – To coroners and medical examiners to identify a deceased person or determine the cause of death. To funeral directors, consistent with law, and as necessary to carry out their duties.
Ø Organ and Tissue Donation – 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.
Ø To Avert a Serious Threat to Health or Safety – 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.
Ø To a Correctional Institution: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your health information to the correctional institution or law enforcement official. The information released must be necessary for the institution to provide you with health care, protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
Ø Military and Veterans – If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Ø National Security and Intelligence Activities – To authorized federal officials for intelligence, counterintelligence, protection of the President or foreign heads of state and other national security activities authorized by law.
Ø Government Programs Providing Public Benefits – To determine eligibility for or enrollment in a government funded health plan, such as Medicare or Medicaid.
Ø Workers’ Compensation or Similar Programs – As authorized by law to relating to workers’ compensation programs.
Ø Facility Directories – Should we use facility directories, and if you do not object, we may provide your status and location in the facility to individuals who ask for you by name.
Ø Individuals Involved in Your Care or Payment for Your Care – Unless there is a specific written request from you to the contrary, we may disclose your medical information to a friend or family member who is involved in your medical care or payment for that care. In addition, 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.
Your Written Authorization is required:
In order to use or disclose your medical information for any reason not listed above, we must get your written authorization. If you give us your authorization, you may choose to take it back in writing and we will stop using or disclosing your medical information indicated in the authorization. However, please understand that we are unable to take back any disclosure we may have already made based on the authorization, and that we are required to retain our records of the care that we provided for you.
Your Medical Information Rights:
Right to Inspect and Copy
You have the right to inspect and obtain a copy of the medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include information that is needed for civil, criminal or administrative actions or proceedings or psychotherapy notes. We may charge a fee for the costs of copying, mailing or other supplies associated with your request.
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. 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;
• Is not part of the medical information kept by or for our purposes;
• Is not 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 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 with other expectations pursuant to the law. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003.
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 surgery you had. We are not legally required to agree to your request.
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. 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 request a copy of this notice at any time.
We reserve the right to change our information practices in accordance with applicable law and to make the new provisions effective for all medical health information we maintain. Should our information use and disclosure practices change, we will provide you with a revised Notice of Privacy Practices at your next health care visit or refer you to www.drfoust.net for the update..
Questions or Complaints:
If you have any questions about this notice or your privacy rights, please contact your provider at 714 779 5722.
If you believe your privacy rights have been violated, you may file a complaint, in writing, with the APC or with the Secretary of the Department of Health and Human Services. To file a complaint with APC, contact your provider at 714 779 5722. To file a complaint with DHHS, write to DHHS, Region IX office of Civil Rightrs, 50 United Nations Plaza, room 322, San Francisco, Ca 94102. Or Call 415 437 8310 tdd 415 437 8311.
You will not be penalized for filing a complaint.