Effective Date: August 25, 2026
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.
Our Commitment to Your Privacy
AmpleHealth is committed to protecting the privacy and security of your protected health information (PHI). PHI includes information that identifies you and relates to your past, present, or future physical or mental health or condition, the health care you receive, or payment for that care. This Notice explains how we may use and disclose your PHI, your rights regarding your information, and our responsibilities under the Health Insurance Portability and Accountability Act (HIPAA), the California Confidentiality of Medical Information Act (CMIA), and other applicable federal and California laws.
Your Rights
- Get an electronic or paper copy of your medical record. You may ask to inspect or obtain an electronic or paper copy of your medical record and other health information we maintain about you. We will provide access within the time required by law and may charge only fees permitted by law.
- Ask us to correct your medical record. If you believe information is incorrect or incomplete, you may ask us to amend it. We may deny the request in certain circumstances, but we will explain the reason in writing.
- Request confidential communications. You may ask us to contact you in a specific way, such as at a particular phone number, email address, or mailing address. We will accommodate reasonable requests as required by law.
- Ask us to limit what we use or share. You may ask us not to use or disclose certain PHI for treatment, payment, or health care operations. We are not required to agree to every request. If you pay in full out of pocket for a service or item and ask us not to disclose information about that service or item to your health plan for payment or health care operations, we will honor the request unless disclosure is required by law.
- Get a list of certain disclosures. You may request an accounting of certain disclosures of your PHI made during the six years before your request. The accounting does not include all disclosures, such as many disclosures for treatment, payment, or health care operations.
- Get a copy of this Notice. You may request a paper copy at any time, even if you agreed to receive it electronically.
- Choose someone to act for you. If you have given someone medical power of attorney, or if someone is your legal guardian or otherwise legally authorized to act for you, that person may exercise your rights as permitted by law.
- Receive breach notification. We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your unsecured PHI.
- File a complaint. You may complain if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you may tell us your preferences about what we share. These choices may include:
- Sharing information with family members, close friends, or others involved in your care or payment for your care.
- Sharing information in a disaster relief situation.
- Receiving fundraising communications, if AmpleHealth conducts fundraising. You may tell us not to contact you again.
If you are unable to tell us your preference, for example because you are unconscious, we may share information when we believe it is in your best interest and the disclosure is permitted by law.
Uses and Disclosures Requiring Your Written Authorization
We will obtain your written authorization for uses or disclosures of PHI when required by law. In particular:
- Most uses and disclosures of psychotherapy notes require written authorization, subject to limited exceptions permitted by law.
- We will not sell your PHI without written authorization when authorization is required by law.
- Most uses and disclosures of PHI for marketing require written authorization, subject to exceptions permitted by law.
- Other uses and disclosures not described in this Notice will be made only with your written authorization unless otherwise permitted or required by law.
You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance on it.
How We Typically Use and Share Your Health Information
Treatment
We may use your PHI and share it with physicians, nurses, specialists, laboratories, pharmacies, hospitals, therapists, and other health care professionals involved in your care.
Payment
We may use and disclose PHI to bill for services and obtain payment from you, your health plan, Medicare, Medi-Cal, or another payer.
Health Care Operations
We may use and disclose PHI to operate our practice, coordinate care, improve quality, train staff, conduct compliance activities, evaluate performance, manage services, and contact you when necessary.
Appointments, Results, Referrals, and Health-Related Services
We may contact you about appointments, test results, referrals, treatment alternatives, follow-up care, preventive services, and other health-related services that may be of interest to you.
Business Associates
We may share PHI with vendors and service providers that perform functions for us, such as billing, electronic health records, technology, records management, analytics, and clinical documentation support. When required, these organizations must protect PHI under written agreements and applicable law.