Palm Imaging Institute's
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 IT CAREFULLY.
Uses and Disclosures
Your health information may be used by our staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions and providing treatment. For example, results of tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by our staff members.
Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Health Care Operations
Your health information may be used as necessary to support the day-to-day activities and management of our Company and the physicians providing professional services at this Facility. For example, information on the services you received may be used to medical record reviews, support budgeting and financial reporting, and activities to evaluate and promote quality assurance. Or we may use and disclose information to get your health plan to authorize services or referrals.
Public Health Reporting
Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state's public health department.
Health Oversight Activities
We may, and are sometimes required by law to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by federal and state law.
Other Uses and Disclosures Require Your Authorization
Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.
We may use and disclose medical information to contact and remind you about appointments.
In the case of a breach of unsecured protected health information, we will notify you as required by law.
You have certain rights under the federal privacy standards. These include:
The right to request instructions on the use and disclosure of your protected health information.
The right to receive confidential communications concerning your medical condition and treatment.
The right to inspect and copy your protected health information.
The right to amend or submit corrections to your protected health information.
The right to receive an accounting of how and to whom your protected health information has been disclosed.
The right to receive a printed copy of this Notice.
Upon request, we are required by law to maintain the privacy of your protected health information and to provide you with this Notice of Privacy Practices. We are also required to abide by the privacy policies and practices that are outlined in this Notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.
Requests to Inspect Protected Health Information
As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the office manager.
Privacy Officer: Complaints / Contact Person
If you would like to submit a comment or concerns about our privacy practices, you can do so by sending a letter outlining your concerns or call us at (909) 882-2266.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Office of Civil Rights - U.S. Department of Health & Human Services
90 7th Street, Suite 4-100, San Francisco, CA 94103
Phone: (415) 437-8310
You will not be penalized or otherwise retaliated against for filing a complaint.
This Notice is effective on or after September 1, 2011.