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. |
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Folsom Family & Sports Medical Group [FF&SMG] is
committed to protecting the confidentiality of your health information. We are required by law to maintain the privacy of your medical
information. We are also required to notify you of our legal duties and
privacy practices regarding your medical information, and abide by the
practices of this Notice, unless more stringent laws or regulations
apply. This Notice of Privacy Practices provides detailed information
about how we may use and disclose your medical information with or without
authorization as well as more information about your specific rights with
respect to your medical information. Disclosures Of Your Medical Information That We May Make Without Authorization for Treatment, Payment, and Operations Treatment: Your information may be shared with any
provider who is providing you with health care services. This includes
coordinating your care with other providers and providing referrals to other
providers. Examples of health care providers who may need your
information to treat you include your doctor, pharmacist, nurse, and other
providers such as physical therapists, home health providers, and x-ray
technicians. We may also use your information to contact you for
appointments and to provide information about health-related products and
services that we believe may be helpful to you. We may share your information
electronically with your health care providers in order to make sure they
have your information as quickly as possible to treat you. We will use
the utmost care in any situation where we need to disclose your information
electronically. We may also share your medical information with any family
member or friend who is involved in assisting with your health care. We
will only do this if you agree, and will only share with them the information
they need in order to help you. If you are unable to either
agree or object to such a disclosure, we may disclose your health care
information as necessary if we determine that it is in your best interest
based on our professional judgment. Payment: In
order to get your health care services paid for, we may have to provide your
medical information to the party responsible for paying. Your insurance
company or health plan may need your information for activities such as
determining your eligibility for coverage, reviewing the medical necessity of
the health care services, or providing approval for hospital stays. Other Disclosures That We May Make Without Your Authorization There are a number of ways that your medical information may
be used without your authorization, generally either because they are
required by law or for public health and safety purposes. Those include: Required by Law: Your medical information may be used or
disclosed by us when required by law. If this happens, we will
comply with the law and will only disclose the information necessary.
You will be notified, as required by law, of any such uses or disclosures. Public Health: Your medical information may be used for
public health activities. Public health authorities are
authorized to collect or receive the information for purposes such as
controlling disease, injury or disability. Disaster Relief: We may disclose health care
information about you to an entity assisting in a disaster relief effort so
that your family and friends can be notified about your condition, status,
and location. Incidental Disclosures: Certain incidental disclosures of your
health care information may occur as a by-product of lawful and permitted use
and disclosures of your health care information. For example, a visitor
may overhear a discussion about your care at the nursing station. These
incidental disclosures are permitted if we apply reasonable safeguards to
protect the confidentiality of your health care information. Communicable Diseases: If required by law to do so, we may
disclose your medical information to a person who may have been exposed to a
communicable disease or may otherwise be at risk of contracting or spreading
the disease or condition. Health Oversight: Health oversight agencies are authorized
to have access to medical information maintained by us for activities such as
audits, investigations, and inspections. Agencies with this authority
include government agencies that oversee the health care system, government
benefit programs, government regulatory programs and civil rights laws. Abuse or Neglect: We may disclose your medical
information to a public health authority that is authorized by law to receive
reports of child abuse or neglect. We may also disclose your protected
health information to the governmental agency authorized to receive such
information if we believe that you have been a victim of abuse, neglect or
domestic violence. Any disclosures of this nature will be made
consistent with state and federal law. Food and Drug Administration: We may disclose your
medical information to a person or agency required by the Food and Drug
Administration to report adverse events, product defects or problems,
biologic product deviations, or for product recalls, repairs or replacements. Legal Proceedings: We may disclose your medical
information if required to by a court or administrative order to do so for an
administrative or judicial proceeding, or in some cases in response to a
subpoena, discovery request or other legal process. Law Enforcement: We may disclose your medical
information, so long as applicable legal requirements are met, for law
enforcement purposes. Examples of these purposes would be: (1) legal
processes and otherwise required by law; (2) limited information requests for
identification and location purposes; (3) pertaining to crime victims; (4)
suspicion that death has occurred as a result of criminal conduct, (5) if
crime occurs on the premises, and (6) for medical emergencies where it
appears likely a crime occurred. Coroners, Funeral Directors, and Organ Donation: Your medical
information may be disclosed to a coroner or medical examiner for
identification purposes, determining cause of death or other legally required
duties. Your medical information may also be released to a
funeral director in order to permit him/her to perform their duties.
Your information may be disclosed if we reasonably anticipate your death, and
may also be used and disclosed for cadaveric organ, eye or tissue donation
purposes. Research: Your medical information may be disclosed
to researchers, provided that the research has been approved by in
Institutional Review Board and the research protocols have been approved to
ensure your privacy. We may disclose health care information about you
to people preparing to conduct a research project; for example, to help the
researcher identify patients with specific medical needs that would relate to
the proposed research. Information used for this purpose will not leave
Providence Health System SFVSA. Criminal Activity: As required by state and federal
laws, we may disclose your medical information if we believe that the use or
disclosure is necessary to prevent or lessen a serious and imminent threat to
the health or safety of a person or of the public. We may also disclose
your medical information if it is necessary for law enforcement authorities
to identify or apprehend an individual. Military Activity and National Security: Under
certain circumstances, the medical information of Armed Forces personnel may
be disclosed (1) for activities deemed necessary by appropriate military
command authorities; (2) for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits, or (3) to foreign military
authority if you are a member of that foreign military serves. Your
medical information may also be disclosed to authorized federal officials for
conducting national security and intelligence activities, including for the
provision of protective services to the President or others legally
authorized. Workers’ Compensation: Your medical information may be used
or disclosed as necessary to comply with workers’ compensation laws and other
similar legally established programs. How We Will Use and Disclose Your Medical Information With Authorization Other uses and disclosures of your medical information will be
made only with your written authorization, unless otherwise permitted or
required by law. You may revoke the authorization, at any time,
in writing, except to the extent that we have already taken an action in
reliance on the use or disclosure indicated in the authorization. Your Rights The following information describes your rights with respect to
your medical information that we maintain. Right to Request Restrictions: You have the
right to ask us to place restrictions on the way we use or disclose your
medical information for treatment, payment, or healthcare operations.
We are not required to agree to the restriction, but if we agree to a
restriction, we will not use or disclose your medical information in
violation of that restriction, unless it is needed for an emergency. If
a restriction is no longer feasible, we will notify you. Confidential Communications: We will accommodate
reasonable requests to communicate with you about your medical information by
different methods or alternative locations if you make your request in
writing. For example, if you are covered on a health plan but are not
the subscriber, and would like your medical information sent to a different
address than the subscriber, we can usually do that for you. Access to Your Medical Information: You have the
right to receive a copy of your medical information that we maintain, with
some limited exceptions. You may request access to those records in
writing and provide us with information about the specific information you
need so that it can fulfill your request. We reserve the right to charge a
reasonable fee for the cost of producing and mailing the copies. For
more information about the cost, you may contact the FF&SMG office
manager. Amendment of Your Medical Information: You have the
right to ask us to change any of your medical information. You
need to request this amendment in writing and submit it. In certain
situations we may have to deny your request, such as when the medical
information in your records was created by another provider. Any denials
will be in writing. You have the right to appeal our denial by filing a
written statement of disagreement Accounting of Certain Disclosures. You
have a right to a listing of the disclosures we make of your medical
information, except for those disclosures made for treatment, payment, or
healthcare operations, or those disclosures made pursuant to your
authorization. The type of disclosures typically contained in an
listing would be disclosures made for mandatory public health purposes, law
enforcement, legal proceedings, or for other required reporting such as birth
and death certificates. Paper
Copy of Notice. As a
patient you retain the right to obtain a paper copy of this Notice of Privacy
Practices, even if you have requested such copy by e-mail or other electronic
means. You may download or copy from this web site. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice of Privacy Practices effective for all personal health information maintained by us. You may receive a copy of any revised notice from this internet location.
Complaints.
If you believe your
privacy rights have been violated, you may file a complaint in writing with
the doctor's office or Guest Services department of the hospital you visited.
You may also file a complaint with the Secretary of the U.S. Department of
Health and Human Services in Washington D.C. All complaints must be made in writing and in no way will
affect the quality of care you receive from us. You will not be retaliated against for filing a complaint! For
further information.
If you have questions or need further assistance regarding this Notice of
Privacy Practices, you may contact us in writing at Folsom Family &
Sports Medical Group, 4987 Golden Foothill Pwy, El Dorado Hills, CA 95762, or by telephone at 916.792.7143, or by e-mail at mail2sark@yahoo.com.
Contact S. Matossian Office Manager
Effective Date. This Notice of Privacy Practices is effective February 13, 2008
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