Privacy Notices

Notice of Privacy Practices

Notice of Privacy Practices
Pacific Fertility Center, 55 Francisco St, Suite 500, San Francisco, CA, 94133
Privacy Officer: David Bjorklund, (415) 249-3699

Effective Date: October 18, 2013

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.

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information.  We make a record of the medical care we provide and may receive such records from others.  We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information (PHI), to provide individuals with notice of our legal duties and practices with respect to PHI, and to notify affected individuals following a breach of unsecured PHI. This notice describes how we may use and disclose your medical information.  It also describes your rights and our legal obligations with respect to your medical information.  If you have any questions about this Notice, please contact our Privacy Officer listed above.

TABLE OF CONTENTS

  1. How This Medical Practice May Use or Disclose Your Health Information
  2. When This Medical Practice May Not Use or Disclose Your Health Information
  3. Your Health Information Rights
    1. Right to Request Special Privacy Protections
    2. Right to Request Confidential Communications
    3. Right to Inspect and Copy
    4. Right to Amend or Supplement
    5. Right to an Accounting of Disclosures
    6. Right to a Paper or Electronic Copy of this Notice
  4. Changes to this Notice of Privacy Practices
  5. Complaints


A.  How This Medical Practice May Use or Disclose Your Health Information

This medical practice collects health information about you and stores it in a chart and on a computer.  This is your medical record.  The medical record is the property of this medical practice, but the information in the medical record belongs to you.  The law permits us to use or disclose your health information for the following purposes:

  1. Treatment.  We use medical information about you to provide your medical care.  We disclose medical information to our employees and others who are involved in providing the care you need.  For example, we may share your medical information with your gynecologist, your primary care physician, other physicians or other health care providers who will provide services that we do not provide or we may share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test.  We may also disclose medical information to members of your family or others who can help you with your care or if you become ill.
  2. Payment.  We use and disclose medical information about you to obtain payment for the services we provide.  For example, we give your health plan the information it requires for payment.  We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you. If you are not using any health or insurance plan to pay for services, you may direct us not to disclose PHI to your health or insurance plan.
  3. Health Care Operations.  We may use and disclose medical information about you to operate this medical practice.  For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff.  Or we may use and disclose this information to get your health plan to authorize services or referrals.  We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management.  We may also share your medical information with our "business associates," such as our Electronic Medical Record (EMR) service provider, that perform administrative services for us.  We have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your protected health information. California law prohibits all recipients of healthcare information from further disclosing it except as specifically required or permitted by law. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health care costs, protocol development, case management or care coordination activities, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, their activities related to contracts of health insurance or health benefits, or their health care fraud and abuse detection and compliance efforts.
  4. Appointment Reminders.  We may use and disclose medical information to contact and remind you about appointments.  If we are unable to contact you, we may leave a reminder for you in the manner specified by you (available options include: email, voicemail or text message).
  5. Patient Check In.  When you arrive, you will check in at our front desk.  We may call out your name when we are ready to see you.
  6. Notification and Communication with Family.  We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or, unless you had instructed us otherwise, in the event of your death.  In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts.  We may also disclose information to someone who is involved with your care or helps pay for your care.  If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances.  If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
  7. Marketing.  We may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may be of interest to you. We will not otherwise use or disclose your medical information for marketing purposes or accept any payment for other marketing communications without your prior written authorization. The authorization will disclose whether we receive any financial compensation for any marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke that authorization.
  8. Sale of Health Information. We will not sell your health information.
  9. Required by Law.  We will use and disclose your health information as required by law, but we will limit our use or disclosure to the relevant requirements of the law.  When the law requires us to respond to judicial or administrative proceedings, or to law enforcement officials or  report abuse, neglect or domestic violence, , we will comply with the requirements set forth below concerning those activities.
  10. Public Health.  We may, and are sometimes required by law, to disclose your health information to public health authorities for purposes related to:
    1. preventing or controlling disease, injury or disability;
    2. reporting child, elder or dependent adult abuse or neglect;
    3. reporting domestic violence;
    4. reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. 
    5. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.
  11. Health Oversight Activities.  We may, and are sometimes required by law, to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by federal and California law.
  12. Judicial and Administrative Proceedings. We may, and are sometimes required by law, to disclose your health information in the course of an administrative or judicial proceeding.  We will also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
  13. Law Enforcement.  We may, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
  14. Coroners.  We may, and are sometimes required by law, to disclose your health information to coroners in connection with their investigations of deaths.
  15. Organ or tissue donation (including egg, sperm or embryo donation).  We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues which may include sperm, egg or embryo donation.
  16. Public Safety.  We may, and are sometimes required by law, to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
  17. Specialized Government Functions.  We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
  18. Change of Ownership.  In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.
  19. Breach Notification. In the case of a breach of unsecured PHI, we will notify you as required by law. We will use the contact information you provided to us in your Patient Portal to communicate information related to the breach. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate.
  20. Psychotherapy Notes.  We will not use or disclose your psychotherapy notes without your prior written authorization except for the following: (1) your treatment, (2) for training our staff, students and other trainees, (3) to defend ourselves if you sue us or bring some other legal proceeding, (4) if the law requires us to disclose the information to you or the Secretary of HHS or for some other reason, (5) in response to health oversight activities concerning your psychotherapist, (6) to avert a serious threat to health or safety, or (7) to the coroner or medical examiner after you die. To the extent you revoke an authorization to use or disclose your psychotherapy notes, we will stop using or disclosing these notes.
  21. Research.  In the event that we wish to use (or allow anyone else to use) information from your medical record for the purpose of research, we will seek your written permission unless the Institutional Review Board (IRB) or other appropriate privacy board indicates that written permission is not necessary or all identifying data that could link the record to you has been removed in compliance with governing law.
  22. Fundraising.  PFC generally does not engage in fundraising activities. If PFC does, in order to contact you we might use or disclose the following information: your demographic information, affiliation with PFC, health insurance status and indicator of whether you were a patient or research participant.  We will obtain your written authorization for any other disclosures for fundraising. If you do not want to receive these materials, notify the Privacy Officer listed at the top of this Notice of Privacy Practices and we will stop any further fundraising communications. Similarly, you should notify the Privacy Officer if you decide you want to start receiving these solicitations again.
     
