Effective 10/2019
PLEASE REVIEW THIS PRIVACY PRACTICES NOTICE CAREFULLY. THIS NOTICE DESCRIBES AND EXPLAINS HOW PERSONAL MEDICAL INFORMATION ABOUT YOU MAY BE DISCLOSED AND USED AND HOW YOU CAN ACCESS THIS INFORMATION.
OUR PLEDGE TO PROTECT YOUR PRIVACY
We are committed to the right to privacy of our patients and anyone who visits our website. We understand that medical information about you and your health is personal and at our office we are committed to protecting your medical information. We may require that you provide us with personally identifiable information. All information collected is held in complete confidence.
This privacy policy will tell you about ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to: make sure that medical information that identifies you is kept private (with certain exceptions); give you this notice of our legal duties and privacy practices with respect to medical information about you; notify you of any breach of your unsecured medical information; and follow the terms of the version of this Notice of Privacy Practices that is currently in effect.
We create a record of the care you receive at Gustavo A. Alza, M.D. INC. (“Dr. Alza”). “Protected health information,” or “health information” that identifies you includes medical records and/or other information relating to your healthcare and/or payment for such. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by Dr. Alza, whether made by Dr. Alza’s personnel or yourself. If you have other doctors, they may have different policies or notices regarding their respective use and disclosure of your medical information created at the other doctor’s office or clinic.
We may automatically collect certain information via our website and services or other methods of web analysis, including but not limited to your Internet protocol (IP) address, mobile carrier, browser type, language, hardware type, operating system, Internet service provider, cookie identifiers, MAC address, IMEI, Advertiser ID, and any and all other device identifiers that are automatically assigned to your device when accessing the Internet. Furthermore, such information reveals the date and time of your visit, the amount of time you spend on each page, the links you click and pages you view on our website, and other actions taken through use of our website.
HOW WE MAY DISCLOSE AND USE HEALTHCARE INFORMATION ABOUT YOU
The following categories include but are not limited to the different ways that we may use and/or disclose medical information. Not every use or disclosure in a category will be listed. That being said, all of the ways we are permitted to use and disclose information will typically fall within one of these categories:
- TREATMENT; PAYMENT; HEALTHCARE OPERATIONS;
- HEALTHCARE RELATED BENEFITS AND SERVICES;
- LAWSUITS AND DISPUTES; BUSINESS ASSOCIATES;
- LAW ENFORCEMENT;
- CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS;
- MEDICAL RESEARCH;
- COMMUNICABLE DISEASES AND OTHER SPECIAL CATEGORIES OF INFORMATION;
- TO PREVENT SERIOUS THREAT TO HEALTH OR SAFETY;
- HEALTH OVERSIGHT ACTIVITIES;
- AS REQUIRED BY LAW;
- NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES;
- PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS;
- DISASTER RELIEF; INMATES;
- AND PERSONAL REPRESENTATIVES (WITH POWER OF ATTORNEY ON RECORD AT OUR OFFICE).
TREATMENT, PAYMENT, AND HEALTHCARE OPERATIONS (“TPO”)
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, physician assistants, nurses, technicians, medical students, or other personnel who are involved in taking care of you at Dr. Alza’s office.
We may use and disclose medical information about you so that the treatment and services you receive at Dr. Alza’s office may be billed to and payment may be collected from you, an insurance company, the government, or a third party. We may disclose and use protected health information for healthcare operation activities; including, functions required to run our office and assure that our patients receive quality healthcare, including functions such as appointment and laboratory scheduling.
Our web site provides the capability to request an appointment online. To make an appointment online you utilize a portal hosted, created, and secured by Microsoft. Use of the scheduling feature will be subject to Microsoft’s terms of service and Microsoft’s privacy policy. We are not responsible for the privacy practices or content of Microsoft or any other websites or applications. USE OF MICROSOFT’S WEBSITE AND ANY OTHER WEBSITE OR APPLICATION IS AT YOUR OWN RISK.
HEALTH OVERSIGHT ACTIVITIES
We may disclose medical information to federal and state agencies that oversee our activities. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
BUSINESS ASSOCIATES
Our office contracts with entities that perform business services for us to provide quality healthcare to our patients. In certain circumstances, we may need to use or disclose your healthcare information with a business associate so it may perform services on our behalf. Such companies include billing companies; appointment schedulers; communication systems; management consultants; quality assurance reviewers; accountants and attorneys; and electronic healthcare record providers. We will have a written agreement in place with the business associate requiring the protection, privacy, and security of healthcare information about you.
LAWSUITS & DISPUTES
If involved in a lawsuit or dispute, we may disclose medical information about you to comply with a court or administrative order. We may also disclose medical information about you to comply with a subpoena, discovery request or other lawful process by someone else involved in the dispute.
