A MEDICAL CORPORATION
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
We will keep your medical information private and confidential, as required by law and as listed in this Policy.
We will disclose the minimum necessary of required information to protect your privacy. We will notify you of any significant changes to these Policies, if any are changed.
Our current Policy will be posted in prominent places in our office.
Your Medical Information That We May Disclose
We will disclose your medical information as follows:
1. To other health care providers that your doctor has referred you to for the purpose of treatment or testing;
2. To obtain authorization or payment from your insurance carrier unless you prefer to prepay for your services in cash;
3. To support health care organizations assessing the quality of your care that we have provided.
4. To non-employee Associates that perform services on our behalf, such as transcription services.
Without your prior authorization, we may disclose your medical information as required by law as follows to:
1. Public Health agencies as required;
2. In cases of abuse, neglect or domestic violence reporting;
3. Health oversight audits or inspections;
4. Public Health research studies;
5. Coroners or medical examiner services;
6. For funeral arrangements;
7. For Organ donation;
8. For tracking FDA regulated products;
9. For Worker Compensations purposes;
10. In case of emergencies;
11. To law enforcement or judicial agencies with valid administrative orders;
12. To our authorized representative.
IN ALL OTHER SITUATIONS NOT MENTIONED IN THIS NOTICE, WE WILL
ASK FOR YOUR WRITTEN AUTHORIZATION BEFORE RELEASING ANY MEDICAL INFORMATION.
You can later revoke your authorization by notifying us in writing.
Please note that we reserve the right to call you or send appointment reminders.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
You have the right to look at your medical record, within a reasonable time, after sending your written request.
You have the right to obtain a copy of your medical record, after receiving your written request. We have the right to charge you a reasonable fee covering the retrieval, copying and mailing costs.
You have the right to request that your doctor amends, corrects or adds information to your medical records, by submitting in writing, the reasons for requesting the changes. We reserve the right to deny your request if the information to be changed was not created by our doctors or if your doctor deems the record to be complete and accurate. If we deny your request for changes, you may submit a written request to review the denial. You have the right to request in writing, a listing of all those instances where we may have disclosed your medical information, other than for treatment, payment, health care operations or where you specifically authorized as disclosure. The request must be received in writing and can only cover the period starting April 14, 2003, for a maximum of 6 years. We have the right to charge you reasonable costs for retrieval and mailing of this information and will discuss this before you incur any costs.
You have the right to request that medical information 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 communicate with you. You may request in writing that your medical information not be disclosed 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 but may not be able to accommodate you and we are not legally required to do so. We will inform you if we must deny your request.
If you have a complaint regarding the privacy of your medical information or confidentiality, you may contact our Privacy Officer as follows:
SparcMed Attn: Privacy Officer
2363 Main Street, Suite B | Redwood City CA 94063 | 650.780.0575 | Fax 650.780.0587
Finally, you may also send a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights.