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.
We
are required by law to maintain the privacy of your
health information and to provide you with this notice
of our legal duties and privacy practices with respect
to such information. We are also required by law to
abide by the terms of the Notice of Privacy Practices
currently in effect.
Our
Use and Disclosure of Medical Information About You
As you permitted upon admission/registration,
the following is a description of the types
of uses and disclosures of medical information about
you that the Center, or contractors using or disclosing
medical information on behalf of the Center, may make:
Treatment. We may use medical information
about you in order to provide you with medical treatment.
For example, a doctor treating you for a hip fracture
may need to know if you have diabetes because diabetes
may affect the healing process. We may disclose medical
information about you to Center personnel or another
health care provider involved in treating you. For
example, a doctor may need to tell the dietitian if
you have diabetes so that the Center can arrange for
appropriate meals. We also may disclose medical information
about you to people outside the Center who may be
involved in your medical care after you leave the
Center.
Payment.
We may use and disclose medical information about
you so that the Center can get paid for the services
it gives you. For example, we may need to give your
health plan information about rehabilitation you received
at the Center so it will pay us or reimburse you for
services rendered. 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.
Health
Care Operations. We may use and disclose medical
information about you for general administrative and
business functions necessary for operation of the
Center. For example, we may use medical information
about you to assess the quality of care we are giving
to our patients, to review the competence of health
care professionals working at the Center, to train
medical students, to make sure we are complying with
legal rules and regulations or to conduct business
planning or management or other general administrative
activities.
In
addition to the uses and disclosures listed above:
Individuals Involved in Your Care. With you
or your Health Care Proxy's permission, we may disclose
to a family member, other relative or close personal
friend, medical information directly relevant to that
person's involvement with your care or payment related
to your health care. We may also notify your family
or other person involved with your health care that
you are in the Center.
Center Directory. Unless you notify us to the
contrary, we will include certain limited information
about you in the Center directory while you are a patient
at the Center. This information may include your name,
location in the Center, a description of your condition
in general terms that does not communicate specific
medical information about you and your religious affiliation.
The directory information, except for your religious
affiliation, may be disclosed to people who ask for
you by name. Your religious affiliation may be given
to members of the clergy, such as priests or rabbis,
even if they do not ask for you by name. This is so
your family, friends and clergy can visit you in the
Center and generally know how you are doing.
Reviews
Preparatory to Research. We may use and disclose
medical information about you without your consent if
necessary for reviews preparatory to research, but none
of your medical information would be removed from the
Center in the course of such reviews. For example, in
order to prepare for research on rehabilitation of female
hip fracture patients over the age of 75 with osteoporosis,
it would be necessary to review Center medical records
to determine which patients might be appropriate subjects
for such research.
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 patients with a particular
condition who received one type of rehabilitation to
those who received another. Before we use or disclose
medical information about you for research, the project
would have to be approved through a process that the
Center uses for the protection of human research subjects.
We will ask for your specific permission (with exception
in those instances allowed by law) if the researcher
will be using or disclosing medical information about
you for research and will have access to your name,
address or other information that could be used to identify
who you are.
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.
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.
Coroners, Medical Examiners and Funeral Directors.
We may disclose medical information to a coroner
or medical examiner for the purpose of identifying a
deceased person or determining a cause of death, or
to funeral directors as necessary for them to carry
out their duties.
Organ and Tissue Donation. If
you are an organ donor, the Center may use or disclose
medical information about you to organ procurement organizations
or other entities engaged in the procurement, banking,
or transplantation of cadaver organs, eyes, or tissue
for the purpose of facilitating organ, eye or tissue
donation and transplantation.
Government Authorities. We may
use and disclose medical information about you when
necessary to report evidence of a crime or to prevent
a serious threat to your health or safety or the health
or safety of the public or another person, including
the reporting of cases of suspected elder abuse or maltreatment.
