THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED BY US, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective Date: March 14, 2019
When it comes to your health information, you have certain rights guaranteed by California statues and federal laws. In this section, we will explain your rights and some of our responsibilities to help you.
Get a copy of health and claims records
You can inspect your health information we have about you. Please ask us how to do this.
We will provide a copy or a summary of your health and claims records. California Health & Safety Code § 123110(b) requires us to provide you copies within 15 days of your written request. We will charge a reasonable, cost-based fee. We may say “no” to your request, but we’ll tell you why in writing.
Ask us to correct health and claims records
You can correct your records if you think they are incorrect or incomplete. Please ask us how to do this.
We may say “no” to your request. If we deny your request, we will let you know how you can add an addendum to your records in writing allowed by California Health & Safety Code§123111 within 30 days of your written request.
Request confidential communications
You can ask us to contact you in a specific way or to send mail to a different address. Please ask us how to do this.
Example: You can ask us to call you at home rather than at work.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We may say “no” only if the request would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for 6 years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide 1 accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
Please let us know if we have violated your rights. Please contact:Privacy Officer, InBalance AcuPT,615 E. Union StreetPasadena, CA 91101, telephone - (626) 551-1108, email - firstname.lastname@example.org
If we have not adequately addressed your concerns, you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W. Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information, please let us know. You have both the right and choice to tell us to:
Share medical information with your employer, family member(s), close friends, domestic partners, or others involved in payment for your care
Allow your family, close friends, domestic partners, or others involved in payment for your care to pick up filled prescriptions, medical supplies, X-rays, or other similar forms of medical information
We will never share your medical information with your employer, family member(s), close friends, domestic partners, or others involved in payment for your care unless we received authorization from you. You may revoke the authorization at any time. However, California Civil Code §56.10(c)(8) and §56.1007(d) allow some exceptions:
If you are unconscious or incapacitated, we will share your information with emergency medical professionals directly involved in your health care only if we believe it is in your best interest.
We may also share your information when needed to lessen a serious and imminent threat to health or safety.
We may share limited medical information with your employer, as a result of employment-related health care services with specific prior written request and payment by your employer.
We may use professional judgement to make reasonable inferences in your best interest to allow a person to pick up filled prescriptions, medical supplies, X-rays, or other similar forms of medical information.
In these cases, we never share your information without your permission:
Sale of your information
In the case of fundraising, we may contact you, but you can tell us not to contact you.
Our Uses and Disclosures.
Pursuant to the California Confidentiality of Medical Information Act and federal law, we can use your medical information in the following ways:
We can use your health information and share it with other health professionals employed by InBalance Acu Physical Therapy.
Example: A licensed acupuncturist treating you for an injury asks a licensed physical therapist about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information with health plans or other entities to the extent necessary to determine responsibility for payment and payment to be made.
Example: We give information about you to your health insurance plan so it will pay for your treatment.
Help with public health and safety issues We can share your medical information for certain situations such as:
Preventing disease, injury, or disabilities
Helping with product recalls authorized by law
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence to appropriate agencies
Preventing or reducing a serious threat to anyone’s health or safety
Comply with the law
We will share information about you if state or federal laws require it, including with governmental boards, commissions, arbitration panel, or administrative agencies
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations or tissue bank.
Work with a medical examiner
We can share your health information with a coroner or medical examiner for the purpose of identifying the decedent, locating next of kin, or when investigating deaths.
Respond to research requests
We may share your medical information with public health agencies or clinical investigators conducting epidemiologic studies for bona fide research purposes, only if compelled by law.
Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you:
For workers’ compensation claims
For law enforcement purposes, such as search warrants issued to a governmental agency
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share medical information about you in response to a court or administrative order, or in response to a subpoena.
We are required by law to maintain the privacy and security of your protected health information.
We will let you know within 5 days of discovering a data breach that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.