Notice of Privacy Practices & Your Rights
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 may use and share your information as we:
- Administer care to you
- Run our organization
- Bill for services
- Help with public health and safety issues
- Do research
- Comply with the law
- Address law enforcement and other government requests
- Respond to lawsuits and other legal actions
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get a copy of your health record
- You can ask to see or get a paper copy of your health record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually within 3 days of your request. We may charge a reasonable, cost-based fee for photocopying and postage.
Ask us to correct your medical record
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll tell you why in writing within 10 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to: Share information with your family, close friends, or others involved in your care
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
We may use your information for internal marketing purposes unless you tell us not to. Your information will never be shared or sold to anyone for marketing purposes.
In the case of fundraising: We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures – We typically use or share your health information in the following ways:
To administer care to you – We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
To run our organization – We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your care and services.
To bill for your services – We can use and share your health information to bill and get payment through billing entities.
To deliver product orders – We will share your information in order to fulfill product orders and payments for product or service package orders
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues – We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
Do research – We can use or share your information for health research.
Comply with the law – We will share information about you if state or federal laws require it, including with the Department of Health and Human Services.
Work with a medical examiner or funeral director – We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address law enforcement and other government requests – We can use or share health information about you:
- For law enforcement purposes or with a law enforcement officials
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions – We can share health information about you in response to a court or administrative order, or in response to a subpoena.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
Additional Information for Notice
- Effective date: September 24, 2015
- Privacy Official: Lisa Giusiana 866-955-9925 firstname.lastname@example.org
This notice pertains to patients of Lisa Giusiana, DC, CTN, HHP
222 Fashion Lane Suite 109, Tustin CA 92780