NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this notice, please contact our Executive Administrative Assistant at (909) 864-2085.
OUR PLEDGE REGARDING INFORMATION:
We are committed to protecting information about you and your health. We create a record of care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of our records.
The Law requires us to:
- Maintain the privacy of your information
- Give you this notice of legal duties and privacy practices related to your information; and
- Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU:
- Treatment: We may use and disclose Personal Health Information (PHI), to treat or provide services for you.
- Payment: We may use and disclose PHI so that we can bill and be paid for treatment and services you receive from us.
- Health Care Operations: We may use and disclose PHI as needed to carry out our organizational needs, to provide services for you.
- Organized Health Care Arrangement: For certain activities, we may disclose information about you to other health care providers participating in an organized health care arrangement, to provide services for you.
- Those Involved in Your Care: We may release relevant PHI to a friend, family member, or anyone else you designate that is involved in your care or payment related to your care. In the event of a disaster, we may also disclose PHI to those assisting in disaster relief efforts so that your family can be notified about your condition, status and location.
- Other: We may use or disclose PHI for the following purposes:
- As required by law
- To avert a threat to health or safety
- Worker’s Compensation
- Public Health activities
- Health oversight activities
- Lawsuits and disputes
- Government functions
- Custodial law enforcement
YOUR RIGHTS REGARDING YOUR INFORMATION:
You have the following rights regarding information we maintain about you:
- Right to Inspect and Copy: You have the right to inspect and obtain a copy of the PHI contained in your records. You must submit your request in writing to: PCMS, ATTN: Executive Administrative Assistant. PCMS reserves the right to deny your request. There may be a fee for the costs of copying, mailing or supplies associated with your request.
- Right To Amend: You have the right to amend your PHI. You must submit your request along with the reason for amendment to the Executive Administrative Assistant
- Right to Accounting of Disclosures: You have the right to request an “ accounting of disclosures.” This is a list of disclosures of your PHI except any made (1) to you, (2) prior to April 14, 2003, (3) as a result of specific written permission, or (4) for Treatment, Payment, Health Care Operations, those involved in your care or for government functions. You may submit a request in writing to the Executive Administrative Assistant. The request must include the time period (not longer than six years) for the disclosures you wish to be listed. The first list you request will be free. We may charge you for the cost of providing other lists within a twelve-month period.
- Right To Request Restrictions: You have the right to request restrictions on the PHI we use or disclose about you as described in the sections above for Treatment, Payment, Health Care Operations, and Those Involved in Your Care. In some cases, we may not agree to your request. You must submit your request for restrictions in writing to the Executive Administrative Assistant.
- Right To Request Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location. You must submit your request for confidential communications in writing to the Executive Administrative Assistant. We will honor all reasonable requests.
- Right to a Paper Copy of this Notice: You have the right to a paper copy of this notice at any time. To obtain a paper copy of this notice, contact our Executive Administrative Assistant.
To submit your written request for any of your rights regarding your information please mail your request to 7216 Palm Ave, Suite C, Highland, CA 92346
We reserve the right to change the terms of this notice, and apply any changes to all PHI that we maintain. We will notify you of any changes in writing to your current address.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our office at 909-864-2085. You will not be penalized for filing a complaint.
OTHER USES AND DISCLOSURES OF INFORMATION:
Other uses and disclosures of PHI not covered by this notice will be made only with your authorization. You may also revoke the authorization at any time by sending a request in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note, we are required to retain records of your care.
Effective: April 15, 2003 Revised: June, 17, 2014; Revised August 18, 2016