Notice of Privacy Practices
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.
If you have any questions about this notice, please contact the Privacy Officer at firstname.lastname@example.org
Our Pledge to Protect Your Privacy
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at My Chula Vista Doctors (MCVD). We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by MCVD, whether made by MCVD personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- Make sure that medical information that identifies you is kept private (with certain exceptions)
- Give you this notice of our legal duties and privacy practices with respect to medical information about you
- Follow the terms of the notice that is currently in effect
Who Will Follow This Notice
This notice describes MCVD’s practices and that of:
- Any health care professional authorized to enter information into your MCVD medical record
- All departments and units of MCVD, including our outpatient clinics
- All employees, volunteers, trainees, students and medical staff members of MCVD
All of these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information about you with each other for treatment, payment or health care operations purposes described here.
How My Chula Vista Doctors May Use and Disclose Medical Information About You
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in every category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
- DISCLOSURE AT YOUR REQUEST – We may disclose medical information about you when requested by you. This disclosure at your request may require a written authorization by you.
- FOR TREATMENT – We may use and disclose medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, health care students or other hospital personnel who are involved in taking care of you at the hospital. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and X-rays. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as skilled nursing facilities, home health agencies, and physicians or other practitioners. For example, we may give your physician access to your medical information to assist your physician in treating you.
- FOR PAYMENT – We may use and disclose medical information about you so that the treatment and services you receive at MCVD may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give information about surgery you received at MCVD to your health plan so it will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may also provide basic information about you and your health plan, insurance company or other source of payment to practitioners outside MCVD who are involved in your care, to assist them in obtaining payment for services they provide to you. However, we cannot disclose information to your health plan for payment purposes if you ask us not to, and you pay for the services yourself.
- FOR HEALTH CARE OPERATIONS – We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run MCVD and make sure that all of our patients receive quality care. For example, we may use medical information about you to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose medical information about you to doctors, nurses, technicians, medical students and other hospital personnel for review and learning purposes. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.
- AS REQUIRED BY LAW – We will disclose medical information about you when required to do so by federal, state or local law.
- FUNDRAISING ACTIVITIES – We may use information about you, or disclose such information to a foundation related to MCVD, to contact you in an effort to raise money for MCVD and its operations. You have the right to opt out of receiving fundraising communications. If you receive a fundraising communication, it will tell you how to opt out.
- HOSPITAL DIRECTORY – We may include certain limited information about you in the hospital directory, while you are a patient at MCVD. This information may include your name, location in the hospital, your general condition (e.g., good, fair, etc.) and your religious affiliation. Unless there is a specific written request from you to the contrary, this directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name.
- INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE – We may release medical information about you to a friend or family member who is involved in your medical care. We may also give your information to someone who helps pay for your care. Unless there is a specific written request from you to the contrary, we may also tell your family or friends your condition and that you are in the hospital.
In addition, we may disclose medical information about you to an organization assisting in a disaster relief effort so that your family can be notified about your condition, status and location. If you arrive at the emergency department either unconscious or otherwise unable to communicate, we are required to attempt to contact someone we believe can make health care decisions for you (e.g., a family member or agent under a health care power of attorney) and we may disclose medical information about you to that individual.
- MARKETING AND SALES – Most uses and disclosures of medical information for marketing purposes, and disclosures that constitute a sale of medical information, require your authorization.
- RESEARCH – Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another medication, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with the patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, as long as the medical information they review does not leave MCVD.
- TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY – We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- APPOINTMENT REMINDERS AND CALL BACKS – We may use and disclose health information to contact you as a reminder that you have an appointment for care at MCVD. We will communicate with you using the information (such as telephone number and email address) that you provide. Unless you notify us to the contrary, we may use the contact information you provide to communicate general information about your care, such as appointment location, department, date and time.
- BUSINESS ASSOCIATES – MCVD contracts with outside entities that perform business services for us, such as billing companies, management consultants, quality assurance reviewers, accountants or attorneys. In certain circumstances, we may need to share your medical information with a business associate so it can perform a service on our behalf. We will have a written contract in place with the business associate requiring protection of the privacy and security of your medical information.
- CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS – We may release medical information about you to a coroner or medical examiner. This may be necessary, for example to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
- HEALTH CARE REGISTRIES – MCVD participates in several health care registries, where information about our patients is entered into a database shared by other health care providers. The registries are used by health care providers, public health departments, and other programs that serve children to protect the child’s health by allowing access to certain records about patients that help track, or treat, patients. The registries are private and confidential and can only be used by authorized individuals who serve the child.
- HEALTH INFORMATION EXCHANGE (HIE) – MCVD participates in a Health Information Exchange for treatment purposes. The HIE is an electronic system that allows participating health care providers to share patient information in compliance with federal and state privacy laws. Unless you notify us otherwise that you object, we will share your medical information electronically with your participating health care providers as necessary for treatment. Patient medical information that currently by law requires an additional signed authorization for release will not be transmitted to the HIE without your consent or as otherwise mandated by law or regulatory requirement. If you would like to opt out of being included in the HIE, please notify the admission staff.
- HEALTH OVERSIGHT ACTIVITIES – We may disclose medical information about you to a health oversight agency for activities required by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
- HEALTH-RELATED BENEFITS AND SERVICES – We may use or disclose your medical information to tell you about health-related benefits or services that may be of interest to you.
