NOTICE
OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE READ IT CAREFULLY
Uses
and Disclosures
Treatment. Your protected health information may be used by staff members
or disclosed to other health care professionals for the purpose of evaluating
your health, diagnosing medical conditions and providing treatment. For
example, results of laboratory tests and procedures will be available in your
medical record to all health professionals who may provide treatment or who may
be consulted by staff members.
Payment. Your protected health information may be used to seek
payment from your health plan, from other sources of coverage such as an
automobile insurer or from credit card companies that you may use to pay for
services. For example, your health plan may request and receive information on
dates of service, the services provided and the medical condition being
treated.
We will also use and disclose your
protected health information for any accounts that are referred to a collection
agency.
Health care operations. Your protected health information may be used as necessary
to support the day-to-day activities and management of San Diego American
Indian Health Center. For example, information on the services you received may
be used to support budgeting and financial reporting and activities to evaluate
and promote quality.
Law enforcement. Your protected health information may be disclosed to law
enforcement agencies to support government audits and inspections, to
facilitate law-enforcement investigations and to comply with government
mandated reporting.
Public health reporting. Your protected health information may be disclosed to
public health agencies as required by law. For example, we are required to
report certain communicable diseases to the state’s public health department.
Other uses and disclosures require
your authorization. Disclosure of your protected
health information or its use for any purpose other than those listed above
requires your specific written authorization. If you change your mind after
authorizing a use or disclosure of your information you may submit a written
revocation of the authorization. However, your decision to revoke the
authorization will not affect or undo any use or disclosure of information that
occurred before you notified us of your decision to revoke your authorization.
Additional
Uses of Information
Appointment reminders: Your protected health information will be used by our
staff to send you appointment reminders.
Information about treatments: Your protected health information may be used to send you
information that you may find interesting on the treatment and management of
your medical condition. We may also send you information describing other
health-related products and services that we believe may interest you.
Interpreters: In order to provide you proper care and services, San
Diego American Indian Health Center (SDAIHC) may use the services of an
interpreter. This may require disclosure of your personal health information to
the interpreter.
Research: SDAIHC may use or disclose your protected health
information for research purposes that has been approved by SDAIHC Board of
Directors that has reviewed the research proposal and established protocols to
ensure the privacy of your health information.
Individual Rights: You have certain rights under federal privacy standards.
These include:
San Diego American Indian Health
Center Duties: We are required by law to maintain
the privacy of your protected health information to provide you with this
notice of privacy practices. We are also required to abide by the privacy
policies and practices that are outlined in this notice.
Right to Revise Privacy Practices: As permitted by law, we reserve the right to amend or
modify our privacy policies and practices. These changes in our policies and
practices may be required by changes in federal and state laws and regulations.
Upon request, we will provide you with the most recently revised notice on any
office visit. The revised policies and practices will be applied to all
protected health information we maintain.
Requests to Inspect Protected Health
Information: You may generally inspect or copy
the protected health information that we maintain. As permitted by federal
regulation, we require that requests to inspect or copy protected health
information be submitted in writing. You may obtain a form to request access to
your records by contacting Medical Records. Your request will be reviewed and
will generally be approved unless there are legal or medical reasons to deny
the request. Please note there may be a fee to obtain copies of your protected
health information.
Complaints: If you would like to submit a comment or complaint about
your privacy practices you can do so by sending a letter outlining your
concerns to:
Karen Grant
San Diego American Indian Health Center
2602 1st Avenue, Suite 105
San Diego, CA 92103
If you believe that your privacy
rights have been violated you should call the matter to our attention by
sending a letter describing the cause of your concern to the same address.
You will not be penalized or
otherwise retaliated against for filing a complaint.
Contact Person: The name and address of the person you can contact for
further information concerning our privacy practices is:
Karen Grant
San Diego American Indian Health Center
2602 1st Avenue, Suite 105
San Diego, CA 92103
Effective Date: This notice is effective on or after March 21, 2005
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