SUMMARY OF NOTICE OF PATIENT PRIVACY PRACTICES
The Notice of Privacy Practices ("Notice") covers services provided to you by Prospect Medical Group. We are required by law, the Health Insurance and Portability and Accountability Act (HIPAA), to maintain the privacy of protected health information and to provide you with the Notice of our legal duties and privacy practices with respect to protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
The Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations. Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. The Notice also describes your rights to access and control your protected health information. Further, the Notice informs you of your rights to complain to the Secretary of Health and Human Services or us, if you believe your privacy rights have been violated by us.
We are required to abide by the terms of the Notice. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. You can always request a written copy of our most current privacy notice by calling the Privacy Officer at (714) 796-5900.
Please read the attached Notice carefully.
NOTICE OF PATIENT 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 REVIEW IT CAREFULLY.
If you have any questions about this Notice, please contact our Privacy Officer at (714) 796-5900 Prospect Medical Group May Use and/or Disclose Your Protected Health Information for the Following Purposes:
Treatment: We may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party, consultations with another health care provider, or your referral to another health care provider for your diagnosis and treatment. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you.
Payment: We may use your protected health information, as needed, to obtain or provide payment for your health care services, including disclosures to other entities. For example, we may need to tell your health plan about a treatment you are going to receive in order to obtain prior approval for the services or to determine whether your health plan will cover the treatment.
Healthcare Operations: We may use or disclose your protected health information, as needed, in order to support the business activities of your health care provider's practice. These activities include, but are not limited to: quality assessment and improvement activities; reviewing the competence or qualifications of health care professionals; training of medical students; securing stop-loss or excess of loss insurance; obtaining legal services or conducting compliance programs or auditing functions; business planning and development; business management and general administrative activities, such as compliance with the Health Insurance Portability and Accountability Act; resolution of internal grievances; due diligence in connection with the sale or transfer of assets of your health care provider's practice; creating de-identified health information; and conducting or arranging for other business activities.
Business Associates: We will share your protected health information with third party "business associates" that perform various activities (e.g., billing, transcription services, accounting services, legal services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
In addition, we may disclose your protected health information to another provider, health plan, or health care clearinghouse for limited operational purposes of the recipient, as long as the other entity has, or has had, a relationship with you. Such disclosures shall be limited to the following purposes: quality assessment and improvement activities, population-based activities relating to improving health or reducing health care costs, case management, conducting training programs, accreditation, certification, licensing, credentialing activities, and health care fraud and abuse detection and compliance programs.
Prospect Medical Group May Use and/or Disclose Your Protected Health Information, Without Your Written Authorization, For the Following Purposes:
To a public health agency, for purposes such as to prevent or control disease, injury and disability.
To health oversight authorities for activities authorized by law, including inspections, investigations, audit, licensure or disciplinary actions.
As required by law, to comply with a court or administrative order, subpoena, warrant or similar lawful process; if necessary to protect public health or welfare; regarding a victim of a crime if, under certain circumstances, we are unable to obtain the person's agreement; to report death that we believe may be the result of criminal conduct; in case of suspected child abuse, neglect or domestic violence
To provide information about you to workers compensation programs when your health condition arises out of a work-related illness or injury.
To coroners, medical examiners, or funeral directors for identification of an individual, the determination of the cause of death, and for burial activities.
To organ procurement organizations in order to facilitate organ, eye or tissue donation, and transplantation.
For research activities, only under certain limited circumstances because all research projects are subject to a special review process.
For specialized government functions, such as, if you are a member of the armed forces; for intelligence, counterintelligence or other national security activities; if you are an inmate of a correctional institution or under custody of a law enforcement official as may be necessary to provide information about your general health status.
To prevent a serious threat to the health or safety of you or other individuals.
In emergency situations, to render emergency treatment to you; to assist a disaster relief organization.
Uses and Disclosures that May Be Made With Your Written Authorization and/or Opportunity to Object:
Individuals Involved in Your Care or Payment for Your Care: Unless, you object we may release medical information about you to a friend or family member who is involved in your medical care or who helps to pay for your care.
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization, at any time, in writing, except to the extent that your health care provider or the provider's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and any other records that your health care provider and the practice use for making decisions about you. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information.
We may deny your request to inspect and copy your protected health information in certain limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Your health care provider is not required to agree to a restriction that you may request. If your health care provider believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your health care provider does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your health care provider.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.
You may have the right to have your provider amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer to determine if you have questions about amending your designated record set.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes, or disclosures for which you have signed an authorization. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this Notice from us, upon request, even if you have agreed to accept this Notice electronically.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.
You may contact our Privacy Officer, in writing, at Prospect Medical Group, 1920 E. 17th St. Suite 200, Santa Ana, CA 92705 or by calling (714) 796-5900 for further information about the complaint process.
This notice is effective April 14, 2003.
SUMMARY OF NOTICE OF PATIENT PRIVACY PRACTICES