Effective September 20, 2013<br/><br/>S. D. Henry, M.D., Inc.<br/>2319 E Washington Blvd, Suite 2<br/>Pasadena, California 91104-1945<br/><br/>This notice describes how we use and disclose your protected health data and explains how you can access this information.<br/>Dr. Henry and by extension his staff, understand the importance of patient confidentiality and commit to maintaining the privacy of your health information. This notice describes how we may use and share your medical information and explains our responsibilities and your rights. If you have any questions about this document after reading it in its entirely, please contact us via U.S. Mail to Attention Privacy Officer, at the address above or email: privacy@stephenry.com.<br/><br/>How Dr. Henry and his practice staff may use or disclose your health information.<br/>Your medical record is the property of Dr. Stephen Henry, but the information in the medical record belongs to you. The law permits Dr. Henry to use or disclose your health information as described in the following several paragraphs.<br/><br/>Treatment We use medical information about you to best provide your medical care. We share your medical information within our practice and with others who are involved in providing the care you need, e.g.: physician referrals, pharmacists, hospitals. We may also disclose your medical information to members of your family or others who can help you when you are sick, injured or following your death. <br/><br/>Appointment Reminders We may use and disclose medical information to contact and remind you about appointments, and we may leave this information on your answering machine, voicemail or in a message left with the person answering the phone.<br/><br/>Sign-in Sheet We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.<br/><br/>Payment We use and disclose your medical information to obtain payment for the services we provide, e.g.: Medicare or your insurance, through our billing clearinghouse. We may also disclose your information to other health care providers to assist their reimbursement efforts. <br/><br/>Health Care Operations We may use and disclose your medical information to operate this medical practice, to improve the quality of care we provide and to obtain coverage for specific procedures or referrals from your health insurance. We maintain a written agreement with all business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your medical information.<br/><br/>Natural Disaster or Terrorism In the event of such an event, we may disclose information to a relief organization if we believe it is necessary to respond to the emergency circumstances.<br/><br/>Required by Law The government is ubiquitous in health care and in many cases we are required to disclose your protected health information, but we only provide the minimal amount to meet the obligation. Listed in italics in the next several paragraphs are different scenarios where we may disclose your private health information to government agencies. <br/><br/>Public Health authorities, for purposes related to injury or disease prevention; reporting abuse, neglect or domestic violence; reporting adverse reactions to vaccines or medications. <br/><br/>Health Oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings. <br/><br/>Judicial and Administrative Proceedings when authorized by a court or administrative order, discovery request or other lawful process. <br/><br/>Coroners in connection with their lawful investigations of deaths.<br/><br/>Organ or Tissue Donation involved in procuring, banking or transplanting organs and tissues. <br/><br/>Public Safety and Law Enforcement in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public. <br/><br/>Proof of Immunization We will disclose proof of immunization only when required by law.<br/><br/>Worker's Compensation Although we do not treat work related injury, participate in any worker's compensation network, nor bill any worker's compensation claims, we may be required to disclose your health information necessary to comply with worker compensation law. <br/><br/>Privacy Violation Notice We are required by federal and California law to securely maintain your health information, to provide all patients with this description of our privacy practices and to notify affected patients (and in extreme cases the government) following a non-permissible disclosure. In the case of a breach of unsecured protected health information, we will notify you, usually via email if you provided us with a current email address, but we may use other methods as appropriate. <br/><br/>When This Medical Practice May Not Use or Disclose Your Health Information<br/>Dr. Henry's practice will not use or disclose health information which identifies you without your revocable written authorization except as specified elsewhere in this document. <br/><br/>Your Rights as Owner of Protected Health Information<br/>You have the right to request restrictions on specific uses and disclosures of your health information by a written request specifying the limitations. If you tell us not to disclose information to your commercial health plan concerning services for which you paid for in full out-of-pocket, we will abide by your request. We reserve the right to accept or reject any other request.<br/><br/>You have the right to request that you receive your health information in a specific way or at a specific location, e.g.: via a particular email account or to alternative address. We will comply with all reasonable requests submitted in writing which provide the parameters.<br/><br/>You have the right to inspect and copy your health information when you submit a written request detailing what, how, which format, etc. We (or an outside copy service) will charge a reasonable fee which covers 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. In limited circumstances we may deny your request if Dr. Henry believes allowing access would be reasonably likely to cause harm to his patient; you will have a right to appeal his decision. <br/><br/>You have a right to request that we amend your health information that you believe is incorrect or incomplete, but must be submitted in writing on standard sized business paper (not email) and include the reasons you believe the information is inaccurate or incomplete. If we deny your request, you may submit a written statement of rebuttal. You also have the right to request that we add to your record a statement of up to 250 words 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.<br/><br/>You have a right to receive an accounting of disclosures of your health information made by this medical practice beyond those which you have authorized in writing or as described in this document.<br/><br/>You have a right to this notice of our legal duties and privacy practices including a right to a hardcopy of this Notice of Privacy Practices. 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 via email privacy@stephenry.com or by US Mail at Attention Privacy Officer, 2319 E Washington Blvd, Suite 2, Pasadena, CA 91104-1945.<br/><br/>Changes to this Notice of Privacy Practices<br/>Dr. Henry reserve the right to amend his 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. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment. Any changes will also be posted on our website.<br/><br/>Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer whose contact data is listed at the top of this page. If you are not satisfied with the manner in which we handle a complaint, you may submit a formal complaint to the address below. You will not be penalized in any way for filing a complaint.<br/><br/>Office for Civil Rights<br/>U.S. Department of Health & Human Services<br/>90 Seventh Street, Suite 4-100 <br/>San Francisco, CA 94103-6730.<br/><br/>(415) 437-8310 or www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf<br/>
