PSYCHIATRY
3017
TELEPHONE 310 829-5540
This notice describes how
medical information about you
may be used, disclosed and
Safeguarded, and how you can get access to this information. Please review it carefully.
Edward Elliott, M.D.
The confidentiality of your personal health information is very important to us. Your health information includes records that we create and obtain when we provide you care, such as a record of your symptoms, examination and test results, diagnoses, treatments and referrals for further care. It also includes bills, insurance claims, or other payment information that we maintain related to your care.
This Notice describes how we handle your health information and your rights regarding this information. Generally speaking, we are required to:
- Maintain the privacy of your health information as required by law;
- Provide you with this Notice of our duties and privacy practices regarding the health information about you that we collect and maintain;
- Follow the terms of our Notice currently in effect.
After reviewing this Notice, if you need further information or want to contact us for any reason regarding the handling of your health information, please direct any communications to the following contact person:
Privacy Officer Edward Elliott, M.D.
(310) 829-5540
Under federal law, we are permitted to use and disclose personal health information without authorization for treatment, payment, and health care operations. However, the American Psychiatric Association’s Principles of Medical Ethics or state law may require us to obtain your express consent before we make certain disclosures of your personal health information.
Example of using or disclosing health information for treatment:
- A nurse takes your pulse and blood pressure, records it in the medical record, and informs your doctor of the results.
Example of using or disclosing health information for payment:
- We submit a bill to your health insurer to receive payment for your care; the insurer asks for health information (for example, your diagnosis and what care we provided) in order to pay us. In such situations, we will disclose only the minimum amount of information necessary for this purpose.
In addition to uses and disclosures related to treatment, payment, and health care operations, we may also use and disclose your personal information without authorization for the following additional purposes:
- As required or permitted by law, we may disclose health information about you to a state or federal agency to report suspected abuse, neglect, or domestic violence. If such a report is optional, we will use our professional judgment in deciding whether or not to make such a report. If feasible, we will inform you promptly that we have made such a disclosure.
- We may use or disclose your health information to remind you about appointments or to inform you about treatment alternatives or other health-related benefits and services that may be of interest to you, such as case management or care coordination.
- To the extent authorized by law, we may disclose information to a person who may have been exposed to a communicable disease or who is otherwise at risk of spreading a disease or condition.
- We may disclose information about you to persons who are involved in your care or payment for your care, such as family members, relatives, or close personal friends. Any such disclosure will be limited to information directly related to the person’s involvement in your care.
- If you are available, we will provide you an opportunity to object before disclosing any such information. If you are unavailable because, for example, you are incapacitated or because of some other emergency circumstance, we will use our professional judgment to determine what is in your best interest regarding any such disclosure.
- We may disclose health information about you to a coroner or medical examiner, for example, to assist in the identification of a decedent or determining cause of death. We may also disclose health information to funeral directors to enable them to carry out their duties.
- We may disclose health information about you to government entities or private organizations (such as the Red Cross) to assist in disaster relief efforts.
- If you are available, we will provide you an opportunity to object before disclosing any such information. If you are unavailable because, for example, you are incapacitated, we will use our professional judgment to determine what is in your best interest and whether a disclosure may be necessary to ensure an adequate response to the emergency circumstances.
- If you are receiving inpatient care, we may include in our facility directory certain information about you, including your name, your location in our facility, your condition in general terms (for example, “critical” or “fair”), and your religious affiliation. Directory information about you is available to members of the clergy, and (excluding information about your religious affiliation) to visitors who ask for you by name.
- If you object to having some or all of this information about you included in our facility directory, let us know, and we will refrain from doing so. If emergency circumstances prevent us from asking you about the directory, we will use our professional judgment to determine what is in your best interest until there is a reasonable opportunity for you to object.
Food and Drug Administration (FDA)
- We may disclose health information about you to the FDA, or to an entity regulated by the FDA, in order, for example, to report an adverse event or a defect related to a drug or medical device.