- INMATES – If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This disclosure would be necessary: 1) for the institution to provide you with health care; 2) to protect your health and safety or the health and safety of others; 3) or for the safety and security of the correctional institution.
- LAW ENFORCEMENT – We may release medical information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar process
- To identify or locate a suspect, fugitive, material witness or missing person
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement
- About a death we believe may be the result of criminal conduct
- About criminal conduct at the hospital
- In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime
- LAWSUITS AND DISPUTES – If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested.
- MILITARY AND VETERANS – If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign medical personnel to the appropriate foreign military authority.
- MULTIDISCIPLINARY PERSONNEL TEAMS – We may disclose medical information to a multidisciplinary personnel team relevant to the prevention, identification, management or treatment of an abused child and the child’s parents, or elder abuse and neglect.
- NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES – We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
- ORGAN AND TISSUE DONATION – We may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
- ORGANIZED HEALTH CARE ARRANGEMENT (OHCA) – In accordance with Title 45 of the Code of Federal Regulations §164.501, My Chula Vista Doctors designates itself as an Organized Health Care Arrangement (OHCA) for the sole purpose of complying with the Privacy Regulations of the Health Insurance Portability and Accountability Act of 1996. These entities will share information necessary for the joint health care activities of the Organized Health Care Arrangement.
- PROTECTED SERVICES FOR THE PRESIDENT AND OTHERS – We may disclose medical information about you to the authorized federal officials so they may provide protection to the President of the United States, other authorized persons or foreign heads of state or conduct special investigations.
- PUBLIC HEALTH ACTIVITIES – We may use or disclose medical information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability
- To report births and deaths
- To report the abuse or neglect of children, elders and dependent adults
- To report reactions to medications or problems with products
- To notify people of recalls of products they may be using
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make the disclosure if you agree or when required or authorized by law.
- To notify emergency response employees regarding possible exposure to HIV/AIDS, to the extent necessary to comply with state and federal laws
- SPECIAL CATEGORIES OF INFORMATION – In some circumstances, your medical information may be subject to restrictions that may limit or preclude some uses or disclosures described in this notice. For example, there are special restrictions on the use or disclosure of certain categories of information – e.g., tests for HIV or treatment for mental health conditions or alcohol and drug abuse. Government health benefit programs, such as Medi-Cal, may also limit the disclosure of beneficiary information for purposes unrelated to the program.
- TREATMENT ALTERNATIVES – We may use or disclose your medical information to tell you about or recommend possible treatment-related options, activities or alternatives that may be helpful to you.
- WORKERS’ COMPENSATION – We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you.
- RIGHT TO INSPECT AND COPY – You have the right to inspect and obtain a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information.
To inspect and obtain a copy of medical information that may be used to make decisions about you, you must submit your request in writing to MCVD’s Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by MCVD will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- RIGHT TO AMEND – If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for MCVD.
To request an amendment, your request must be made in writing and submitted to MCVD’s Privacy Officer. In additional, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
- Is not part of the medical information kept by or for MCVD
- Is not part of the information which you would be permitted to inspect and copy
- Is accurate and complete
Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your medical record we will attach it to your records and include whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.
- RIGHT TO AN ACCOUNTING OF DISCLOSURES – You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you other than our own uses for treatment, payment and health care operations (as those functions are described above), and with other exceptions pursuant to the law.
To request this list or accounting of disclosures, you must submit your request in writing to MCVD’s Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
In addition, we will notify you as required by law following a breach of your unsecured protected health information.
- RIGHT TO REQUEST RESTRICTIONS – You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your request, except to the extent that you request us to restrict disclosure to a health plan or insurer for payment or health care operations purposes if you, or someone else on your behalf (other than the health plan or insurer), has paid for the item or service out of pocket in full. Even if you request this special restriction, we can disclose the information to a health plan or insurer for the purposes of treating you.
If we agree to another special restriction, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to MCVD’s Privacy Officer. In your request, you must tell us: 1) What information you want to limit; 2) Whether you want to limit our use, disclosure or both; and 3) To whom you want the limits to apply; for example, disclosures to your spouse.
- RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS – You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to MCVD’s Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- RIGHT TO A PAPER COPY OF THIS NOTICE – You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain an electronic copy of this notice at our website at www.mychulavistadoctors.com
To obtain a paper copy of this notice, contact MCVD’s Privacy Officer via email email@example.com, by telephone at 619-427-3361 or by mail at Privacy Officer, My Chula Vista Doctors, 480 Fourth Avenue #202, Chula Vista, CA 91910.
If you believe your privacy rights have been violated, you may file a complaint with MCVD or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with MCVD, contact MCVD Privacy Officer via email at firstname.lastname@example.org, by telephone at 619-427-3361 or by mail at Privacy Officer, My Chula Vista Doctors, 480 Fourth Avenue #202, Chula Vista, CA 91910. All complaints must be submitted in writing.
You may also file a written complaint with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, our Privacy Office will provide you with the current address for the Director.
You will not be penalized for filing a complaint.
Changes to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice within MCVD. The notice will contain the effective date. In addition, each time you register or are admitted to MCVD for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
Other Uses of Medical Information
Other uses and disclosure of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, this will stop any further use or disclosure of your medical information for the purposes covered by your written authorization, except if we have already acted in reliance on your permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
This notice is effective as of April 1, 2018.