NOTICE OF HEALTH INFORMATION PRACTICES

This Notice describes how information about you may be disclosed and how you can get access to this information.

Please read this carefully.

Understanding Your Health Record/Information

Each time you visit a healthcare provider a record of your visit is documented. The record contains your symptoms, examination, diagnoses, test results, treatment plan, etc. This information is referred to as your health information or medical record.

Your Health Information Rights

Although your health record is the physical property of the facility, the information belongs to you and you may have a right to:

• Request a restriction on certain uses and disclosures of your information
• Obtain a paper copy of the notice of information practices upon request
• Amend your health record
• Obtain an accounting of disclosures
• Inspect and obtain a copy of your health record
• Request alternative means of communication of health information or at alternative locations
• Revoke your authorization to disclose or use health information except for releases that have taken place previously

Our Responsibilities

• Maintain privacy of your health information
• Provide you a notice of our legal duties and privacy practices with respect to the information collected and maintained about you
• Abide by terms of notice
• Accommodate reasonable request for alternative methods to communicate health information or at alternative location

We reserve the right to change our practices and to make new provisions for all protected health information we maintain. Should our practices change, a revised notice shall be provided. We will not disclose health information without your authorization except as described in the notice.

For More Information or to Report a Problem

For any questions or additional information, you may contact the director of Health Information or the Privacy Officer at (562) 923-9449. If you believe your privacy rights have been violated, you may file a complaint with the Director of Health Information or the Secretary of Health and Human Services. There will be no retaliation for reporting or filing the complaint.