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. 

Clinicas del Camino Real, Inc. (Clinicas) is committed to providing quality healthcare services to you. An important part of that is protecting your medical information according to applicable law. If you have any questions about this notice, please ask to speak to the Privacy Officer or visit any of the Clinicas del Camino Real, Inc. locations.

YOUR RIGHTS 

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. 

Right to Inspect and Copy 

You have the right to inspect and obtain a copy your health information, in the format that you request. You must submit a written request in order to inspect or copy your health information. We may charge a reasonable cost-based fee. We will provide a copy or a summary of your health information, usually within 15 days of your request. We may deny your request in certain limited circumstances. 

Right to Amend 

You can ask us to correct health information about you that you think is incorrect or incomplete by submitting a Medical Record Amendment Form to be made a part of your medical record. You will receive a copy of this form and a response will be provided to you no later than 60 days of receipt. We may deny your request to amend or correct your records. If your request is denied, we will provide you a written denial including the reason for the denial. You have the right to submit a written statement disagreeing with the denial. 

Right to Request Confidential Communications 

You can ask that we communicate with you in a specific way (for example, home or office phone) or to send mail to a different address. We will accommodate all reasonable requests. 

Right to Request Restrictions 

You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree with your request, and we may deny if we have reason to believe it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will approve unless a law requires us to share that information.

Right to an Accounting of Disclosures 

You can ask for a list (accounting) of the times we’ve shared your health information, who we shared it with, and why.  We will include all the disclosures for six years prior to the date you ask, except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months. 

Right to a Paper Copy of This Notice 

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Right to Choose Someone to Act for You 

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

Right to Submit a Complaint

You can complain if you feel we have violated your rights by contacting the Clinicas Privacy Officer at 1040 Flynn Road, Camarillo C.A., 93012, calling (805) 659-1740, fax: (805) 659-9959, or emailing compliance@clinicas.org. 

You may also file a complaint directly with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html. We will not retaliate against you for filing a complaint. 

YOUR CHOICES 

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care by completing a Consent to Release Health Information to Individuals/Family Members Form
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again. 

OUR USES AND DISCLOSURES 

How do we typically use or share your health information? We typically use or share your health information in the following ways.

For Treatment 

We can use your health information and share it with other professionals who are treating you. For example, a doctor treating you for an injury asks another doctor about your overall health condition.

For Payment 

We can use and share your health information to bill and get payment from health plans or other entities. For example, we will give information about you to your health insurance plan so it will pay for your services.

For Operations 

We can use and share your health information to run our practice, improve your care, and contact you when necessary. For example, we use health information about you to manage your treatment and services. 

Appointment Reminders: We may contact you to remind you that you have an appointment. 

Health-Related Products and Services: We may tell you about health-related products or services that may be of interest to you.

Organized Health Care Arrangement (OHCA) 

Clinicas del Camino Real is part of an organized health care arrangement including participants in OCHIN. A current list of OCHIN participants can be requested on their website at <http://www.ochin.org&gt;www.ochin.org. The request form is available here: https://ochin.org/member-request/. As a business associate of Clinicas del Camino Real, OCHIN supplies information technology and related services to Clinicas del Camino Real and other OCHIN participants. OCHIN also engages in quality assessment and improvement activities on behalf of its participants. For example, OCHIN coordinates clinical review activities on behalf of participating organizations to establish best practice standards and access clinical benefits that may be derived from the use of electronic health record systems. OCHIN also helps participants work collaboratively to improve the management of internal and external patient referrals. Your health information may be shared by Clinicas del Camino Real with other OCHIN participants when necessary for health care operation purposes of the organized health care arrangement.

How else can we use or share your health information? 

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Public Health Risks

We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do Research

We can use or share your information for health research.

Comply with the Law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to Organ and Tissue Donation Requests

We can share health information about you with organ procurement organizations.

Work with a Medical Examiner or Funeral Director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies. 

Address Workers’ Compensation, Law Enforcement, and Other Government Requests

We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to Lawsuits and Legal Actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena. 

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. 

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site at www.clinicas.org