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NOTICE OF PRIVACY
PRACTICES
To our patients – this notice
describes how health information about you (as a patient of this practice)
may be used and disclosed, and how you can get access to your health
information. This is required
by the Privacy Regulations created as a result of the Health Portability
and accountability Act of 1996 (HIPAA).
OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your health
information. WE are required
by law to maintain the confidentiality of your health information.
We realize that these laws are complicated, but we must provide you
with the following important information.
USE AND DISCLOSURE OF YOUR HEALTH
INOFRMATION ON CERTAIN SPECIAL CIRCUMSTANCES
The following circumstances may require us to use or disclose your health
information:
| 1. |
To public health authorities and health oversight agencies that are authorized by law to collect information. |
| 2. |
Lawsuits and similar proceedings in response to a court or administrative order. |
| 3. |
If required to do so by a law enforcement official. |
| 4. |
When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. We will only make disclosures to a person or organization able to help prevent the threat. |
| 5. |
If you are a member of U.S. or foreign military forces (Including veterans) and if required by the appropriate authorities. |
| 6. |
To federal officials for intelligence and national security activities authorized by law. |
| 7. |
To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. |
| 8. |
For Workers Compensation and similar programs |
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Communications – You
can request that our practice communicate with you about your health and
related issues in a particular manner or at a certain location.
For instance, you may ask that we contact you at home, rather than
work. We will accommodate reasonable requests.
Restrict
Use/Disclosure – You can request a restriction in our use of
disclosure of your health information for treatment, payment, or health
care operations. Additionally,
you have the e right to request that we restrict our disclosure of your
health information to only certain individuals involved in your care or
the payment for your care, such a s family members and friends.
We are not required to agree to your request.
However, if we do agree, we are bound by our agreement except when
otherwise required by law, in emergences, or when the information is
necessary to treat you.
Inspect/Obtain
Information – You have the right to inspect and obtain a copy of the
health information that may e sued to make decisions about you, including
patient medical records and billing records, but not including
psychotherapy notes. You must
submit your request in writing to Dr. Carla Herriford, 6200 Wilshire
Blvd., Ste. 1012, LA, CA 90048. For
further information please call 323-931-7807.
Ammend
Information – You may ask us to amend your health information if you
believe it is incorrect or incomplete, and as long as the information is
kept by or for our practice. To
request an amendment, your request must be made in writing and submitted
to Dr. Carla Herriford, 6200 Wilshire Blvd., Ste. 1012, LA, CA 90048.
For further information, call 323-931-7807.
You must provide us with a reason that supports your request for
amendment.
Right
to Copy of Notice – You are entitled to receive a copy of this
Notice of Privacy Practices. You
may ask us to give you a copy of this notice at any time.
To obtain a copy, contact our front desk receptionist.
Right
to File Complaint – If you believe your privacy rights have been
violated, you may file a complaint with our practice or with the Secretary
of the Department of Health and Human Services.
To file a complaint with our practice, contact Dr. Carla Herriford.
For further information please call 323-931-7807.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
Right
to Provide Authorization for Other Uses and Disclosures – Our
practice will obtain your written authorization for uses and disclosures
that are not identified by this notice or permitted by applicable law.
If you have any questions regarding this notice or our health information
privacy policies, contact Dr. Carla Herriford.
For further information please call 323-931-7807.
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