Notice of Privacy Practices

Our Commitment to Your Privacy

Angeles Medical Clinic is committed to protecting the privacy of your protected health information (PHI). We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations to maintain the privacy of your PHI, to provide you with this Notice of our legal duties and privacy practices with respect to your PHI, and to abide by the terms of this Notice. This Notice applies to all of the medical records and other PHI we maintain.

How We May Use and Disclose Your PHI

The following describes the ways we may use and disclose your protected health information:

• For Treatment: We may use your PHI to provide, coordinate, or manage your healthcare and related services. This includes sharing information with other healthcare providers involved in your care, such as specialists, laboratories, or pharmacies
• For Payment: We may use and disclose your PHI to bill and collect payment for the healthcare services we provide. This includes submitting claims to your health insurance company, verifying coverage, and engaging in utilization review activities
• For Healthcare Operations: We may use and disclose your PHI for our healthcare operations, including quality assessment and improvement activities, case management, care coordination, training programs, licensing, accreditation, and business planning
• With Your Authorization: Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke your authorization at any time by submitting a written request to our Privacy Officer
• As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law
• For Public Health Activities: We may disclose your PHI to public health authorities for the purpose of preventing or controlling disease, injury, or disability, including reporting vital events, conducting public health surveillance, and reporting adverse events related to medications or medical devices
• For Health Oversight Activities: We may disclose your PHI to health oversight agencies for activities authorized by law, including audits, investigations, inspections, licensure, and other proceedings necessary for oversight of the healthcare system
• For Judicial and Administrative Proceedings: We may disclose your PHI in response to a court order, subpoena, discovery request, or other lawful process
• For Law Enforcement: We may disclose your PHI to law enforcement officials in certain limited circumstances, such as reporting certain types of wounds, identifying or locating a suspect or missing person, or reporting a crime on our premises
• To Avert a Serious Threat: We may use and disclose your PHI when necessary to prevent a serious and imminent threat to your health or safety or the health or safety of others

Your Rights Regarding Your PHI

You have the following rights with respect to your protected health information:

• Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI contained in our records. To exercise this right, submit a written request to our Privacy Officer. We may charge a reasonable fee for copying, mailing, or other costs associated with your request
• Right to Amend: You have the right to request an amendment to your PHI if you believe it is incorrect or incomplete. Submit your request in writing to our Privacy Officer, including the reason for the amendment. We may deny your request under certain circumstances
• Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI. This accounting will not include disclosures made for treatment, payment, or healthcare operations, or disclosures you authorized in writing
• Right to Request Restrictions: You have the right to request that we restrict certain uses and disclosures of your PHI. We are not required to agree to your request unless the disclosure is to a health plan for payment or healthcare operations and the PHI relates to a service for which you paid in full out of pocket
• Right to Confidential Communications: You have the right to request that we communicate with you about your healthcare in a certain way or at a certain location. For example, you may ask that we contact you only by mail or at a specific phone number
• Right to a Copy of This Notice: You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically

Our Duties

We are required by law to:

• Maintain the privacy of your protected health information
• Provide you with this Notice of our legal duties and privacy practices with respect to your PHI
• Abide by the terms of this Notice currently in effect
• Notify you in the event of a breach of your unsecured PHI

Minimum Necessary Standard

When using or disclosing your PHI or when requesting PHI from another covered entity, we will make reasonable efforts to limit the information to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request. This standard does not apply to disclosures for treatment purposes, disclosures to you, disclosures made pursuant to your written authorization, or disclosures required by law.

Uses and Disclosures Requiring Your Authorization

The following uses and disclosures of your PHI require your written authorization:

• Marketing communications (with limited exceptions)
• Sale of your PHI
• Most uses and disclosures of psychotherapy notes
• Any other uses and disclosures not described in this Notice

Breach Notification

In the event of a breach of your unsecured PHI, we will notify you as required by law. A breach is defined as the acquisition, access, use, or disclosure of PHI in a manner not permitted by HIPAA that compromises the security or privacy of the information. We will provide notification without unreasonable delay and no later than 60 days after discovery of the breach.

Changes to This Notice

We reserve the right to change the terms of this Notice at any time. Any changes will apply to all PHI we maintain, including information created or received before the changes were made. The revised Notice will be available at our facility and on our website. You may request a copy of the current Notice at any time.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights:

• Internal Complaint: Contact our Privacy Officer using the information below
• HHS Office for Civil Rights: You may file a complaint online at hhs.gov/ocr/complaints, by mail, or by calling (800) 368-1019

You will not be retaliated against for filing a complaint.

Contact Information

For questions about this Notice, to exercise your rights, or to file a complaint, please contact our Privacy Officer:

• Privacy Officer
• Email: info@angelesurgentcare.com
• Phone: (213) 457-4000
• Address: 204 E Pico Blvd, Los Angeles, CA 90015