Patient Privacy Notice
PENINSULA UROLOGY CENTER, INC.
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.
At our office we have always kept your health information secure and confidential. A new law requires us to continue maintaining your privacy, to give you this notice and to follow the terms of this notice.
Protected health information is health information created by your health care provider that contains information that may be used to identify you. It includes written or oral health information that relates to your past, present, or future physical or mental health; the provision of health care to you; and your past, present or future payment for health care.
The law permits us to use or disclose your health information to those involved in your treatment. For example, a review of your file by a specialist doctor whom we may involve in your care. Or we may share this information with a pharmacist who needs it to dispense a prescription to you or a laboratory that performs a test.
We may use or disclose your health information for payment of the services we provide. For example, we may give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.
We may use or disclose health information about you to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide. We may use and disclose this information to get your health plan to authorize services or referrals.
We may share your health information with our business associates, such as our answering service. We have a written contract with each business associate that requires them to protect your privacy.
We may use your information to contact you. For example, we may send newsletters or other information. We may also want to call and remind you about your appointments. If you are not home, we may leave this information on your answering machine or with the person who answers the telephone.
In an emergency, we may disclose your health information to a family member or another person responsible for your care.
We may release some or all of your health information when required by law, but we will limit our use or disclosure to that which has been requested.
We may and are sometimes required by law to disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability: reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; and reporting disease or infection exposure.
If this practice is sold, your information will become the property of the new owner.
Except as described above, this practice will not use or disclose health information which identifies you without your prior written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
You have the right to request restrictions on certain uses and disclosures of your health information, by a written request. We reserve the right to accept or reject your request, and will notify you of our decision.
You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that we send information to your work address or use your work phone number to contact you. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
You have the right to inspect and copy your health information which has been created to treat you and is used to make decisions about your care. This includes medical and billing records. You must submit a written request detailing what information you want access to and whether you want to inspect it or get a copy of it. We may charge a reasonable fee, as allowed by California and federal law. We may deny your request under limited circumstances.
You have the right to request that copies of your health information be transferred to another physician or medical group. We will mail the files for you.
You have the right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information, and will provide you with information about this medical practice’s denial and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information, if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. You also have the right to request that we add to your record a statement of up to 250 words concerning any statement or item you believe to be incomplete or incorrect.
You have a right to receive a copy of this notice.
If we change any of the details of this notice, we will notify you of the changes in writing.
For more information regarding these rights or if you would like to exercise one or more of these rights, please contact our Privacy Officer @ 650 306-1016.
You may file a complaint with the Department of Health and Human Services, Office of Civil Rights, 200 Independence Avenue, S.W., Room 509F HHH Building, Washington, DC 20201.
You will not be penalized for filing a complaint.
This notice goes into effect as of March 1, 2005.
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Peninsula Urology Center, Inc. 2900 Whipple Ave, Ste 132 Redwood City, CA 94062 650 306-1016 or fax at 650 369-3627