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.
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. It also describes your rights and our legal obligations with respect to your medical information. If you have any information about this notice, please contact our privacy office listed below:
Contact: Teresa M. Neria or Georgina Licup
Address: 23441 Madison Street, Suite 340, Torrance, CA 90505
USES AND DISCLOSURES OF HEALTH INFORMATION. The medical record is the
property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes.
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. We may share your medical information with other physicians or 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.
Payment: We use and disclose medical information about you to obtain payment for the services we provide.
Health Care Operations: 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 "business associates" that perform administrative services for us. We have a confidentiality of your medical information. 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 healthcare providers, health care clearinghouses or health plans that have a relationship with
Appointment Reminders: We may use and disclose medical information to contact and remind you about your appointments. If you are not at home, we may leave this information on your answering machine or in a message left with the person answering the phone.
Change of Ownership: In the event that this medical practice 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 the copies of your health information be transferred to another physician or medical group.
WHEN THIS MEDICAL PRACTICE MAY NOT USE OR DISCLOSE YOUR HEALTH INFORMATION.
Except, as described in this Notice of Privacy Practices, this medical practice will not use or disclose health information which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
YOUR HEALTH INFORMATION RIGHTS
Right to request special privacy protections: You have the right to request restrictions on certain uses and disclosers 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 you request, and will notify you of our decision.
Right to request confidential communication: Within reason, you have the right to request that you receive your health information in a specific way or at a specific location. We will comply with requests submitted in writing which specify how or where you wish to receive these communications.
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 record because we believe allowing access would be reasonably likely to cause substantial harm to your child, you will have the right to have them transferred to another mental health professional.
Right to amend or supplement: You have the right to request that we amend your health information that you believe is incorrect or incomplete. We are not required to change your health information, and will provide you with information about this medical practice's denial policy and how you can protest this 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 your record a statement of up to 250 words concerning any statement or item you believe to be incomplete or incorrect.
Right to an accounting of disclosures: You have the right to receive an accounting of disclosures of your health information made by this medical practice, except that this medical practice does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in paragraphs treatment, payment, health care operations, notification, and communications of this Notice of Privacy 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 accounting would reasonably likely to impede their activities. You have the 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 our Privacy Officer(s) listed at the beginning of this Notice of Privacy Practices.
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 we will offer you a copy.
COMPLAINTS: Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Office listed at the top of this Notice of Privacy Practices.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to
Department of Office of Civil Rights
Hubert H. Humphery Building
200 Independence Avenue SW
Room 509F HHH Building
Washington, DC 20201
You will not be penalized for filing a complaint.