NOTICE OF PRIVACY PRACTICES
Updated Date: May 18, 2020
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Our Pledge Regarding Your Health Information
Moreno Valley Community Medical Group (“MVCMG”) is committed to protecting medical and personal information about you (“Health Information”). We are required by law to maintain the privacy of your Health Information, provide you information about our legal duties and privacy practices, inform you of your rights and the ways in which we may use Health Information and disclose it to other entities and persons.
How We May Use and Disclose Health Information About You
The following sections describe different ways that we may use and disclose your Health Information. Some information is entitled to special restrictions related to its use and disclosure. Not every use or disclosure will be listed. Other uses and disclosures not described in this Notice will be made only if we have your written authorization.
We may use Health Information about you to provide you with medical treatment or services. We may disclose Health Information about you to doctors, nurses, technicians, students or other MVCMG personnel who are involved in taking care of you. We may also share Health Information about you with other non-MVCMG providers. The disclosure of your Health Information to non-MVCMG providers may be done electronically through a health information exchange that allows providers involved in your care to access some of your MVCMG records to coordinate services for you.
We may use and disclose Health Information about you so that the treatment and services you receive at MVCMG may be billed for and payment may be collected from you, an insurance company or a third party. We may also tell your health plan about a proposed treatment to determine whether your plan will pay for the treatment.
We may contact you to remind you that you have an appointment at MVCMG.
Individuals Involved in Your Care or Payment for Your Care
We may release medical information to anyone involved in your medical care, e.g., a friend, family member, personal representative or any individual you identify. We may also give information to someone who helps pay for your care. We may also tell your family or friends about your general condition and that you are in the hospital.
As Required By Law
We will disclose Health Information about you when required to do so by federal or state law.
To Prevent a Serious Threat to Health or Safety
We may use and disclose Health Information about you when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person. Any disclosure would be to someone able to help stop or reduce the threat.
We may use or disclose Health Information about you for Workers’ Compensation or similar programs as authorized or required by law. These programs provide benefits for work-related injuries or illness.
Public Health Disclosures
We may disclose Health Information about you for public health activities such as:
preventing or controlling disease (such as cancer and tuberculosis), injury or disability;
reporting vital events such as births and deaths;
reporting child abuse or neglect;
reporting adverse events or surveillance related to food, medications or defects or problems with products;
notifying persons of recalls, repairs or replacements of products they may be using;
notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.
Lawsuits and Other Legal Proceedings
We may disclose Health Information to courts, attorneys and court employees in the course of conservatorship, writs and certain other judicial or administrative proceedings. We may also disclose Health Information about you in response to a court or administrative order, or in response to a subpoena, discovery request, warrant or other lawful process.
Coroners, Medical Examiners and Funeral Directors
We may disclose medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine cause of death. We may also disclose medical information about patients of MVCMG to funeral directors as necessary to carry out their duties.
Other Uses and Disclosures of Health Information
Other uses and disclosures of Health Information not covered by this Notice will be made only with your written authorization. If you authorize us to use or disclose your Health Information, you may revoke that authorization, in writing, at any time. However, the revocation will not be effective for information that we have already used and disclosed in reliance on the authorization.
Your Rights Regarding Your Health Information
Your Health Information is the property of MVCMG. You have the following rights regarding the Health Information we maintain about you:
Right to Inspect and Copy
With certain exceptions, you have the right to inspect and/or receive a copy of your Health Information. If we have the information in electronic format then you have the right to get your Health Information in electronic format if it is possible for us to do so. If not, we will work with you to agree on a way for you to get the information electronically or as a paper copy.
To inspect and/or to receive a copy of your Health Information, you must complete and submit a Medical Records Request Form, which can be requested via email, phone, or in person. If you request a paper copy of your Health Information, there is a fee for these services.
Right to Request an Amendment or Addendum
If you feel that Health Information we have about you is incorrect or incomplete, you may ask us to amend the information or add an addendum (addition to the record). You have the right to request an amendment or addendum for as long as the information is kept by or for MVCMG. To request an amendment or addendum, your request must be made in writing and submitted to the Moreno Valley Community Medical Group, 23180 Hemlock Ave, Suite 201, Moreno Valley, CA 92557. You must be specific about the information that you believe to be incorrect or incomplete and you must provide a reason that supports the request.
We may deny your request for an amendment if it is not in writing, we cannot determine from the request the information you are asking to be changed or corrected or your request does not include a reason to support the change or addition. In addition, we may deny your request if you ask us to amend information that MVCMG believes to be accurate and complete.
Right to an Accounting of Disclosures
You have the right to receive a list of certain disclosures we have made of your Health Information. Your request must state a time period that may not be longer than the six previous years. You are entitled to one accounting within any 12-month period at no cost. If you request a second accounting within that 12-month period, there will be a charge for the cost of compiling the accounting. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions
You have the right to request a restriction or limitation on the Health Information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the Health Information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, only to you and your spouse. We are not required to agree to your request except in the limited circumstance described below. If we do agree, our agreement must be in writing, and we will comply with your request unless the information is needed to provide you emergency care.
We are required to agree to a request not to share your information with your health plan, if the following conditions are met:
We are not otherwise required by law to share the information;
The information would be shared with your insurance company for payment purposes;
You pay the entire amount due for the health care item or service out of your own pocket or someone else pays the entire amount for you.
Right to a Paper Copy of this Notice
You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice on our website: mvcmg.com.
Right to be Notified of a Breach
You have the right to be notified if we or one of our Business Associates discovers a breach of unsecured Health information about you.
Changes to MVCMG’s Privacy Practices and this Notice
We reserve the right to change MVCMG’s privacy practices and this Notice. We reserve the right to make the revised or changed Notice effective for Health Information we already have about you as well as any information we receive in the future. At any time you may request a copy of the current Notice in effect.
Questions or Complaints
If you have any questions about this Notice, please contact:
Moreno Valley Community Medical Group
23180 Hemlock Ave, Suite 201
Moreno Valley, CA 92557
Call 951-243-6460 or email: firstname.lastname@example.org