The Stone Clinic - 3727 Buchanan Street - San Francisco CA
94123
Privacy Officer – Office Manager – 415-563-3110
Effective Date: April 14, 2003
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 may 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 Privacy Officer listed above.
TABLE OF CONTENTS
A. How this Medical Practice May Use or Disclose Your Health Information …….………...
2
B. When This Medical Practice May Not Use or Disclose Your Health
Information ….…… 4
C. Your Health Information Rights.……………………………………………………………… 4
- Right to Request Special Privacy Protections
- Right to Request Confidential Communications
- Right to Inspect and Copy
- Right to Amend or Supplement
- Right to an Accounting of Disclosures
- Right to a Paper Copy of this Notice
D. Changes to this Notice of Privacy Practices …………………………………………….… 5
E. Complaints ……………………………………………………………………………………..
5
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 chart and 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.
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.
3. 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 a billing service, that performs 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. We
may give your name to another patient with a similar problem who may
want to speak with you about your experience.
4. Telephone Communications. We
may use and disclose medical information to contact and remind you about
appointments, insurance items, and calls pertaining to clinical care
including normal laboratory results. 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.
5. 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.
6. 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.
7. 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
may receive payment for these communications for your health plan to
describe 1) a provider’s participation in the health plan’s
network, 2) the extent of covered benefits, or 3) concerning the availability
of more cost-effective pharmaceuticals. We will not accept any
other payment for these types of communications unless you have a chronic
and seriously debilitating or life-threatening condition, and in that
case we will tell you who is paying us, and we will also tell you how
to stop them if you prefer not to receive them. We will not otherwise
use or disclose your medical information for marketing purposes without
your written authorization, and we will disclose whether we receive any
payments for that marketing activity.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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 of locating
a suspect, fugitive, material witness or missing person, complying with
a court order, warrant, grand jury subpoena and other law enforcement
purposes.
13. Coroners. We may,
and are often required by law, to disclose your health information to
coroners in connection with their investigations of deaths.
14. Organ or tissue donation. We
may disclose your health information to organizations involved in procuring,
banking or transplanting organs and tissues.
15. 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.
16. 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.
17. 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.
18. 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 request that copies of your health
information be transferred to another physician or medical group.
19. Research. We may
share your information for research projects, such as studying the effectiveness
of a treatment you received. This will be done confidentially and
reported anonymously.
20. Fundraising. We
may use or disclose your demographic information and the dates that you
received treatment in order to contact you for fundraising activities. If
you do not want to receive these materials, notify the Privacy Officer
listed at the top of this Notice of Privacy Practices.
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
a particular e-mail account or to 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 it or get a copy of it. We
will charge a reasonable fee, as allowed by California and federal law. We
may deny your request under limited circumstances. If we deny your
request to access your child's records or the records of an incapacitated
adult you are representing because we believe allowing access would be
reasonably likely to cause substantial harm to the patient, you will
have a 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, even if you have previously
requested its receipt by e-mail.
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 Privacy Officer listed at the top of this Notice of Privacy Practices.
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 a copy will be available at each appointment. We
will also post the current notice on our website.
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 listed at the top of this Notice of Privacy Practices.
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
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, DC 20201
You will not be penalized for filing a complaint.
