Notice of Privacy Practices

This notice describes how medical information (Protected Health Information or “PHI”) about you may be used and disclosed and how you can get access to this information. Please review it carefully

We typically use or share your health information in the following ways: 

Treat You. We can use your health information and share it with other professionals who are treating you. Example: During the course of your treatment, the physician determines that he/she will need to consult with your primary care physician. The physician will share information with that physician and obtain the physician’s input. 

Health Information Exchange. We, along with other California health care providers, participate in CAHIE (California Association of Health Information Exchange), which allows patient information to be shared electronically through a secured network that is accessible to the providers treating you. We may disclose your PHI to CAHIE unless you opt-out of participating in the HIE. 

Run Our Organization (our health care operations). 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 treatment and services. 

Bill for Your Services. We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurer so it will pay for your services.

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 www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.htm

We can share health information about you for certain situations such as

• Preventing disease 
• Helping with product recalls 
• Reporting adverse reactions to medications 
• Reporting suspected abuse, neglect, or domestic violence 
• Preventing or reducing a serious threat to anyone’s health or safety

We will share information about you if state or federal laws require it, for example, with the U.S. Department of Health and Human Services, if they want to see that we’re complying with federal privacy law.

We can share health information about you with organ procurement organizations.

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

We can use or share health information about you, in accordance with applicable law: 

• For workers’ compensation claims 
• For law enforcement purposes or with a law enforcement official 
• With health oversight agencies for activities authorized by law 
• For special government functions such as military, national security, and presidential protective services

We may disclose your Protected Health Information to your employer in accordance with applicable law if We are retained to conduct an evaluation relating to medical surveillance of your workplace or to evaluate whether you have a work-related illness or injury. You will be notified of these disclosures by your employer or as required by applicable law.

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 notify you 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. 
• We will not use or share your information other than as described here unless you authorize us in writing. You can revoke your authorization at any time, for future uses and disclosures of your information. Let us know in writing if you want to revoke an authorization.

When it comes to your health information, you have certain rights. The health and billing records we maintain are the physical property of our office but the information in those records belongs to you unless limited by applicable law. This section explains your rights and some of our responsibilities to help you.

• You can ask to inspect or get an electronic or paper copy of your medical record. Ask us how to do this (including through our patient portal). 
• We will provide a copy of your medical record within 30 days of your request. We will charge a reasonable, cost-based fee as allowed by law, which you will be advised of in advance.

• You can ask us to amend health information about you that you think is incorrect or incomplete. 
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

• You can ask us to contact you in a specific way (for example, home rather than office phone) or to send mail to a different address. 
• We will say “yes” to all reasonable requests.

• 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. 
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information (for the purpose of payment or our operations) with your health insurer. We will say “yes” unless a law requires us to share that information.

You can ask for a list (accounting) of the times we’ve shared your health information for 6 years prior to the date you ask, who we shared it with, and why, except for certain disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

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.

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.

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 
• Share information in a disaster relief situation 

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. 

In these cases we never share your information unless you give us written permission: 

• Marketing purposes 
• Sale of your information 
• Alcohol or substance abuse treatment information 
• Confidential HIV-related information 
• Genetic information 
• Mental Health/Psychotherapy notes 

We may contact you for fundraising efforts, but you can tell us not to contact you again.

• You can complain if you feel we have violated your rights by contacting our Privacy Officer at 5401 Norris Canyon Road, Suite 206, San Ramon, California 94583, or at (925) 667-3538. 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint. 

For more information see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

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 website. 

Notice Revised and Effective: September 1, 2020