Effective
Date of this Notice April 1, 2003
NOTICE
OF PRIVACY PRACTICES.
A.
OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy
of your protected health information (PHI). In conducting our
business, we will create records regarding you and the treatment
and services we provide to you. We are required by law to maintain
the confidentiality of health information that identifies you.
We also are required by law to provide you with this notice of
our legal duties and the privacy practices that we maintain in
our practice concerning your PHI. By federal and state law, we
must follow the terms of the notice of privacy practices that
we have in effect at the time.
We realize that these laws are complicated, but we must provide
you with the following important information:
- How
we may use and disclose your PHI
- Your
privacy rights in your PHI
- Our
obligations concerning the use and disclosure of your PHI
The terms of this notice apply to all records containing
your PHI that are created or retained by our practice. We reserve
the right to revise or amend this Notice of Privacy Practices. Any
revision or amendment to this notice will be effective for all of
your records that our practice has created or maintained in the
past, and for any of your records that we may create or maintain
in the future. Our practice will post a copy of our current Notice
in our offices in a visible location at all times, and you may request
a copy of our most current Notice at any time.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
- Cynthia
Cabalka, Privacy Officer (310)394-3690
C. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI)
IN THE FOLLOWING WAYS:
The
following categories describe the different ways in which we may
use and disclose your PHI.
1. Treatment. Our practice may use your PHI
to treat you. For example, we may ask you to have laboratory tests
(such as blood or urine tests), and we may use the results to
help us reach a diagnosis. We might use your PHI in order to write
a prescription for you, or we might disclose your PHI to a pharmacy
when we order a prescription for you. Many of the people who work
for our practice — including, but not limited to, our doctors
and nurses — may use or disclose your PHI in order to treat
you or to assist others in your treatment. Additionally, we may
disclose your PHI to others who may assist in your care, such
as your spouse, children or parents.
Finally, we may also disclose your PHI to other health care providers
for purposes related to your treatment.
2. Payment. Our practice may use and disclose
your PHI in order to bill and collect payment for the services
and items you may receive from us. For example, we may contact
your health insurer to certify that you are eligible for benefits
(and for what range of benefits), and we may provide your insurer
with details regarding your treatment to determine if your insurer
will cover, or pay for, your treatment. We also may use and disclose
your PHI to obtain payment from third parties that may be responsible
for such costs, such as family members. Also, we may use your
PHI to bill you directly for services and items. We may disclose
your PHI to other health care providers and entities to assist
in their billing and collection efforts.
3. Health Care Operations. Our practice may
use and disclose your PHI to operate our business. As examples
of the ways in which we may use and disclose your information
for our operations, our practice may use your PHI to evaluate
the quality of care you received from us, or to conduct cost-management
and business planning activities for our practice. We may disclose
your PHI to other health care providers and entities to assist
in their health care operations.
OPTIONAL:
4. Appointment Reminders. Our practice may use
and disclose your PHI to contact you and remind you of an appointment.
OPTIONAL:
5. Treatment Options. Our practice may use and
disclose your PHI to inform you of potential treatment options
or alternatives.
OPTIONAL:
6. Health-Related Benefits and Services. Our practice
may use and disclose your PHI to inform you of health-related
benefits or services that may be of interest to you.
OPTIONAL:
7. Release of Information to Family/Friends. Our
practice may release your PHI to a friend or family member that
is involved in your care, or who assists in taking care of you.
For example, a parent or guardian may ask that a babysitter take
their child to the pediatrician’s office for treatment of
a cold. In this example, the babysitter may have access to this
child’s medical information.
8. Disclosures Required By Law. Our practice
will use and disclose your PHI when we are required to do so by
federal, state or local law.
D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES:
The following categories describe unique scenarios in which we
may use or disclose your identifiable health information:
1. Public Health Risks. Our practice may disclose
your PHI to public health authorities that are authorized by law
to collect information for the purpose of:
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