NOTICE OF PRIVACY POLICY & PRACTICES
DANIEL C. MILLS, M.D.
THIS
NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN ACCESS THIS INFORMATION.
PLEASE REVIEW THIS
NOTICE CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS VERY IMPORTANT
TO OUR OFFICE.
We
are required by applicable federal and state law to maintain the privacy of
your health information. We are also required to give you this Notice about our
privacy practices, our legal duties, and your rights concerning your health
information. We must follow the privacy practices that are described in this
Notice while it is in effect. This Notice takes effect
We reserve the right to change our privacy practices and
the terms of this Notice at any time, provided such changes are permitted by
applicable law. We reserve the right to make the changes in our privacy
practices and the new terms of our Notice effective for all health information
that we maintain, including health information we created or received before we
made the changes. Before we make a significant change in our privacy practices,
we will change this Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For
more information about our privacy practices, or for additional copies of this
Notice, please contact us using the information listed at the end of this
Notice.
We use and disclose health information about you for
treatment, payment, and healthcare operations. For example:
Treatment: We may use or disclose your health information to
another physician or other healthcare provider treating you.
Payment: We may use and disclose your health information to
obtain payment for services we provide to you.
Healthcare Operations: We may use and disclose your health information in
connection with our healthcare operations. Healthcare operations include
quality assessment and improvement activities, reviewing the competence or
qualifications of healthcare professionals, evaluating practitioner and
provider performance, conducting training programs, accreditation,
certification, licensing or credentialing activities.
Your Authorization: In addition to
our use of your health information for treatment, payment or healthcare
operations, you may give us written authorization to use your health
information or to disclose it to anyone for any purpose. If you give us an
authorization, you may revoke it in writing at any time. Your revocation will
not affect any use or disclosures permitted by your authorization while it was
in effect. Unless you give us a written authorization, we cannot use or
disclose your health information for any reason except those described in this
Notice.
To Your Family and
Friends: We
must disclose your health information to you, as described in the Patient
Rights section of this Notice. We may disclose your health information to a
family member, friend or other person to the extent necessary to help with your
healthcare or with payment for your healthcare, but only if you agree that we
may do so.
Persons Involved in
Care: We
may use or disclose health information to notify, or assist in the notification
of (including identifying or location) a family member, your personal
representative or another person responsible for your care, of your location,
your general condition, or death. If you are present, then prior to use or
disclosure of your health information, we will provide you with an opportunity
to object to such uses or disclosures. In the event of your incapacity or
emergency circumstances, we will disclose health information based on a
determination using our professional judgment disclosing only health information
that is directly relevant to the person’s involvement in your healthcare. We
will also use our professional judgment and our experience with common practice
to make reasonable inferences of your best interest in allowing a person to
pick up filled prescriptions, medical supplies, x-rays, or other similar forms
of health information.
Marketing
Health-Related Services: We will not use your health information for
marketing communications without your written authorization.
Required by Law: We may use or disclose your health information when we
are required to do so by law.
Abuse or Neglect: We may disclose your health information to appropriate
authorities if we reasonably believe that you are a possible victim of abuse,
neglect, or domestic violence or the possible victim of other crimes. We may
disclose your health information to the extent necessary to avert a serious
threat to your health or safety or the health or safety of others.
National Security: We may disclose to military authorities the health
information of Armed Forces personnel under certain circumstances. We may
disclose to authorized federal officials health information required for lawful
intelligence, counterintelligence, and other national security activities. We
may disclose to correctional institution or law enforcement official having
lawful custody of protected health information of inmate or patient under
certain circumstances.
Appointment Reminders: We may use or disclose your health information to
provide you with appointment reminders (such as voicemail messages, postcards,
or letters).
Access: You have the right to look at or get copies of your
health information, with limited exceptions. You may request that we provide
copies in a format other than photocopies. We will use the format you request
unless we cannot practicably do so. (You must make a request in writing to
obtain access to your health information. You may obtain a form to request
access by using the contact information listed at the end of this Notice. We
will charge you a reasonable cost-based fee for expenses such as copies and
staff time. You may also request access by sending us a letter to the address
at the end of this Notice. If you request copies, we will charge you 50 cents
for each page, $20 per hour for staff time to locate and copy your health
information, and postage if you want the copies mailed to you. If you prefer,
we will prepare a summary or an explanation of your health information for a
fee. Contact us using the information listed at the end of this Notice for a
full explanation of our fee structure.)
Disclosure Accounting: You have the
right to receive a list of instances in which we or our business associates
disclosed your health information for purposes other than treatment, payment,
healthcare operations and certain other activities, for the last 6 years, but
not before
Restrictions: You have the right to request that we place additional
restrictions on our use or disclosure of your health information. We are not
required to agree to these additional restrictions, but if we do, we will abide
by our agreement (except in an emergency).
Alternative
Communication: You have the right to request that we
communicate with you about your health information by alternative means or to
alternative locations. (You must make your request in writing.) Your request
must specify the alternative means or location, and provide satisfactory
explanation how payments will be handled under the alternative means or
location you request.
Amendment: You have the
right to request that we amend your health information. (Your request must be
in writing and it must explain why the information should be amended.) We may
deny your request under certain circumstances.
Electronic Notice: If you receive
this Notice on our Web site or by electronic mail (e-mail), you are entitled to
receive this Notice in written form.
If you want more information about our privacy practices
or have questions or concerns, please contact us.
If
you are concerned that we may have violated your privacy rights, or you
disagree with a decision we made about access to your health information or in
response to a request you made to amend or restrict the use or disclosure of
your health information or have us communicate with you by alternative means or
at alternative locations, you may complain to us using the contact information
listed at the end of this Notice. You also may submit a written complaint to
the U.S. Department of Health and Human Services. We will provide you with the
address to file your complaint with the U.S. Department of Health and Human
Services upon request.
We
support your right to the privacy of your health information. We will not
retaliate in any way if you choose to file a complaint with us or with the U.S.
Department of Health and Human Services.
CONTACT
INFORMATION
Contact
Officer: Practice Administrator
Telephone: (949) 499-2800 Fax: (949)499-9590
Address: