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. No action on your part is required.
OUR PRIVACY
PRACTICES REGARDING MEDICAL INFORMATION
The protection of our
members’ privacy and the confidentiality of medical
information has always been a priority. We understand that
medical information about you and your health is personal.
This Notice applies to all records of your care generated
and maintained by Serra Community Medical Clinic. The
hospital or non-Serra Community Medical Clinic providers may
have different policies or notices about the use and
disclosure of information in their possession.
We are required by law to:
1) make sure that medical information that identifies you is
kept private; 2) make available to you this Notice of our
legal and privacy practices with respect to medical
information about you; and 3) follow the terms of the Notice
that is currently in effect.
HOW WE MAY USE AND DISCLOSE
MEDICAL INFORMATION ABOUT YOU
· We
may disclose medical information about you to doctors,
nurses, medical students, or other Serra Community Medical
Clinic personnel involved in taking care of you. We may
also disclose medical information to people outside the
medical group, such as specialists or others who are
involved in providing services that are part of your care.
· We
may use or disclose medical information about you so that
the treatment and services you receive at Serra Community
Medical Clinic may be billed to and payment may be collected
from you, an insurance company or a third party.
· We
may use or disclose medical information about you for Serra
Community Medical Clinic operations. These may include use
of information to evaluate the performance of our staff,
effectiveness of programs, and ways to improve care and
services we offer. These uses and disclosures are necessary
to ensure that all of our patients receive quality care.
·
We may use and disclose medical information
to contact you as a reminder that you have an appointment
for treatment or care at Serra Community Medical Clinic.
·
We may use or disclose medical information to
tell you about or recommend possible treatment options or
alternatives, and about health-related benefits and services
that may be of interest to you.
· We
may disclose medical information about you to other
healthcare providers in the event you need emergency care.
· We
will disclose medical information about you as required by
federal, state or local law.
· We
may use or disclose medical information to a public health
organization or federal organization when necessary to
prevent a serious threat to your health and safety or the
health and safety of the public or another person.
· We
may use or disclose medical information about you in special
situations such as for workers’ compensation programs, as
required by military command authorities or the Department
of Veterans Affairs, in response to a court or
administrative order, or for public health activities.
· Other
uses and disclosures of medical information not covered by
this Notice or the laws that apply to us will be made only
with your written authorization. You may later revoke this
permission in writing, at any time.
YOUR RIGHTS REGARDING
MEDICAL INFORMATION ABOUT YOU
· You
have the right to review and receive a copy of medical
information that may be used to make decisions about your
care. Usually this includes medical and billing records,
but does not include psychotherapy notes. You must submit
a written request to review and copy your medical
information. We may charge a fee for the costs of supplying
a copy of the records.
· You
have the right to ask us to amend medical information that
you feel is incorrect or incomplete. Your request for an
amendment must be submitted in writing and must provide a
reason that supports your request.
We may deny your request
for 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 the information: 1) was not created by us;
2) is not part of the medical information kept by or for
Serra Community Medical Clinic; 3) is not part of the
information which you are permitted to inspect and copy; or
4) is accurate and complete.
· You
have the right to request an “accounting of disclosures.”
This is a list of disclosures we have made of medical
information about you, with some exceptions. The exceptions
are governed by federal health privacy law, and include: 1)
routine disclosures for treatment, payment and operations
conducted pursuant to your signed consent form; and 2)
disclosures to you. You must submit a written request.
The request must state a time period that may not be longer
than six years and may not include dates before April 14,
2003, when current federal health privacy laws become
effective for Serra Community Medical Clinic.
· You
have the right to request restrictions or limitations on the
use or disclosure of medical information about you. You
must submit a written request for restriction that
specifies: 1) what information you want to limit; 2) whether
you want to limit our use, disclosure, or both; and 3) to
whom you want the limits to apply. Serra Community Medical
Clinic reserves the right to refuse your restriction if it
is in conflict of providing you quality healthcare or in an
emergency situation.
· You
have the right to request that we communicate with you about
medical matters in a certain way or at a certain location,
such as only at work or by mail. You must submit a written
request for confidential communications restrictions,
specifying how or where you wish to be contacted. We will
accommodate reasonable requests.
· You
have the right to possess a copy of this Privacy Notice upon
request. You may receive a paper copy of this notice, or
you can also obtain a copy of this Notice at our website,
www.serramedicalclinic.com
· You
have the right to file a complaint with Serra Community
Medical Clinic if you believe your rights to privacy have
been violated. All complaints must be submitted in writing
to the Privacy Officer at the address noted at the end of
this Notice. All complaints will be investigated.
No personal issue will be raised for
filing a complaint.
CHANGES TO THIS NOTICE
Serra Community Medical
Clinic reserves the right to change this Notice at any
time. We will post a copy of the current notice in our
clinical sites and on our website.
If
you have any questions about this Privacy Notice, please
contact:
Attn: Chief Privacy Officer
Serra Community Medical Clinic
9375 San Fernando Road
Sun Valley, CA 91352