  1. When This Medical Practice May Not Use or Disclose Your Health Information
    1. Except as described in this Notice of Privacy Practices, this medical practice will not use or disclose health information which identifies you without your written authorization.  If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
       
  1. Your Health Information Rights
    1. Right to Request Special Privacy Protections.  You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed.  If you tell us not to disclose information to your commercial health plan concerning health care items or services for which you paid for in full, out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request, and will notify you of our decision.
    2. Right to Request Confidential Communications.  You have the right to request that you receive your health information in a specific way or at a specific location.  For example, you may ask that we send information to a particular email account or to your work address.  We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
    3. Right to Inspect and Copy.  You have the right to inspect and copy your health information, with limited exceptions.  To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format.  We will provide copies in your requested form and format if it is readily producible, or we will provide you with an alternative format you find acceptable, or if we can’t agree and we maintain the record in an electronic format, your choice of a readable electronic or hardcopy format. We will also send a copy to any other person you designate in writing. We may charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary, as allowed by federal and California law. We may deny your request under limited circumstances.  If we deny your request to access the records of an incapacitated adult you are representing because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision.  If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.
    4. Right to Amend or Supplement.  You have a right to request that we amend your health information that you believe is incorrect or incomplete.  You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete.  We are not required to change your health information, and will provide you with information about this medical practice's denial and how you can disagree with the denial.  We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is.  If we deny your request, you may submit a written statement of your disagreement with that decision, and we may, in turn, prepare a written rebuttal. You also have the right to request that we add to your record a statement concerning anything in the record you believe to be incomplete or incorrect. All information related to any request to amend or supplement will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
    5. Right to an Accounting of Disclosures.  You have a right to receive an accounting of disclosures of your health information made by this medical practice, except that this medical practice does not have to account for the following:
      1. disclosures provided to you or
      2. pursuant to your written authorization, or
      3. as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notification and communication with family) and 17 (specialized government functions) of Section A of this Notice of Privacy Practices or
      4. disclosures for purposes of research or public health which exclude direct patient identifiers, or
      5. the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities, or
      6. which are incident to a use or disclosure otherwise permitted or authorized by law.
    6. You have a right to notice of our legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top of this Notice of Privacy Practices.

  1. Changes to this Notice of Privacy Practices

We reserve the right to amend our privacy practices and the terms of this Notice of Privacy Practices at any time in the future.  Until such amendment is made, we are required by law to comply with this Notice.  After an amendment is made, the revised Notice of Privacy Practices will apply to all protected health information that we maintain, regardless of when it was created or received.  We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment.  We will also post the current notice on our website.

 

  E. Complaints

Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer:

David Bjorklund
Privacy Officer
Pacific Fertility Center
55 Francisco Street, Suite 500
San Francisco, CA 94133
(415) 249-3699
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:

Region IX
Office of Civil Rights
U.S. Department of Health & Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
(415) 437-8310; (415) 437-8311 (TDD)
(415) 437-8329 (fax)
OCRMail@hhs.gov

The complaint form may be found at http://www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf.  You will not be penalized in any way for filing a complaint.