HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date (08/2005)
This notice describes how medical information about you
be used and disclosed and how you can get access to this
information. Please review it carefully. If you have any
questions about this notice, please contact :
Jules Steimnitz at .
This notice describes the privacy practices at our office.
We are required by law to:
* Maintain the privacy of protected health information
* Give you this notice of our legal duties and privacy
practices regarding your health information
* Follow the terms of the notice currently in effect.
How we may use and disclose your health information
Described as follows are the ways we may use and disclose
your health information. Except for the following purposes
we will use and disclose your health information only with
your written permission. You may revoke such permission at
any time by writing to Jules Steimnitz.
Treatment. We may use and disclose your health information
for your treatment and to provide you with treatment-
related health care services. For example, we may disclose
your health information to doctors, nurses, technicians,
other personnel, including people outside our office, who
are involved in your medical care and need the information
to provide you with medical care.
Payment. We may use and disclose your health information
that others or we may bill and receive payment from you,
insurance company, or a third party for the treatment and
services you received. For example, we may give
to your health plan so that they will pay for your
Health Care Operations. We may use and disclose your
information to evaluate and improve our medical care and
operate and manage our office. For example, we may use and
disclose information to a peer review organization or a
health plan that is evaluating our care. We may also share
information with others that have a relationship with you
for their health care operation activities.
Appointment Reminders, Treatment Alternatives, and Health-
Related Benefits and Services. We may use and disclose
health information to contact you and remind you of your
appointment, to tell you about treatment alternatives or
health-related benefits and services you could use.
Individuals Involved in Your Care or Payment for Your
When appropriate, we may share your health information
a person involved in, or paying for, your care (such as
your family or a close friend). We may notify your family
about your location or condition or disclose such
information to an entity assisting in disaster relief.
Research. We may use and disclose your health information
for research. For example, a research project may involve
comparing the health of patients who received one
to those who received another for the same condition.
Before we do so, the project needs to go through a special
approval process. Even without special approval, we may
permit researchers to look at records to help identify
patients who may be included in their research, as long as
they do not remove or copy any of your health information.
As Required by Law. We will disclose your health
information when required to do so by international,
federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use
and disclose your health information when necessary to
prevent a serious threat to the health and safety of you,
another person, or the public. Disclosures will be made
only to someone who can prevent the threat.
Business Associates. We may disclose your health
information to our business associates that perform
functions on our behalf or provide us with services if
necessary. For example, we may use another company to
perform billing services on our behalf. All of our
associates are obligated to protect the privacy of your
information and are not allowed to use or disclose the
information for any other purpose than appears in their
contract with us.
Military and Veterans. If you are a member of the armed
forces, we may release your health information as required
by military command authorities. If you are a member of a
foreign military we may release your health information to
the foreign military command authority.
Worker's Compensation. We may release your health
information for worker's compensation or similar programs
that provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your health
information for public health activities to prevent or
control disease, injury or disability. We may use your
health information in reporting births or deaths,
child abuse or neglect, medication reactions or product
malfunctions or injuries, and product recall
We may use your health information to notify someone who
may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition. If we are
concerned that a patient may have been a victim of abuse,
neglect, or domestic violence we may ask your permission
make a disclosure to an appropriate government authority.
We will make that disclosure only when you agree or when
required or authorized to do so by law.
Health Oversight Activities. We may disclose your health
information to a health oversight agency for activities
authorized by law. These may include audits,
investigations, inspections, and licensure. These
activities are necessary to for the government to monitor
the health care system, government programs, and
with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or
dispute, we may disclose your health information in
response to a court or administrative order. We may
disclose your health information in response to a
discovery request, or other lawful process by someone else
involved in the dispute, but only if efforts have been
to tell you about the request or to obtain an order
protecting the information requested.
Law Enforcement. We may release your health information
request by law enforcement official if 1) there is a court
order, subpoena, warrant, summons or similar process; 2)
the request is limited to information needed to identify
locate a suspect, fugitive, material witness, or missing
person; 3) the information is about the victim of a crime
even if, under certain very limited circumstances, we are
unable to obtain your agreement; 4) the information is
about a death that may be the result of criminal conduct;
5) the information is relevant to criminal conduct on our
premises; and 6) it is needed in an emergency to report a
crime, the location of a crime or victims, or the
description, or location of the person who may have
committed the crime.
Coroners, Medical Examiners, and Funeral Directors. We may
release your health information to a coroner, medical
examiner, or funeral director to identify a deceased
or cause of death, or other similar circumstance.
National Security and Intelligence Activities. We may
disclose your health information to authorized federal
officials for intelligence and other national security
activities authorized by law.
Inmates or Individuals in Custody. If you are an inmate of
a correctional institution or in custody we may disclose
your information 1) for the institution to provide you
health care, 2) to protect your health and safety or that
of others, and 3) for the safety and security of the
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Inspect and Copy. You have the right to inspect
and copy your medical and billing records by written
request to Jules Steimnitz.
Right to Amend. You have the right to request an amendment
to your records by written request to Jules Steimnitz.
Right to an Accounting Of Disclosures. You have a right to
an accounting of certain disclosures by written request to
Right to Request Restrictions. You have the right to
request restriction or limitation on your health
information used for treatment, payment or health care
operations. You may request us to limit disclosure to
someone involved in your care or in payment for your care
(such as a spouse) by written request to Jules Steimnitz.
We are not required to agree with your request, but we
will try to comply.
Right to Request Confidential Communication. You have the
right to request that we communicate with you about
matters in a certain way or at a certain location. You can
ask, for example, that we contact you only by mail or at
work. Your written request must specify how or where you
wish to be contacted and be addressed to Jules Steimnitz.
We will accommodate reasonable requests.
CHANGES TO THIS NOTICE
We may change this notice and make it effective for
information we already have about you as well as new
information. The current notice will be posted and
available at all times. You have a right to request a
copy of the current notice at any visit or by written
request to Jules Steimnitz.
Office Phone: (415)-641-8631
Office Fax: (415)-970-9576