NOTICE OF PRIVACY PRACTICES

Hilltop Medical Clinic 1093 Hilltop Drive Redding, CA 96003 530.221.1565
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Understanding Your Health
Records/Information

Each time you visit our office, a record of your visit is made. Typically this record contains your symptoms, examination and test results, diagnosis, treatment, and a plan for future care or treatment. This information often referred to as your health or medical record, serves as follows:

• Basis for planning your care and treatment;
• Means of communication amount the many health professionals who contribute to your care;
• Legal document describing the care you received;
• Means by which you or a third party payer can verify that services billed were actually provided;
• Tool in educating health professionals;
• Source of data for medical research;
• Source of information for public health officials charged with improving the health of the nation;
• Source of data for facility planning and marketing;
• Tool with which we can access and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to:

• Ensure its accuracy;
• Better understand who, what, when, where, and why others may access your health information;
• Make informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of he healthcare practitioner or facility that compiled it, the nformation belongs to you. You have the right to:

• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522;
• Obtain a paper copy of the notice of information practices upon request;
• Inspect and copy your health record as provided for in 45 CFR 164.524;
• Amend your health record as provided in 45 CFR 164.528;
• Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528
• Request communications of your health information by alternative means or at alternative locations;
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities

Hilltop Medical Clinic is required to:

• Maintain the privacy of your health information;
• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
• Abide by the terms of this notice;
• Notify you if we are unable to agree to a requested restriction;
• Accommodate reasonable
requests you may have to communicate health information by alternative means or at alternative locations. We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post a revised notice in our lobby. A written copy will be given to you upon your request.

We will not use or disclose your health information without your authorization, except as described in this notice.

For More Information or to Report a Problem

If you have questions and would like additional information, you may speak with our Privacy Officer and/or the Co-Administrator(s) at (530) 221-1565.

If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint .

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.

For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We will also provide your family physician or a subsequent healthcare provider with copies of various reports that should assist him or her in your further treatment.

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We will use your health information for payment

For example: A bill may be sent to you, your insurance, or your employer. The information on, or accompanying, the bill may include information that identifies you as well as your diagnosis, and procedures and supplies used.

We will use your health information for regular health operations.

For Example: Members of the medical staff or risk and quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Additional health operations disclosures in our day-to-day business may include:

Business Associates: There are some services provided to our organization through contracts with business associates. Examples include outside radiology and laboratory services, and also photocopy companies used to copy
your information. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do and bill you or your other payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Registration List (Directory): Unless you notify us that you object, we will use your name and chief complaint for our sign-in purposes. This information may be provided to others whom may ask for you by name to see if you are here.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition.

Communication with Family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement
in your care or payment related to your care.

Medical Record Requests: Subpoena, and Redisclosures: As dictated by law, we are required to honor valid medical records requests and Subpoenas. Your medical file will be copied as specified in the type of release received. We will
also include associated medical correspondence from other healthcare professionals pertinent to the requested information. This is considered redisclosure.

Research: We may disclose information to researchers when their research has been approved by our Medical Director, who has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Phone/Answering Machine Messaging: We may contact you to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services that may be of interest to you. We may also contact
you regarding insurance problems as well as payment issues. This information may be left on your answering machine referencing any or all of the above.

Medical Education and Training: This facility works with local entities such a:: Mercy Family Practice Residency Program, Shasta College and other medical academy’s for on the job training and work experience. On occasion your medical situation (symptoms, diagnosis, and treatment), x-ray films or lab reports, can be valuable in a teaching environment, thus they may be used (with appropriate removal of patient identifying information) for this purpose.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to medications or medical supply defects. This includes product recalls, repairs, or replacement.

Worker’s Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with the laws relating to worker’s compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially
endangering one or more patients, workers, or the public.

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