This page describes the type of
information we gather about you, with whom that information may be shared and
the safeguards we have in place to protect it. You have the right to the
confidentiality of your medical information and the right to approve or refuse
the release of specific information except when the release is required by law.
If the practices described in this notice meet your expectations, there is
nothing you need to do. If you prefer that we not share information we may
honor your written request in certain circumstances described below. If you
have any questions about this notice, please contact our Privacy Officer at the
address below.
This notice describes Golden
Valley Health CenterŐs practices regarding the use of your medical information
and that of:
We understand that medical
information about you and your health is personal. Protecting medical information
about you is important. We create a record of the care and services you
receive. 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 Golden Valley Health Centers, whether made by health
care professionals or other personnel.
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:
The following categories describe
different ways that we may use and disclose medical information. For each
category of uses or disclosures we will try to give some examples. Not every
use or disclosure in a category will be listed.
For Treatment. We may use medical information about you to provide
you with medical treatment or services. We may disclose medical information
about you to doctors, nurses, technicians, training doctors, or other health
care professionals who are involved in taking care of you. 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 health care professionals 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 health center who may be involved in your
medical care after you leave the health center or that provide services that
are part of your care.
For Payment. We may use and disclose medical information about you
so that the treatment and services you receive may be billed to and payment may
be collected from you, an insurance company or a third party. For example, your
insurance may need to know about services you received so they will pay us or
reimburse you for the service. We may also use and disclose medical information
about you to obtain prior approval or to determine whether your insurance will
cover the treatment.
For Health Care Purposes. We may use and disclose medical information about you
for health care purposes. This is necessary to make sure that all of our
patients receive quality care. For example, we may use medical information to
review our treatment and services and to evaluate the performance of our staff
in caring for you. We may also disclose information to doctors, nurses,
technicians, training doctors, and other health center personnel for review and
learning purposes. 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.
Appointment Reminders. We may use and disclose medical information to
contact you as a reminder that you have an appointment for treatment or medical
care. Staff or an automated
telephone system will do this process.
We may also disclose to third parties who answer your phone limited
protected health information regarding pending appointments, and leave a
reminder message on your voice mail system or answering machine.
Treatment Alternatives. We may use and disclose medical information to tell
you about or recommend possible treatment options or alternatives that may be
of interest to you.
Health-Related Benefits and
Services. We may use and disclose
medical information to tell you about health-related benefits or services that
may be of interest to you.
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 information to someone who
helps pay for your care. We may also tell your family or friends your condition
and that you are in the health center. In addition, we may disclose medical
information about you to an entity assisting in a disaster relief effort so
that your family can be notified about your condition, status and location.
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, 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 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, so long as the medical
information they review does not leave the health center. We will almost always
ask for your specific permission if the researcher will have access to your
name, address or other information that reveals who you are, or will be involved
in your care at the health center.
As Required By Law. We will disclose medical information about you when
required to do so by federal, state or local law.
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.
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.
Workers' Compensation. We may release medical information about you for
workers' compensation or similar programs. These programs provide benefits for
work-related injuries or illness.
Public Health Risks. We may disclose medical information about you for
public health activities. These activities generally include the following:
Health Oversight Activities. We may disclose medical information to a health
oversight agency for activities authorized 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.
Lawsuits and Disputes. We may disclose medical information about you in
response to a subpoena, discovery request, or other lawful order from a court.
Law Enforcement. We may release medical information if asked to do so
by a law enforcement official as part of law enforcement activities; in
investigations of criminal conduct or of victims of crime; in response to court
orders; in emergency circumstances; or when required to do so by law.
Coroners, Medical Examiners and
Funeral Directors. We may release
medical information 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 health center to
funeral directors as necessary to carry out their duties.
Protective Services for the
President, National Security and Intelligence Activities. We may release medical information about you to
authorized federal officials so they may provide protection to the President,
other authorized persons or foreign heads of state or conduct special
investigations, or for intelligence, counterintelligence, and other national
security activities authorized by law.
You have the following rights
regarding medical information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy medical
information that may be used to make decisions about your care. Usually, this
includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical
information that may be used to make decisions about you, you must submit your
request in writing to our Privacy Officer at the address below. 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 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 Golden Valley Health
Centers 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.
To request an amendment, your
request must be made in writing and submitted to our Privacy Officer. In
addition, 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:
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.
To request this list or accounting
of disclosures, you must submit your request in writing to our Privacy Officer.
Your request must state a time period that 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, 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.
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.
We are not required to agree to
your request. If we do agree, 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 our Privacy Officer at the address below. 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
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 our 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 at any time. Even if you have agreed to receive this notice
electronically, you are still entitled to a paper copy of this notice.
To obtain a paper copy of this
notice, please request one in writing from our Privacy Officer at the address
below.
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. The notice will contain on the first page, in the top right-hand
corner, the effective date.
If you believe your privacy rights
have been violated, you may file a complaint with Golden Valley Health Centers
or with the Secretary of the Department of Health and Human Services. To file a
complaint with Golden Valley Health Centers, contact our Privacy Officer at the
address and phone number below. All complaints must be submitted in writing.
You will not be penalized for
filing a complaint.
Other uses and disclosures 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, thereafter we will no
longer use or disclose medical information about you for the reasons covered by
your written authorization. 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.
Scott Penner
Privacy Officer
727 West Childs Ave.
Merced, CA 95340
Department # 209-383-1848