Download a PDF of this Privacy Policy.

Notice of Privacy Practices
MED7 URGENT CARE CENTER

Effective Date: April 2, 2003
Revised/updated: June 26, 2013

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 ma
y 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
. This notice describes how we may
use and disclose your medical information
. It also describes your rights and
our legal obligations with respect to your medical information
. If you have
any questions about this Notice, please contact our Chief Operating Officer who is our Privacy Officer.

A. How this Medical Practice May Use or Disclose Your Health
Information

This medical practice collects health information about you and stores it in a
paper chart and/or electronically within our EMR system on a computer. This is your medical record. 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:

1.       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. For example, we may share your medical information with

other physicians or other 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, or following your death.

2.       Payment: We use and disclose medical information about you to

obtain payment for the services we provide. For example, we give
your health plan the information it requires before it will pay us. We
may also disclose information to other health care providers to assist
them in obtaining payment for services they have provided to you.

  1. Health Care Operations: We may use and disclose medical
    information about you to operate this medical practice. For example,
    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 our
“business associates”, such as our billing service, that perform
administrative services for us. We have a written contract with each
of these business associates that contains terms requiring them to
protect the confidentiality of your medical information. Although
federal law does not protect health information which is disclosed to
someone other than another healthcare provider, health plan or
healthcare clearinghouse, 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 health care providers, health care
clearinghouses or health plans that have a relationship with you,
when they request this information to help them with their quality
assessment and improvement activities, their efforts to improve
health or reduce health care costs, their review of competence,
qualifications and performance of health care professionals, their
training programs, their accreditation, certification or licensing
activities, or their health care fraud and abuse detection and


compliance efforts.

4.       Appointment Reminders: We may use and disclose medical

information to contact and remind you about appointments. If you
are not home, we may leave this information on your answering
machine or in a message left with the person answering the phone.
We may also contact you by mail. We may leave a message on your voicemail.

5.       Call Backs: We may contact you by phone after your visit to see

how you are doing, to give you test results or to remind you of a
recheck appointment. Our billing department may call. you if they
have a question or a problem regarding payment for our services.
Our medical records department may call if we have received a
request to release your medical records. If you are not home, we
may leave a message on your answering machine or we may leave a
message with the person answering the phone. We may also contact
you by mail for the same reasons.  We may leave a message on your voicemail.

6.      Sign in sheet: We may use and disclose medical information about

you by having you sign in when you arrive at our office. We may
also call out your name when we are ready to see you.

7.       Notification and communication with family: We may disclose

your health information to notify or assist in notifying a family
member, your personal representative or another person responsible
for your care about your location, your general condition or in the
event of your death. In the event of a disaster, we may disclose
information to a relief organization so that they may coordinate
these notification efforts. We may also disclose information to
someone who is involved with your care or helps pay for your care.
If you are able and available to agree or object, we will give you the
opportunity to object prior to making these disclosures, although we
may disclose this information in a disaster even over your objection
if we believe it is necessary to respond to the emergency
circumstances. If you are unable or unavailable to agree or object,
our health professionals will use their best judgment in
communication with your family and others.

8.       Marketing: We may contact you to give you information about

products or services related to your treatment, case management or

care coordination, or to direct or recommend other treatments or
health-related benefits and services that may be of interest to you, or
to provide you with small gifts. We may also encourage you to
purchase a product or service when we see you. We will not use or
disclose your medical information without your written
authorization.

9.       Required by law: As required by law, we will use and disclose

your health information, but we will limit our use or disclosure to
the relevant requirements of the law. When the law requires us to
report abuse, neglect or domestic violence, or respond to judicial or
administrative proceedings, or to law enforcement officials, we will
further comply with the requirement set forth below concerning

those activities.                                                          .

10.     Public health: We may, and are sometimes required by law to

disclose your health information to public health authorities for
purposes related to: preventing or controlling disease, injury or
disability; reporting child, elder or dependent adult abuse or neglect;
reporting domestic violence; reporting to the Food and Drug
Administration problems with products and reactions to
medications; and reporting disease or infection exposure. When we

. ”                     report suspected elder or dependent adult abuse or domestic
violence, we will inform you or your personal representative
promptly unless in our best professional judgment, we believe the
notification would place you at risk of serious harm or would
require informing a personal representative we believe is responsible
for the abuse or harm.

