Effective April 14, 2003
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED, DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our practice is required by law to protect the privacy of the information we have about your protected health information (PHI). We collect information about you when we provide treatment and services to you. We must give you this Notice of how the law allows us to use and share your health information and what your rights are.
HOW WE MAY USE AND SHARE INFORMATION ABOUT YOU
Our practice uses and shares information about you in operating our practice. This information includes such data as your name, address, personal facts, medical history and medical care given to you. We use this information and share it with others for the following reasons:
- For treatment: We will share information with doctors, hospitals, laboratories and others in order to get you the care you need.
- For payment: We share information with your health plans (insurance carrier) in order to coordinate payment for your care.
- For health care operations: We may use information in your health records to judge the quality of care given to you. This information may also be used in audits or fraud investigations, or for planning and general administration.
This law also allows us to use or give our information we have about you for the following purposes:
- To contact you about you appointment
- To inform you of treatment options
- To inform you of health related services
- To release information to your family/friends involved in your care with a release signed by you
- For public health activities, such as reporting disease outbreaks
- For judicial and administrative proceedings, such as law suits
- For limited law enforcement purposes, such as to locate a missing person
- For research studies that meet all privacy law requirements
- To avoid a serious and immediate threat to health and safety
- For purposes required by law
- To agencies that oversee the health care system, for audits or investigations
- In appeals of decisions about health care claims paid or denied
- And certain other specific uses allowed under the law
We may give out information about you to organizations, which can help us in our operations, such as billing and collection of claims. If we do so, we will make sure that they protect the privacy of information we share with them.
Some state laws limit the sharing of information described above. For example, there are special laws, which protect information about HIV status, mental health treatment, developmental disabilities, and drug/alcohol abuse treatment; we will obey these laws. When there is a conflict between the statutes governing the information to be released, the stricter standard will be applied.
WHEN WRITTEN PERMISSION IS NEEDED
Before our practice may use your personal health information for any reason not listed above, we will obtain written permission from you. You may take back your permission in writing at any time but that withdrawal of permission cannot be applied retroactively.
WHAT ARE YOUR PRIVACY RIGHTS UNDER THE LAW?
- You have the right to ask us not to use or share your personal health care information in the ways described above. We may not be able to agree with your request.
- You have the right to ask us to contact you only in writing or at a different address or telephone number. We will accept reasonable requests regarding alternate contact methods.
- You, and/or your personal representative, have the right to see and copy personal, medical and billing information, but not psychotherapy notes that we have about you. You may be charged a fee for the costs of copying and mailing records. We may keep you from seeing all or part of the records for reasons allowed by law. If we do, we will give you information on how to file an appeal of our decision.
- If you believe that certain information in our records about you is wrong, you have the right to ask us to amend the records. We may deny your request if the information was not created by us or is already accurate and complete.
- You have the right to request a list of times when we have shared your written health information after April 14, 2003. The list will tell you with whom we shared information, when, for what reasons, and what information was shared. The list will not include when we gave information to you, or with your permission, or shared it for treatment, payment or health care operations.
- You have the right to receive a copy of this Notice when you request it.
HOW DO YOU CONTACT US TO FILE A COMPLAINT?
If you believe that we have not protected your privacy and wish to complain, you may file a written complaint with our office. Please write us at:
Patricia L. Pitts and Associates
766 Colorado Boulevard
Los Angeles, CA 90041
The U.S Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington D.C. 20201
(877) 696-6775 (Toll Free)
You may also contact the Secretary of DHHS. You will not be penalized for filing a complaint.
CHANGES OF NOTICE OF PRIVACY PRACTICES
We must obey the Notice in effect on April 14, 2003. We have the right to change our privacy practices. If we do make any changes, we will revise this Notice and post it in a visible location in our office at all times.