This notice describes how information about you may be used
and disclosed, and how you can get access to this information.
Please review it carefully.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other healthcare
provider, a record of your visit is made. Typically,
this record contains your symptoms, examination and test
results,
diagnosis, treatment, and plan for future care or treatment.
This information, often referred to as your health
or medical record, serves as a:
- basis for planning your care and treatment
- means of communication among the many health professionals
who contribute to your care
- legal document describing the care you received
- means by which you or a third-party payer can verify
that services billed were actually provided
- a tool in educating health professionals/students
- tool in integrating new technical skills or products
in your care
- a source of data for medical research
- a source of information for public health officials
charged with improving the health of the nation
- a source of date for facility planning and marketing
- a tool with which we can assess and continually work
to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information
is used helps you to:
- ensure its accuracy
- better understand who, what, when, where, and why others
may access your health information
- make more informed decisions when authorizing disclosure
to others
Your Health Information Rights
Although your health record is the physical property
of the healthcare practitioner or facility that compiled
it, the
information belongs to you.
You have the right to:
- request a restriction on certain uses and disclosures
of your information as provided by 45 CFR 164.522
- obtain a paper copy of the notice of information practices
upon request
- inspect and obtain a copy of the health record as
provided for in 45 CFR 164.524
- amend your health record a provided in 45 CFR 164.528
- obtain an accounting of disclosures of your health
information as provided in 45 CFR 164.528
- request communications of your health information
by alternative means or at alternative locations
- revoke your authorization to use or disclose health
information except to the extent that action has already
been taken
Our Responsibility
This organization is required to:
- maintain the privacy of your health information
- provide you with a notice as to our legal duties and
privacy practices with respect to information we collect
and maintain about you
- abide by the terms of this notice
- notify you if we are unable to agree to a requested
restriction
- accommodate reasonable requests you may have to communicate
health information by alternative
means or at alternative locations
We reserve the right to change our practices and to make the
new provisions effective for all protected health information
we maintain. Should our information practices change, we will
mail a revised notice to the address you have supplied us.
We will not use or disclose your health information without
your authorization, except as described in this notice.
For More Information or to Report a Problem
If you have any questions and would like additional information
you may contact the Privacy Officer at 661-725-4847
If you believe your privacy rights have been violated, you
can file a complaint with the Privacy Officer or with the United
States Secretary of Health and Human Services. There will be
no retaliation for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health
Operations
We will use your health information for treatment.
For example: Information obtained by a nurse, physician, or
other member of your healthcare team will be recorded in
your record and used to determine the course of treatment
that should work best for you. Your physician will document
in your record his or her expectations of the members of
your healthcare team. Members of your healthcare team will
then record the actions they took and their observations.
In that way, the physician will know how you are responding
to treatment. We will also provide your primary physician
or a subsequent healthcare provider with copies of the various
reports that should assist him or her in treating you once
discharged from the hospital or from our care.
We will use your health information for payment
For example: Members of the medical staff may use your information
in your health record to assess the care and outcomes in
your case and others like it. This information will then
be used in an effort to continually improve the quality and
effectiveness of the healthcare and services we provide.
Business Associates: There are some services provided in our
organization through contracts with business associates. Examples
include physician services in the emergency room department
and radiology, certain laboratory tests and hospital admission
and copy services. When these services are contracted, we may
disclose your health information to our business associate
so that they can perform the job we have asked them to do and
bill you or your third-party payer for services rendered. To
protect your health information, however, we require the business
associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify
or assist in notifying a family member, personal representative,
or another person responsible for your care, your location
and general condition.
Communication with family: Health professionals, using their
best judgment, may disclose to a family member, other relative,
close personal friend or any other person you identify,
health information relevant to that person’s involvement
in your care or payment related to your care.
Research: We may disclose information to researchers when
their research has been approved and established protocols
have been put into place to ensure the privacy of your health
information.
Funeral Directors/Coroner: We may disclose health information
to coroner’s offices or to funeral directors consistent
with applicable law to carry out their duties.
Organ procurement organizations: Consistent with applicable
law, we may disclose health information to organ procurement
organizations or other entities engaged in the procurement,
banking, or transplantation of organs for the purpose of tissue
donation and transplant.
Marketing: We may contact you to provide
appointment reminders or information about treatment alternatives
or other health-related benefits and services that may be
of interest to you.
E-mail: We may contact you via e-mail
as part of pre-operative workup and post-operative care.
Fund raising: We may contact you as part of a fund raising
effort such as charity or promotional walks.
Food and Drug Administration (FDA): We may disclose to the
FDA health information relative to adverse events with respect
to food, supplements, product and product defects, or post
marketing surveillance information to enable product recalls,
repairs, or replacement.
Workers compensation: We may disclose health information to
the extent authorized by and to the extent necessary to comply
with laws relating to workers compensation or other similar
programs established by law.
Public health: As required by law, we may disclose your health
information to public health or legal authorities charged with
preventing or controlling disease, injury or disability.
Correctional institution: Should you be an inmate of a correctional
facility, we may disclose to the institution or agents thereof
health information necessary for your health and the health
and safety of other individuals.
Law enforcement: We may disclose health information for law
enforcement purposes as required by law or in response to a
valid subpoena.
Federal law makes provision for your health information to
be released to an appropriate health oversight agency, public
health authority or attorney, provided that a work force member
or business associate believes in good faith that we have engaged
in unlawful conduct or have otherwise violated professional
or clinical standards and are potentially endangering one or
more patients, workers or the public.
Effective Date: April 01, 2003
We are required to abide by the terms of the Notice of Health
Information Practices currently in effect. We reserve the right
to change the terms of our Notice of Health Information Practices
and to make the new notice provisions effective for all health
information that we maintain. Revisions to our Notice of Health
Information Practices will be posted on the effective date
and you may request a written copy of the Revised Notice from
this office.
You have the right to file a formal, written complaint with
us at the address below, or with the Department of Health and
Human Services, Office of Civil Rights, in the event you feel
your privacy rights have been violated. We will not retaliate
against you for filing a complaint.
For more information about our Privacy Practices, please contact:
Privacy Official
Delano Surgical Group
1205 Garces Hwy Suite 303
Delano CA 93215
(661) 725-4847
(800) 816-6647
For more information about HIPAA, or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(877) 696-6775 toll free
