Notice of 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 carefully.

As part of our professional practice, we maintain personal information about you and your health. State and federal laws protect such information by limiting its uses and disclosures. “Protected health information” (PHI) is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present, or future physical or mental health or condition, the provision of health care services, or the past, present, or future payment for the provision of health care. We are further required by law to notify you of any breach of unsecured PHI that affects you.

Uses and Disclosures of PHI for Treatment, Payment, and Health Care Operations

Treatment. We may use your PHI for the purpose of providing you with health care treatment. To coordinate and manage your care, we may disclose your PHI to others of your current providers, and to the extent you have not raised an objection in writing, to your prior providers, or to other persons, including family members, involved in your care.
Payment. We may use your PHI in connection with billing you, your insurance, or others. In addition, but with your authorization, we may disclose your PHI to third party payers to obtain information concerning benefit eligibility, coverage, and remaining availability, as well as to submit claims for payment and to disclose PHI for medical necessity and quality assurance reviews.
Health Care Operations. We may use and disclose your PHI for the health care operations of our professional practice in support of the functions of treatment and payment. Such disclosures would be to Business Associates for health care education, or to provide planning, quality assurance, peer review, administrative, legal, or financial services to assist us in our delivery of your health care.

Certain Uses and Disclosures Do Not Require Your Authorization

Required by law. We may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Examples are public health reports; child, elder, or dependent adult abuse and neglect reports; law enforcement reports; and reports to coroners and medical examiners in connection with investigation of deaths. We also must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.
Health oversight. We may disclose your PHI to a health oversite agency for activities authorized by law, such as our professional licensure. Oversight agencies also include government agencies and organizations that audit their provision of financial assistance to us (such as third-party payers).
Threat to health or safety. We may disclose your PHI when necessary to minimize an imminent danger to the health or safety of you or any other individual.
Appointment reminders. We may use your PHI to contact you to remind you of your appointments with us.
Lawsuits and disputes. If you are involved in a lawsuit or a dispute, we may disclose mental health information about you in response to a court or administrative order. We may also disclose mental health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested. We may disclose mental health information to courts, attorneys, and court employees in the course of conservatorship, and certain other judicial or administrative proceedings.

Uses and Disclosures of PHI With Your Written Authorization

We will make other uses and disclosures of your PHI only with your written authorization. You may revoke this authorization in writing at any time, unless we have taken a substantial action in reliance on the authorization such as providing you with health care services for which we must submit subsequent claim(s) for payment.

Your rights regarding your PHI. Your rights regarding PHI include the following:

Right of access to inspect and copy. You have the right, which may be restricted only in certain limited circumstances, to inspect and copy your PHI that we maintain. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request. We may charge a reasonable, cost-based fee for copies or preparing a summary.
Right to amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information, although we are not required to agree to the amendment.
Right to an accounting of disclosures. You have the right to request a copy of the required accounting of disclosures that we make of your PHI for purposes other than treatment, payment, or health care operations, or for which you provided an authorization.
Right to request restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request.
Right to request confidential communication. You have the right to request that we communicate with you in a specific way (for example, home or cell phone) or to send mail to a different address. We will accommodate reasonable requests and will not ask why you are making the request.
Right to a copy of this notice. You have a right to a paper and/or electronic copy of this notice.
Right of complaint. You have the right to file a complaint in writing with us or with the Secretary of Health and Human Services if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint.

This Notice

This Notice of Privacy Practices informs you how we may use and disclose your protected health information (PHI) and your rights regarding your PHI. We are required by law to maintain the privacy of your PHI and to provide you with notice of our legal duties and privacy practices with respect to your PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will make available a revised Notice of Privacy Practices by providing you a copy upon your request or providing a copy to you at your next appointment.

Complaints

If you believe we have violated your privacy rights, you may file a complaint to the Department of Health and Human Services Office by: 1) Sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201; 2) visiting www.hhs.gov/ocr/privacy/hippa/complaints or 3) calling 1-877-696-6775. We will not retaliate against you for filing a complaint.

Contact Us:

If you have any questions regarding our privacy policy, you can contact us at:
Phone: 805-643-1446
Mail: 864 E. Santa Clara St., Ventura, CA 93001