LAW ENFORCEMENT; NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES; & PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS
We may release medical information if asked to do so by a federal, state, or local law enforcement official or agent: to comply with a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain limited circumstances, regarding a death believed to be the result of a criminal conduct; regarding criminal conduct on our premises; and in the event of an emergency to report a crime; the location of the crime or victims or the identity, description or location of the person who committed the crime.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
We may release medical information to a coroner or medical examiner as necessary to identify a deceased person or determine the cause of death, and also release medical information about patients as necessary to funeral directors in order to carry out their duties.
INMATES
If you are an inmate associated with a correctional institution or under the custody of law enforcement, we may release medical information about you to the correctional institution or law enforcement official as necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
TO PREVENT SERIOUS THREAT(S) TO HEALTH OR SAFETY
If there is a serious threat to the health or safety to you or others, we may disclose and use protected healthcare information about you to prevent such. Any disclosure made to prevent serious threat(s) to health or safety will be made to parties able to prevent or respond to such a threat, including law enforcement, and/or potential victim. We may opt to not disclose healthcare information if deemed that such disclosure will lead to a serious threat to health or safety.
DISASTER RELIEF
We may disclose healthcare information about you to an entity assisting in a disaster relief effort in order to notify your family of your condition, status, and location.
COMMUNICABLE DISEASES AND OTHER SPECIAL CATEGORIES OF INFORMATION
Communicable diseases such as HIV and others are subject to special handling or treatment under the law. Additionally, treatment and services for mental health conditions or alcohol and drug abuse may also require special handling or treatment under the law. We will handle such in accordance with special requirements and the law.
WE HONOR YOUR RIGHTS REGARDING HEALTHCARE INFORMATION ABOUT YOU
RIGHT TO A COPY OF THIS PRIVACY PRACTICES NOTICE
You are entitled to a copy of this Notice. This notice is available at the office and via the link on our website titled “Privacy Policy”.
RIGHT TO REQUEST RESTRICTIONS & LIMITATIONS
You have the right to request restrictions or limitations on medical information used or disclosed about you for treatment and/or payment, or to someone involved in your care like a family member or friend who accompanies you to our office. For example, a patient could request that we do not disclose a recent surgery or medical condition. If you would like to request restrictions or limitations on medical information used or disclosed about you for treatment and/or payment, you will need to submit aforementioned request to the Medical Records Department. Such a request must include the information you want to restrict and or limit, whether or not you would like to limit our use, disclosure or both, and to whom such restrictions or limitations apply.
RIGHT TO USE AND DISCLOSURE ACCOUNTING
You have the right to request a copy of healthcare information about you, and to receive an accounting of disclosures.
RIGHT TO INSPECT & COPY
You have the right to inspect and copy your medical information that is used to make decisions regarding your care. Typically including medical and billing records; however, some mental health information may be exempt. If you wish to inspect and copy medical information, you must submit your request in writing to the Medical Records Department at Dr. Alza’s office. If a copy is requested, a nominal fee will be charged for the costs of copying, mailing, or any and all other supplies or services involved with fulfilling your request.
RIGHT TO BE NOTIFIED OF A BREACH
Our office is committed to protecting, securing, and safeguarding your protected healthcare information and actively works to prevent breaches of healthcare information. If a breach of healthcare information occurs, we will notify you in accordance with applicable local, state, and federal laws.
RIGHT TO AMEND
You have the right to ask us to amend medical information about you that is incorrect or incomplete. Information subject to this right is information kept by or for Dr. Alza’s office. Request(s) for amendment(s) must be made in writing, and submitted to the Medical Records Department, and requires a reasonable justification that supports such a request, or the Medical Records Department may deny such a request. Furthermore, the Medical Records Department may deny requests regarding information not created by Dr. Alza, information not kept by Dr. Alza, information which you would not be permitted to inspect or copy, and/or is accurate and complete. If the Medical Records Department denies such a request, you may make a request in writing to include an addendum not to exceed 250 words. If an addendum is filed, such will be attached to your record.
NOTICE SUBJECT TO CHANGE
We reserve the right to change our privacy policy and revise such, as we may need to change our Notice of Privacy Practices at anytime. Such revisions will be effective for all medical information we currently have as well as information that we will obtain in the future.
QUESTIONS REGARDING PRIVACY PRACTICES
As we aim to provide you with the best quality of care possible, we also understand that your healthcare information is an important part of the services we provide to you. If you have any questions, comments, or concerns regarding our Privacy Policy or our Notice, please contact our office’s Privacy Department via email at IT@AlzaMD.com, via telephone at (323)259-0456, or by mail at Privacy Department, 5224 N. Figueroa Street, Los Angeles, CA 90042.
COMPLAINTS
If under the belief that your rights to privacy have been violated, you may file a written complaint with our office’s Privacy Department via email at IT@AlzaMD.com, via telephone at (323)259-0456, or by mail at Privacy Department, 5224 N. Figueroa Street, Los Angeles, CA 90042. You also have the right to file a written complaint with the Secretary of Health and Human Services. If requested, our Privacy Department will provide you with the current address for the Secretary of Health and Human Services. We will not retaliate against you for filing any complaint with us or the U.S. Department of Health and Human Services.