Notice
of Privacy Practices
This
notice describes how medical and medical related information about
you may be used and disclosed and how you can get access to this
information. Please review it carefully. If you have any questions,
please contact our privacy office at the address or phone number
at the bottom of this notice.
Who
will follow this notice?
HoseBeGone.com
provides healthcare to our patients in partnership with other professionals
and health care organizations. The information privacy practices
in this notice will be followed by:
Any
healthcare professional that treats you.
All employees, medical staff, trainees, students, or volunteers
of the entities listed above.
The
above listed entities may share your health information for coordination
of care, treatment, payment and healthcare operations purposes.
Our
pledge to you:
We understand
that medical information about you is personal. We are committed
to protecting medical information about you. We create a record
of the care and services you receive to provide quality care and
to comply with legal requirements. This notice applies to all of
the records of your care generated by any of the separate facilities
and providers described above. We are required by law to:
Keep
medical information about you private;
Give you this notice of our legal duties and privacy practices
with respect to medical information about you; and follow the
terms of the notice that is currently in effect.
How
we may use and disclose medical information about you:
We
may use and disclose medical information about you without your
prior authorization for treatment (such as sending medical information
about you to a specialist as part of a referral); to obtain payment
for treatment (such as sending billing information to your insurance
company or Medicare); and to support our healthcare operations
(such as comparing patient data to improve treatment methods or
for professional education purposes).
Other examples of such uses and disclosures include contacting
you for appointment reminders and telling you about possible treatment
options, alternatives, health-related benefits or services that
may be of interest to you. We may use or disclose medical information
about you without your prior authorization for several other reasons.
Subject to certain requirements, we may give our medical information
about you, without prior authorization for public health purposes,
abuse or neglect reporting, health oversight audits or inspections,
medical examiners, funeral arrangements and organ donation, workers’
compensation purposes, emergencies, national security and other
specialized government functions, and for members of the Armed
Forces as required by Military Command authorities. We also disclose
medical information when required by law, such as in response
to a request from law enforcement in specific circumstances, or
in response to valid judicial or administrative orders or other
legal process.
Under certain circumstances, we may use and disclose health information
about you for research purposes, subject to a special approval
process. We may also allow potential researchers to review information
that may help them prepare for research, so long as the health
information they review does not leave our facility, and so long
as they agree to specific privacy protections.
We may disclose medical information about you to a friend or family
member whom you designate or in appropriate circumstances, unless
you request a restriction. We may also disclose information to
disaster relief authorities so that your family can be notified
of your location and condition.
Other
uses of Medical Information:
In
any other situation not covered by this notice, we will ask for
your written authorization before using or disclosing medical
information about you. If you choose to authorize use or disclosure,
you can later revoke that authorization by notifying us in writing
of your decision.
Right
to Access and or Amend Your Records:
In
most cases, you have the right to look at or get a copy of medical
information that we use to make decisions about your care, when
you submit a written request. If you request copies, we may charge
a fee for the cost of copying, mailing, or other related supplies.
If we deny your request to review or obtain a copy, you may submit
a written request for a review of that decision.
If you believe that information in your record is incorrect or
that important information is missing, you have the right to request
that we correct the records, by submitting a request in writing
that provides your reason for requesting the amendment. We could
deny your request to amend a record if the information is not
maintained by us; or if we determine that your record is accurate.
You may submit a written statement of disagreement with a decision
by us not to amend a record.
Right
to an Accounting:
You
have the right to request a list accounting for any disclosures
of your health information we have made, except for uses and disclosures
for treatment, payment, and healthcare operations, circumstances
in which you have specifically authorized such disclosure, and
certain other exceptions.
To request this list of disclosures, indicate the relevant period,
which must be after April 14, 2003, but in no event for more than
the last six years. You must submit your request in writing to
the Office listed below.
Right
to Request Restrictions:
You
may request, in writing, that we not use or disclose medical information
about you for treatment, payment or healthcare operations or to
persons involved in your care except when specifically authorized
by you, when required by law, or in an emergency. We will consider
your request and work to accommodate it when possible, but we are
not legally required to accept it. We will inform you of our decision
on your request.
All
written requests or appeals should be submitted to the Office listed
below.
Requests
for Confidential Communications:
You
have the right to request that medical information about you be
communicated to you in a confidential manner, such as sending mail
to an address other than your home, by notifying us in writing of
the specific way or location for us to use to communicate with you.
Right to request
an email or paper copy of this Notice:
You may receive an email
or paper copy of this Notice from us upon request, even if you have
agreed to receive this notice electronically.
Changes to this
Notice:
We may change our policies
at any time. Changes will apply to medical information or medical
related information, we already hold, as well as new information
after the change occurs. Before we make a significant change in
our policies, we will change our notice and post the new notice
in waiting areas, exam rooms, and on our Web site at yalenewhavenhealth.org.
You can receive a copy of the current notice at any time. The effective
date is listed at the end. Copies of the current notice will be
available each time you come to our facility for treatment. You
will be asked to acknowledge in writing your receipt of this notice.
Complaints:
If you are concerned that your privacy rights may have been violated,
or you disagree with a decision we made about access to your records,
you may contact the Office listed below.
Office:
HoseBeGone.com
HBG Partners LLC
3217 Yosemite Park Way
Elk Grove, CA 95758
(916) 681-8838
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