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This Notice describes how medical
information about you may be used and disclosed and how you can get access
to this information.
Protected Health Information (PHI) about you is obtained as a record of your
contacts or visits for healthcare services provided by the Dr. De LLanos
Clinic. Specifically, PHI is information about you, including demographics
(e.g. name, address, phone, etc.) that may identify you and relates to your
past, present or future physical or mental health condition and related
health care services.
We are required to follow certain rules on maintaining the confidentiality
of your protected health information, how our staff uses your information,
and how we disclose or share this information with other healthcare
professionals involved in your care. This notice describes your rights to
access and control your protected health information. It also describes how
we follow those rules and use and disclose your protected health information
to provide your treatment, obtain payment for your services, manage our
health care operations, and other purposes permitted or required by law.
Your Rights Under the Privacy Rule
- You have the right to receive and we are required to
provide you with a copy of this Notice of Privacy Practices. We are
required to follow the terms of this notice. We reserve the right to
change the terms of our notice at any time. If needed, new versions of
this notice will be effective for all protected health information that we
maintain at that time. Upon you request, we will provide you with a
revised Notice of Privacy Practices if you call our office and request
that a revised copy be sent to you in the mail or ask for one at the time
of service.
- You have the right to authorize other use and
disclosure. This means that you have the right to authorize or deny any
other use or disclosure of protected health information not specified in
this notice. You may revoke an authorization, any time, in writing,
except to the extent that the Dr. De LLanos Clinic has taken an action in
reliance on the use or disclosure indicated in the authorization.
- You have the right to designate a personal
representative. This means you may designate a person with the delegated
authority to consent and authorize the use or disclosure of protected
health information.
- You have the right to inspect and copy your protected
health information. This means you may inspect and obtain a copy of
protected health information about you that is contained in your patient
record.
- You have the right to request a restriction of your
protected health information. This means you may ask us, in writing, not
to use or disclose any part of your protected health information for the
purposes of treatment, payment or healthcare operations. You may also
request that any part of your protected health information not be
disclosed to family members or friends who may be involved in your care.
In certain cases, we may deny your request for a restriction.
- You may have the right to have us amend your protected
health information. This means that you may request an amendment of your
PHI for as long as we maintain this information. In certain cases, we may
deny your request for an amendment.
- You have the right to request disclosure
accountability. This means that you may request a listing of disclosures
we have made of your PHI to entities or persons outside of our office.
Uses and Disclosures Requiring Authorization
- We may use or disclose PHI for purposes outside of
treatment, payment and healthcare operations when you authorization is
obtained. In those instances when we are asked for information for
purposes outside of treatment and payment operations, we will obtain an
authorization from you before releasing this information.
- You may revoke or modify all such authorization of PHI
at any time; however, the revocation or modification is not effective
until we receive it.
Uses and Disclosures Without Consent or Authorization
We may use or disclose PHI without your
consent or authorization in the following circumstances:
Child
Abuse: Whenever we, in our professional capacity, have knowledge of
or observe a child we know or reasonably suspect, has been the victim of
child abuse or neglect, we must immediately report this to a police
department or sheriff's department, county probation department, or county
welfare department. Also, if we have knowledge of or reasonable suspect
that mental suffering has been inflicted upon a child or that his or her
emotional well being is endangered in any other way, we may report it to the
above agencies.
Adult and
Domestic Abuse: If we, in our professional capacity, have observed or
have knowledge of an incident that reasonable appears to be physical abuse,
abandonment, abduction, isolation, financial abuse or neglect of an elder or
dependent adult, or if we are told by an elder or dependent adult that she
or he has experienced these, or if we reasonably suspect such, we must
report the known or suspected abuse immediately to the local law
enforcement agency.
We do not have to report such an incident
if:
- We have been told by an elder or dependent adult that
he or she has experienced behavior constituting physical abuse,
abandonment, abduction, isolation, financial abuse or neglect.
- We are not aware of any independent evidence that
corroborates the statement that the abuse has occurred.
- The elder or dependent adult has been diagnosed with a
mental illness or dementia, or is the subject of a court-ordered
conservatorship because of a mental illness or dementia.
- In the exercise of clinical judgment, we reasonably
believe that the abuse did not occur.
Judicial or
Administrative Proceedings:
If you are involved in a court proceeding
and a request is made about the professional services that we have provided
you, your information will not be released prior to (1) your written
authorization or the authorization of your attorney or personal
representative; (2) a court order; (3) a subpoena, affidavit and the
appropriate notice, and you have not notified us that you are bringing a
motion in the court to block or modify the subpoena. The privilege does not
apply when you are being evaluated for a third party or where the evaluation
is court ordered. We will inform you in advance if this is the case.
Serious Threat to Health or Safety:
If you communicate to us a serious threat
of physical violence against an identifiable victim, we must make reasonable
efforts to communicate that information to the potential victim and to the
police. If we have reasonable cause to believe that you are in such a
condition as to be dangerous to yourself or others, we may release relevant
information as necessary to prevent the threatened danger.
Questions and Complaints
If you have questions about this notice,
disagree with a decision we make about access to your records, or have other
concerns about privacy rights, you may contact us at:
The Dr. De LLanos Clinic
Ariel De LLanos, M.D.,
CEO
32605 Highway 79 South, Suite 219
Temecula, California 92592
Ph: 951-506-9112
Effective Date, Restrictions, and Changes to Privacy Policy
This notice will go into effect on November
14, 2005.
We reserve the right to change the terms of
this notice and to make the new notice provisions effective for all PHI that
we maintain. If requested, we will provide you with a revised notice. |
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