As Otherwise Required By Law. We
will disclose medical information about you when required
to do so by Federal, State or local law. For example,
we are required by law to disclose certain information
about patients to public health authorities and health
oversight agencies.
As Otherwise Permitted or Required by Federal
Standards. We may disclose medical information about
you as permitted or required by Federal Standards for
Privacy of Individually Identifiable Health Information
issued by the United States Department of Health and
Human Services.
Your
Rights Regarding Medical Information About You
You have the following rights regarding
medical information we maintain about you:
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.
We are not required to agree to your request. If we
do agree, we will comply with your requests unless the
information is needed to provide you emergency treatment.
To
request restrictions, you must make your request in
writing to the Medical Records
Department, Dr. Corbin, 400 West Central Avenue, Suite
101, Brea, CA 92821, and phone number (714) 671-3033
for further information.
In
your request, you must tell us:
- what
information you want to limit;
- whether you want to limit our use,
disclosure or both; and
- to whom you want the limits to apply.
Right
to Receive Confidential Communications. You have
the right to request that we communicate with you about
medical matters by alternative means or at alternative
locations. For example, you can ask that we only contact
you at work.
To
request confidential communications, you must make your
request in writing to the Director of
Social Service, Dr.
Corbin, 400 West Central Avenue, Suite 101, Brea, CA
92821, and phone number (714) 671-3033
for further information on such requests. We will accommodate
all reasonable requests. Your request must specify how
or where you wish to be contacted.
Right
to Inspect and Copy. You have the right to inspect
and copy health information that may be used by the
Center to make decisions about you.
To
request access to your records, you must submit your
request in writing to the Medical Records
Department, Dr.
Corbin, 400 West Central Avenue, Suite 101, Brea, CA
92821, and phone number (714) 671-3033
for further information. 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 as required by law. 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.
To
request an amendment, your request must be made in writing
and submitted to the Medical Records
Department, Dr.
Corbin, 400 West Central Avenue, Suite 101, Brea, CA
92821, and phone number (714) 671-3033
for further information. 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:
- 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 information which
you would be permitted to inspect and copy; or
- is accurate and complete.
Right
to an Accounting of Disclosures. You have the right
to request an –accounting” of disclosures. This is a
list of disclosures we made of medical information about
you, but the list does not include disclosures for treatment,
payment, or health care operations, those specifically
authorized by you or certain disclosures for law enforcement
purposes.
To
request this accounting of disclosures, you must submit
your request in writing to the
Medical Records
Department, Dr.
Corbin, 400 West Central Avenue, Suite 101, Brea, CA
92821, and phone number (714) 671-3033
for further information. Your request must state a time
period, which may not be longer than six years and may
not include dates before April 14, 2003. 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 a Paper Copy of This Notice. You have the right
to a paper copy of this notice.
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 in the Center.
The notice will contain the effective date. Each time
you are admitted to the Center for treatment or health
care services as an inpatient we will offer you a copy
of the current notice in effect. If you are registered
as an outpatient to the Center for treatment and health
care services, we will offer you a copy of the current
notice in effect at the time of your first visit.
Complaints
If you believe your privacy rights have been violated,
you may file a complaint with the Center or with the
Office of Civil Rights, United States Department of
Health and Human Services, Jacob Javits Federal Building,
26 Federal Plaza, Suite 3312, New York, NY 10278 and
phone number 212-264-33 13, fax number 212-264-3039,
TDD 212-264-2355. To file a complaint with the Center,
contact the Director of Social Service at Dr.
Corbin, 400 West Central Avenue, Suite 101, Brea, CA
92821, and phone number (714) 671-3033
for further information. All complaints must be submitted
in writing. You will not be retaliated against for filing
a complaint
Questions
If
you have any questions about this notice, please contact
the Director of Social Service, Dr.
Corbin, 400 West Central Avenue, Suite 101, Brea, CA
92821, and phone number (714) 671-3033
for further information.
Other
Uses of Medical Information
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 authorization.
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,
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.
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