11.     Health oversight activities: We may, and are sometimes required

by law, to disclose your health information to health oversight
agencies during the course of audits, investigations, inspections,
licensure and other proceedings, subject to the limitations imposed
by federal and California law.

12.     Judicial and administrative proceedings: We may, and are

sometimes required by law, to disclose your health information in
the course of any administrative or judicial proceeding to the extent
expressly authorized by a court or administrative order. We may
also disclose information about you in response to a subpoena,

discovery request or other lawful process if reasonable efforts have
been made to notify you of the request and you have not objected, or
if your objections have been resolved by a court or administrative
order.

13.       Law.enforcement: We may, and are sometimes required by law, to

disclose your health information to a law enforcement official for
purposes such as identifying or locating a suspect, fugitive, material
witness or missing person, complying with a court order, warrant,
grand jury subpoena and other law enforcement purposes.-,

14.      Coroners: We may, and are often required by law, to disclose your

health information to coroners in connection with their
investigations of deaths.

15.      Organ or tissue donation: We may disclose your health

information to organizations involved in procuring, banking or
transplanting organs and tissues.

16.      Public safety: We may, and are sometimes required by law, to

disclose your health information to appropriate persons in order to
prevent or lessen a serious and imminent threat to the health or
safety of a particular person or the general public.

17.      Specialized government functions: We may disclose your health

information for military or national security purposes or to
correctional institutions or law enforcement officers that have you in
their lawful custody.

18.      Worker’s compensation: We may disclose your health information

as necessary to comply with worker’s compensation laws. For
example, to the extent your care is covered by workers’
compensation, we will make periodic reports to your employer
about your condition. We are also required by law to report cases of
occupational injury or occupational illness to the employer or
workers’ compensation insurer.

19.       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 reqalthough you will maintain the right to request that copies of your health information be transferred to another physician or medical group.

20.     Research: We may disclose your health information to researchers conducting research with respect to which your written authorization is not required as approved by an institutional Review Board or privacy board, in compliance with governing law.

 

21.   Breach Notification:  In the case of a breach of unsecured protected health information, we will notify you as required by law.  If you have provided us with a current email address, we may use email to communicate information related to the breach.  In some circumstances, our business associate may provide the notification.  We may also provide notification by other methods as appropriate.

 

B. 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.

C. Your Health Information Rights

1.       Right to Request Special Privacy Protections: You have the right

to request restrictions on certain uses and disclosures 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 your request, and will notify you of our decision.

2.       Right to Request Confidential Communications: You have the

right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that we send information to your work address. We will comply with all your work address.  We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.

3.       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 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 records because we believe allowing access would be reasonably likely to cause substantial harm to your child, you will have the right to appeal our decision.

 

4.         Right to Amend or Supplement: You have a right to request-that

we amend your health information that you believe is: incorrect or
incomplete. You must make a request to amend in writing, and
include the reasons you believe the information is inaccurate or
‘incomplete. We are not required to change your health information,
and will provide you with information about this medical practice’s
denial and how you can disagree with the 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 to your record a statement of up to 250 words
concerning any statement or item you believe to be incomplete or
incorrect.

5.         Right to an Accounting of Disclosures: You have a 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 1 (treatment),2
(payment), 3 (health care operations), 6 (notification and
communication with family) and 16 (specialized government
functions) of Section A of this Notice of Privacy Practices 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 to the extent this

medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities

 

6.       You have a 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 Chief Operating Officer who is our Privacy Officer.

D. 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 will offer you a copy at each
visit.

E. Complaints

Complaints about this Notice of Privacy Practices or how this medical
practice handles your health information should be directed to our Privacy

. ”        Officer.  If you are not satisfied with the manner in which this office handles
a complaint, you may submit a formal complaint to:

Department of Health and Human Services
Office of Civil Rights

90 7th Street Suite 4-100

San Francisco, CA  94103

(415) 437-8310

(415) 437-8311 (TDD)

(415)437-8329 (fax)

OCRMail@hhs.gov

 

The complaint form can be found at

www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf

You will not be penalized for filing a complaint.

 

Download a PDF of this Privacy Policy.