Privacy Practice

NOTICE TO CONSUMERS

Medical doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov

Effective Date: June 19, 2009

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.

Introduction

At Dr. Elizabeth Salada’s office we are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice applies to all protected health information as defined by federal regulations.

UNDERSATING YOUR HEALTH RECORD/INFORMATION

Each time you visit Dr. Elizabeth Salada, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for the 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,
• A source of data for medical research,
• A source of information for public health officials charged with improving the health of this state and the nation,
• A source of data for our planning and marketing,
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve,

Understand what is in your records and how your health information is used helps you to: ensure it’s accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

YOUR HEALTH INFORMATION RIGHTS

Although your health record is the physical property of Dr. Elizabeth Salada, the information belongs to you. You have the right to:

• Obtain a paper copy of this noticed of information practices upon request,
• Inspect and copy your health record as provided for in 45CFR 164.524,
• Amend your health record as provided in 45 CFR 164.528,
• Obtain an accounting of disclosure of your health information as provided in 45 CFR 164.528,
• Request communications of your health information by alternative means or at alternative locations,
• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522, and
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

OUR RESPONSIBILITIES

Dr. Elizabeth Salada is required to:

• Maintain the privacy of your health information,
• Provide you with this 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, and
• 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 make a revised notice available to you.

EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS

We will use your health information for treatment.

For example: We may share your medical information with other physicians or other healthcare providers who will provide services which we do not provide. Or we may share information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help you when you are sick or injured.

We will use your health information for regular health operations.

For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use 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 service we provide. We may use and disclose this information to get your health plan to authorize services and referrals. We may also share medical information about you to all other health care providers, healthcare clearing houses and health plans who participate in our “contracted medical group” for any healthcare operations activities of our “contracted medical group.”

Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department, hospital and Urgent Care facility, radiology referrals, laboratory tests, and billing services associated with these associates. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve 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.

Appointment Reminders: We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.

Sign in Sheet: we may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another responsible person, for the purposes of continuing care. For Example: A specialist we referred you to may not have your correct telephone number, and need to reschedule an appointment.

Communication with family or designated individual: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other adult person you identify, health information relevant to the person’s involvement in your care or payment related to that care.

Organ procurement organizations: We may disclose your health information to organizations involved in procuring, banking or transplanting of organs and tissues.

Marketing: We may contact you to provide appointment reminders or information about treatment or other health-related services that may be of interest to you.

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.

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.

Judicial and Administrative Proceedings: We may and are sometimes required by law, to disclose your health information required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if you objections have been resolved by a court of administrative order.

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 once or more patients, workers or the public.

Please be aware that due to the new Federal privacy laws and regulations, ALL requests for ANY information from your medical record MUST be in writing and accompanied by your picture ID. All requests must be made by the Patient or legal representative.

For more Information

If you have any questions and would like additional information, you may contact the practice’s Privacy Officer at (760) 212-1484.

To Report a Problem

Complaints about how Dr. Elizabeth Salada’s practice handles your health information should be directed to our Privacy Officer at (760) 212-1484 or fax the office at (858) 312-5632.

If you are not satisfied with the manner in which this office handles a complaint, you may submit a written complaint to The Office for Civil Rights at the address below:

Office for Civil Rights

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201

There will be no retaliation for filing a complaint with either Dr. Elizabeth Salada’s Privacy Officer or the Office for Civil Rights.