Your Practice Online and Synapse Medical Group are interested in the privacy and safety of our visitors. Our Web site contains forms through which users may request information or supply feedback to us. In some cases, telephone numbers or return addresses are required so that we can supply requested information to you. We may also track where you go or what you read in our Web site so that we can supply you with effective follow up information, but only if you have given us explicit permission to do so by filling out a form that asks you if we may do so.
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Protected Health Information (PHI) / HIPAA
Due to recent implemented Federal Regulations the following public notice by Synapse Medical Group is effective as of November 1, 2011.
The Synapse Medical Group is required to:
- Maintain the privacy of your health information.
- Provide you with this notice as to what our legal duties and privacy practices are with respect to information we collect and maintain about you.
- Abide by the terms of this practice.
- Notify you if we are unable to agree to a requested restriction, and accommodate any reasonable request you may have to communicate health alternative means or alternative locations.
- We will not use or disclose your health information without your authorization, except as described in this notice.
- We will use and disclose your PHI in order to bill and collect payment for the services and items you may have received from us. For example, we will contact your insurer to certify that you are eligible for benefits and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.
WE ARE PERMITTED TO USE, AND MAY BE REQUIRED, TO DISCLOSE YOUR PHI UNDER SPECIAL CIRCUSTANCES:
1. Disclose Required By Law: Our practice will use and disclose your PHI when we are required to do so by federal, state, or local law, including health oversight activities, court or administrative orders or similar legal proceedings.
2. Public Health Risk: Our practice may disclose your PHI to public health authorities who are authorized to collect information for such purposes as maintaining vital records, preventing or controlling disease, injury, or disability; or notifying a person regarding potential exposure to a communicable disease.
3. Serious Threats to Health of Safety: Our practice may disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
4. Deceased Patients: Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
5. Organ Donor: Our practice may release PHI to a medical facility for tissue procurement of transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
6. Worker’s Compensation: Our practice may release your PHI for workers’ compensation and similar programs.
Our practice may contact you or your authorized representatives (see authorization form attached) to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. The practice might routinely contact patients via telephone at home and /or work, via mail at home, and unless otherwise requested, may leave messages on the appropriate voice mail or answering service regarding appointments and billing questions.
All requests for medical records should be hand written and should contain:
- Full Name
- Date of Birth
- Mailing Address
- Phone Number
- Written Signature
An additional fee might be asked for generating a copy or mailing all medical records as per the rules practiced by the clinic.
At no time will any person, including your spouse, be able to obtain information from your medical record without prior written authorization. Only parents or legal guardian of a child under the age of 18 will be allowed to access medical record information, with proof of child’s social security number and date of birth.
1. Confidential Communications: You have the right to request that our practice communicate with you about health and related issues in a particular manner or at a certain location. Our practice will accommodate reasonable request.
2. Requesting Restrictions: You have the right to request restriction on our use of disclosure of you PHI for treatment, payment, or health care operations. We are not required to agree to your request; however if we do agree, we are bound by our agreement except when otherwise required bylaw, in emergencies, or when the information is necessary to treat you.
3. Inspection and Copies: You have the right to request and obtain a copy of your PHI. Our practice will charge a fee for the cost of copying, mailing, labor, and supplies associated with your request. Our practice may deny your request to inspect and/or copy limited circumstances. However, you may request a review of our denial.
4. Amendment: You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for this practice. Your request must provide us with the reason that supports your request for amendment. Your request may be denied if you ask us to amend information that is in our opinion: a) accurate and complete; b) not part of the PHI kept by or for the practice; c) not part of the PHI that you would be permitted to inspect and copy; or d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
5. Rights to a paper Copy of This Notice: You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time.
6. Rights to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
If you have any questions regarding this notice or would like to exercise any of your rights under this notice, you may contact:
Sherman Oaks Office
5651 Sepulveda Blvd. | Suite 201
Sherman Oaks, CA 91411