Notice of Privacy
Practices
La Paloma Healthcare Cente
3232 Thunder Dr – Oceanside, CA 92056
760-724-2193
Your Information.
Your Rights. Our Responsibilities.
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.
Your Rights
You have the right to:
• Get a copy of your paper or electronic
medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we
use and share information as we:
• Tell family and friends about your
condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
Our Uses and
Disclosures
We may use and share your information as
we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
Your Rights
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 an electronic or paper copy of your
medical record
• You can ask to see or get an electronic or paper copy of your medical 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 30 days of your request. We may charge a reasonable, cost-based fee.
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 60
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.
• 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.
Get a list of those with whom we’ve shared
information
• You can ask for a list (accounting) of the times we’ve shared your health information
for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment,
payment, and health care operations, and certain other 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.
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 complain if you feel we have violated your rights by contacting us
using the information on page 1.
• 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.
Your Choices
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
• Include your information in a hospital directory
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
• Most sharing of psychotherapy notes
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
How do we typically use or share your health
information? 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: A doctor treating you for an injury asks another doctor about your
overall health condition.
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 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 insurance plan so it will pay for your services.
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: 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:
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 if it wants to see
that we’re complying with federal privacy law.
Respond to organ and tissue donation
requests
• We can share health information about you with organ procurement
organizations.
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 workers’ compensation, law
enforcement, and other government requests
• We can use or share health information about you:
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.
Our
Responsibilities
• 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: 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.
2-8-2018
This Notice of Privacy Practices applies
to the following organizations:
La Paloma Healthcare Center