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Last Updated: 5.2.08
Notice of Privacy Practices
This notice describes how health information about you may be used and disclosed and how you
can get access to this information.
Please review it carefully. The privacy of your health information is important to us.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health
information. We are also required to give you this Notice about our privacy practices, our legal
duties and your rights concerning your health information. We must follow the privacy practices
that are described in this Notice while it is in effect. This Notice takes effect April 14, 2003,
and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time,
provide such changes are permitted by applicable law. We reserve the right to make the changes in
our privacy practices and the new terms of our Notice effective for all health information that we
maintain, including health information we created or received before we made the changes. Before we
make a significant change in our privacy practices, we will change this Notice and make the new
Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy
practices, or for additional copies of this notice, please contact our office.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about your treatment, payment, and healthcare operations,
for example:
Treatment: We may use or disclose your health information to a physician or other
healthcare provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services
we provide to you.
Healthcare Operations: We may use and disclose your health information in connection with
our healthcare operations. Healthcare operations include quality assessment and improvement
activities, reviewing the competence or qualifications of healthcare professionals, evaluating
practitioner and provider performance, conducting training programs, accreditation, certification,
licensing or credentialing activities.
Your Authorization: In addition to our use of your health information to treatment,
payment or healthcare operations, you may give us written authorization to use your health
information or to disclose it to anyone for any purpose. If you give us an authorization, you may
revoke it in writing at anytime. Your revocation will not affect any use or disclosures permitted
by your authorization while it was in effect. Unless you give us a written authorization, we cannot
use or disclose your health information for any reason except those described in this Notice.
To Your Family and Friends: We must disclose your health information to you, as described
in the Patient Rights section of this Notice. We may disclose your health information to a family
member, friend or other person to the extent necessary to help with your healthcare or with payment
for your healthcare, but only if you agree that we may do so.
Persons Involved in Care: We may use or disclose health information to notify, or assist
in the notification of (including identifying or locating) a family member, your personal
representative or another person responsible for your care, of your location, your general
condition, or death. If you are present, then prior to use or disclosure of your health
information, we will provide you with an opportunity to object to such uses or disclosures. In the
event of your incapacity or emergency circumstances, we will disclose health information based on a
determination using our professional judgment disclosing only health information that is directly
relevant to the person’s involvement in your healthcare. We will also use our professional judgment
and our experience with common practice to make reasonable inferences of your best interest in
allowing a person to pick up filled prescriptions, medical supplies, x-rays, other similar forms of
health information.
Marketing Health-Related Services: We will not use your health information for marketing
communications without your written authorization.
Required by Law: We may use or disclose your health information when we are required to
do so by law.
Abuse or Neglect: We may disclose your health information to appropriate authorities if
we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence of the
possible victim of other crimes. We may disclose your health information to the extent necessary to
avert a serious threat to your health or safety or the health or safety of other.
National Security: We may disclose to military authorities the health information of
Armed forces personnel under certain circumstances. We may disclose to authorize federal officials
health information required for lawful intelligence, counterintelligence, and other national
security activities. We may disclose to correctional institution or law enforcement official having
lawful custody of protected health information of inmate or patient under certain
circumstances.
Appointment Reminders: We may use or disclose your health information to provide you with
appointment reminders (such as voicemail messages, postcards, or letters).
PATIENT RIGHTS
Access: You have the right to look at or get copies of your health information, with
limited exceptions. You may request that we provide copies in a format other than photocopies. We
will use the format you request unless we cannot practicably do so. (You must make a request in
writing to obtain access to your health information. You may obtain a form to request access by
calling our office. We will charge you a reasonable cost-based fee for expenses such as copies and
staff time. You may also request access by sending us a letter to the address above of this Notice.
If you request copies, we will charge you $0.25 for each page, $25.00 per hour for staff time to
locate and copy your health information and postage if you want the copies mailed to you. If you
request an alternative format we will charge a cost-based fee for providing your health information
in that format. If you prefer, we will prepare a summary or an explanation of your health
information for a fee. Contact us using the information listed above this Notice for a full
explanation of our fee structure).
Disclosure Accounting: You have the right to receive a list of instances in which we or
our business associates disclosed your health information for purposes, other than treatment
payment, healthcare operations and certain other activities for the last 6 years, but not before
April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge
you a reasonable, cost-based fee for responding to these additional requests.
Restriction: You have the right to request that we place additional restrictions on our
use or disclosure of your health information. We are not required to agree to these additional
restrictions, but if we do, we will abide by our agreement (except in an emergency).
Alternative Communication: You have the right to request that we communicate with you
about your health information by alternative means or to alternative locations. (You must make your
request in writing). Your request must specify the alternative means or locations and provide
satisfactory explanation how payments will be handled under the alternative means or location you
request.
Amendment: You have the right to request that we amend your health information. (Your
request must be in writing and must explain why the information should be amended). We may deny
your request under certain circumstances.
Electronic Notice: If you receive this Notice on our Web site or by electronic mail
(e-mail), you are entitled to receive this Notice in written form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns please
contact our office at 650-692-1530.
If you are concerned that we may have violated your privacy rights, or you disagree with a
decision we made about access to your health information or in response to a request you made to
armed or restrict the use or disclosure o your health information or to have us communicate with
you by alternative means or at alternative locations, you may complain to us using the contact
address information listed above of this Notice. You also may submit a written complaint to the
U.S. Department of Health and Human Services. We will provide you with the address to file your
complaint with U.S. Department of Health and Human Services upon request.
We support your right to the privacy of your health information. We will not retaliate in any
way if you choose to file a complaint with us or with the U.S. Department of Health and Human
Services.
A Special Note About
Children
Children are not eligible to use
our services unsupervised and we ask that children (under the age of 14) do not submit any personal
information to us. If you are a minor, you can use this service only in conjunction with permission
and guidance from your parents or guardians.
Acquisition or Changes
in Ownership
In the event that the web site
(or a substantial portion of its assets) is acquired, your information would be considered part of
those assets, and may be part of those assets that are transferred.
Policy
Modifications
We may change this Privacy
Policy from time to time. If/when changes are made to this privacy policy, we will email users who
have given us permission to do so. We will post any changes here, so be sure to check back
periodically. However, please be assured that if the Privacy Policy changes in the future, we will
not use the personal information you have submitted to us under this Privacy Policy in a manner
that is materially inconsistent with this Privacy Policy, without your prior consent.
For More Information on
this policy click here
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