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This Notice of Privacy Practices applies to Bay Valley Medical Group, Inc. (“BVMG”), a multi-specialty medical group and IPA. The notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information. Protected Health Information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our website www.bayvalleymedicalgroup.com, calling the Customer Service Department and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.
Federal and state law allows BVMG to use and disclose your PHI for treatment, payment and health care operations. Your PHI may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. The examples below are provided to illustrate the types of uses and disclosures we may make without your consent for treatment, payment and health care operations purposes.
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing activities, and conducting or arranging for other business activities.
For example, we may disclose your protected health information to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you would be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. For example, your name and address may be used to send you a newsletter about our practice and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. You may contact the BVMG Customer Service Department to request that these materials not be sent to you.
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
We must disclose your PHI when required to do so by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensing activities. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information.
We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Practice’s premises) and it is likely that a crime has occurred.
We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.
We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.
Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then BVMG may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your physician or another physician in the practice is required by law to treat you and the physician has attempted but has been unable to obtain your consent, he or she may still use or disclose your protected health information to treat you.
We may use and disclose your protected health information if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke an authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to review or obtain copies of your protected health information records maintained by BVMG, with some limited exceptions. Your request to review and/or obtain a copy of your protected health information records must be submitted in writing to the BVMG Customer Service Department at the address listed in section 5. We may charge a reasonable fee to cover any administrative costs accrued by BVMG in producing the copies, to the extent permitted under applicable law. If your request is denied, BVMG will document the denial in writing.
You have the right to request restrictions on how we use and disclose your PHI for our treatment, payment and health care operations. All requests must be submitted in writing to the BVMG Customer Service Department at the address listed in section 5. The request should cite the specific restriction requested and to whom it should apply. Upon receipt, we will review your request and notify you whether it has been accepted or denied.
BVMG is not required to agree to such a restriction. Your PHI is critical for providing you with quality health care. We believe we have taken appropriate safeguards to protect your PHI and believe that additional restrictions may be harmful to your care. Please keep this in mind when submitting a request to restrict access to your PHI.
You have the right to request that we provide your PHI to you in a confidential manner. For example, you may request that we send our patient mailers to an alternative address or that our appointment reminder calls be directed to an alternate telephone number. We will accommodate all reasonable requests unless they are administratively burdensome or prohibited by law. Such requests must be submitted in writing to the BVMG Customer Service Department at the address listed in section 5.
You have the right to request amendments to your PHI. This means you may request an amendment of your protected health information in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, we will explain why. Amendment requests must be submitted in writing to the BVMG Customer Service Department at the address listed in section 5. The request should include the specific detail you want changed and your reasons for such a change.
This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations. You have the right to receive specific information regarding these disclosures that occurred on or after April 14, 2003 and no farther than 6 years in the past. All such requests must be submitted in writing to the BVMG Customer Service Department at the address listed in section 5. All requests must state a time period for which you want an accounting.
You have the right to request and receive a paper copy of this Notice. Copies are available at each of the BVMG offices and/or can be requested by contacting the BVMG Customer Service Department listed in section 5 of this notice.
Access to your PHI is restricted to those employees who need such access to provide services to our members. In addition, BVMG has established appropriate procedural and technical safeguards to protect your PHI against unauthorized use or disclosure. BVMG has also implemented a training program to educate our staff on how to protect the PHI of our membership.
If you believe that your privacy rights have been violated, you may file a complaint directly with BVMG and/or with the Secretary of the Department of Health and Human Services. We may not retaliate against you for filing such a complaint. All complaints to BVMG must be submitted in writing to the following address:
Bay Valley Medical Group
Attn: Privacy Office
27212 Calaroga Avenue
Hayward, CA 94545-4349
510-785-5000
5. Contact Information
Any questions not specifically addressed by this notice should be sent to the following address.
Bay Valley Medical Group
Attn: Customer Service Department
27212 Calaroga Avenue
Hayward, CA 94545-4349
510-785-5000
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