- We may disclose health information about you for oversight activities authorized by law or to an authorized health oversight agency to facilitate auditing, inspection, or investigation related to our provision of health care, or to the health care system.
- We may disclose health information about you in the course of a judicial or administrative proceeding, in accordance with our legal obligations.
- We may disclose health information about you to a law enforcement official for certain law enforcement purposes. For example, we may report certain types of injuries as required by law, assist law enforcement to locate someone such as a fugitive or material witness, or make a report concerning a crime or suspected criminal conduct.
- We may notify a family member, your personal representative, or other person responsible for your care, of your location, general condition, or death.
- If you are available, we will provide you an opportunity to object before disclosing any such information. If you are unavailable because, for example, you are incapacitated or because of some other emergency circumstance, we will use our professional judgment to determine what is in your best interest regarding any such disclosure.
- If you are an adult or emancipated minor, we may disclose health information about you to a personal representative authorized to act on your behalf in making decisions about your health care.
- As required or permitted by law, we may disclose health information about you to a public health authority, for example, to report disease, injury, or vital events such as death.
- Consistent with our legal and ethical obligations, we may disclose health information about you based on a good faith determination that such disclosure is necessary to prevent a serious and imminent threat to the public or to identify or apprehend an individual sought by law enforcement.
- We may disclose health information about you as required by federal, state, or other applicable law.
- We may disclose health information about you for research purposes in accordance with our legal obligations. For example, we may disclose health information without a written authorization if an Institutional Review Board (IRB) or authorized privacy board has reviewed the research project and determined that the information is necessary for the research and will be adequately safeguarded.
- We may disclose health information about you for certain specialized government functions, as authorized by law. Among these functions are the following: military command; determination of veterans benefits; national security and intelligence activities; protection of the President and other officials; and the health, safety, and security of correctional institutions.
-
We may disclose health information about you for
purposes related to workers’ compensation, as required and authorized by law.
Under the law, you have certain rights regarding the health information that we collect and maintain about you. This includes the right to:
-
Request that we restrict certain uses and disclosures
of your health information; we are not, however, required to agree to a
requested restriction.
-
Request that we communicate with you by alternative
means, such as making records available for pick-up, or mailing them to you at
an alternative address, such as a P.O. box. We will accommodate reasonable requests for
such confidential communications.
-
Request to review, or to receive a copy of, the health
information about you that is maintained in our files. If we are unable to satisfy your request, we
will tell you in writing the reason for the denial and your right, if any, to
request a review of the decision.
- Request that we amend the health information about you that is maintained in our files. Your request must explain why you believe our records about you are incorrect, or otherwise require amendment. If we are unable to satisfy your request, we will tell you in writing the reason for the denial and tell you how you may contest the decision, including your right to submit a statement (of reasonable length) disagreeing with the decision. This statement will be added to your records.
-
Request a list of our disclosures of your health
information. This list, known as an
“accounting” of disclosures, will not include certain disclosures, such as
those made for treatment, payment, or health care operations. We will provide you the accounting free of
charge, however if you request more than one accounting in any 12 month period,
we may impose a reasonable, cost-based fee for any subsequent request. Your request should indicate the period of
time in which you are interested (for example, “from
- Request a paper copy of this Notice.
In order to exercise any of your rights described above, you must submit your request in writing to our contact person (see section III above for information). If you have questions about your rights, please speak with our contact person, available in person or by phone, during normal office hours.
If you believe your privacy rights have been violated, you
may file a written complaint by mailing it or delivering it to our contact
person (see section III above). You may
complain to the Secretary of Health and Human Services (HHS) by writing to Office for Civil Rights, U.S. Department of Health and
Human Services,
We reserve the right to amend the terms of this Notice. If this Notice is revised, the amended terms
shall apply to all health information that we maintain, including information
about you collected or obtained before the effective date of the revised
Notice. If the revisions reflect a
material change to the use and disclosure of your information, your rights
regarding such information, our legal duties, or other privacy practices
described in the Notice, we will promptly distribute the revised Notice, post
it in the waiting area of our office, and make copies available to our patients
and others, and post it on our website.