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Gary S. McCarter, DPM
1501 Superior Ave, Suite 110, Newport Beach, CA 92663
NOTICE OF PRIVACY PRACTICES
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.
THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.
Our Legal Duty
We are required by applicable federal and state laws to maintain the privacy of
your protected health information. We are also required to give you this notice
about our privacy practices, our legal duties, and your rights concerning your
protected health information. We must follow the privacy practices that are described
in this notice while it is in effect. This notice takes effect April 14, 2003,
and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice
at any time, provided that such changes are permitted by applicable law. We reserve
the right to make the changes in our privacy practices and the new terms of our
notice effective for all protected health information that we maintain, including
medical information we created or received before we made the changes.
You may request a copy of our notice (or any subsequent revised notice) at any
time. For more information about our privacy practices, or for additional copies
of this notice, please contact us using the information listed at the end of this
notice.
Uses and Disclosures of Protected Health Information
We will use and disclose your protected health information about you for treatment,
payment, and health care operations. Following are examples of the types of uses
and disclosures of your protected health care information that may occur. These
examples are not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made by our office.
Treatment: We will use and disclose your protected health information
to provide, coordinate or manage your health care and any related services. This
includes the coordination or management of your health care with a third party.
For example, we would disclose your protected health information, as necessary,
to a home health agency that provides care to you. We will also disclose protected
health information to other physicians who may be treating you. For example, your
protected health information may be provided to a physician to whom you have been
referred to ensure that the physician has the necessary information to diagnose
or treat you.
In addition, we may disclose your protected health information from time to time
to another physician or health care provider (e.g., a specialist or laboratory)
who, at the request of your physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your physician.
Payment: Your protected health information will be used, as needed,
to obtain payment for your health care services. This may include certain activities
that your health insurance plan may undertake before it approves or pays for the
health care services we recommend for you, such as: making a determination of
eligibility or coverage for insurance benefits, reviewing services provided to
you for protected health necessity, and undertaking utilization review activities.
For example, obtaining approval for a hospital stay may require that your relevant
protected health information be disclosed to the health plan to obtain approval
for the hospital admission.
Health Care Operations: We may use or disclose, as needed, your
protected health information in order to conduct certain business and operational
activities. These activities include, but are not limited to, quality assessment
activities, employee review activities, training of students, licensing, and conducting
or arranging for other business activities.
For example, we may use a sign-in sheet at the registration desk where you will
be asked to sign your name. We may also call you by name in the waiting room when
your doctor is ready to see you. We may use or disclose your protected health
information, as necessary, to contact you by telephone or mail to remind you of
your appointment.
We will share your protected health information with third party "business
associates" that perform various activities (e.g., billing, transcription
services) for the practice. Whenever an arrangement between our office and a business
associate involves the use or disclosure of your protected health information,
we will have a written contract that contains terms that will protect the privacy
of your protected health information.
We may use or disclose your protected health information, as necessary, to provide
you with information about treatment alternatives or other health-related benefits
and services that may be of interest to you. We may also use and disclose your
protected health information for other marketing activities. For example, your
name and address may be used to send you a newsletter about our practice and the
services we offer. We may also send you information about products or services
that we believe may be beneficial to you. You may contact us to request that these
materials not be sent to you.
Uses and Disclosures Based On Your Written Authorization: Other
uses and disclosures of your protected health information will be made only with
your authorization, unless otherwise permitted or required by law as described
below.
You may give us written authorization to use your protected health information
or to disclose it to anyone for any purpose. If you give us an authorization,
you may revoke it in writing at any time. Your revocation will not affect any
use or disclosures permitted by your authorization while it was in effect. Without
your written authorization, we will not disclose your health care information
except as described in this notice.
Others Involved in Your Health Care: Unless you object, we may
disclose to a member of your family, a relative, a close friend or any other person
you identify, your protected health information that directly relates to that
person's involvement in your health care. If you are unable to agree or object
to such a disclosure, we may disclose such information as necessary if we determine
that it is in your best interest based on our professional judgment. We may use
or disclose protected health information to notify or assist in notifying a family
member, personal representative or any other person that is responsible for your
care of your location, general condition or death.
Marketing: We may use your protected health information to contact
you with information about treatment alternatives that may be of interest to you.
We may disclose your protected health information to a business associate to assist
us in these activities. Unless the information is provided to you by a general
newsletter or in person or is for products or services of nominal value, you may
opt out of receiving further such information by telling us using the contact
information listed at the end of this notice.
Research; Death; Organ Donation: We may use or disclose your
protected health information for research purposes in limited circumstances. We
may disclose the protected health information of a deceased person to a coroner,
protected health examiner, funeral director or organ procurement organization
for certain purposes.
Public Health and Safety: We may disclose your protected health
information to the extent necessary to avert a serious and imminent threat to
your health or safety, or the health or safety of others. We may disclose your
protected health information to a government agency authorized to oversee the
health care system or government programs or its contractors, and to public health
authorities for public health purposes.
Health Oversight: We may disclose protected health information
to a health oversight agency for activities authorized by law, such as audits,
investigations and inspections. Oversight agencies seeking this information include
government agencies that oversee the health care system, government benefit programs,
other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information
to a public health authority that is authorized by law to receive reports of child
abuse or neglect. In addition, we may disclose your protected health information
if we believe that you have been a victim of abuse, neglect or domestic violence
to the governmental entity or agency authorized to receive such information. In
this case, the disclosure will be made consistent with the requirements of applicable
federal and state laws.
Food and Drug Administration: We may disclose your protected
health information to a person or company required by the Food and Drug Administration
to report adverse events, product defects or problems, biologic product deviations;
to track products; to enable product recalls; to make repairs or replacements;
or to conduct post marketing surveillance, as required.
Criminal Activity: Consistent with applicable federal and state
laws, we may disclose your protected health information, if we believe that the
use or disclosure is necessary to prevent or lessen a serious and imminent threat
to the health or safety of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement authorities to identify
or apprehend an individual.
Required by Law: We may use or disclose your protected health
information when we are required to do so by law. For example, we must disclose
your protected health information to the U.S. Department of Health and Human Services
upon request for purposes of determining whether we are in compliance with federal
privacy laws. We may disclose your protected health information when authorized
by workers' compensation or similar laws.
Process and Proceedings: We may disclose your protected health
information in response to a court or administrative order, subpoena, discovery
request or other lawful process, under certain circumstances. Under limited circumstances,
such as a court order, warrant or grand jury subpoena, we may disclose your protected
health information to law enforcement officials.
Law Enforcement: We may disclose limited information to a law
enforcement official concerning the protected health information of a suspect,
fugitive, material witness, crime victim or missing person. We may disclose the
protected health information of an inmate or other person in lawful custody to
a law enforcement official or correctional institution under certain circumstances.
We may disclose protected health information where necessary to assist law enforcement
officials to capture an individual who has admitted to participation in a crime
or has escaped from lawful custody.
Patient Rights
Access: You have the right to look at or get copies of your protected
health information, with limited exceptions. You must make a request in writing
to the contact person listed herein to obtain access to your protected health
information. You may also request access by sending us a letter to the address
at the end of this notice. If you request copies, we will charge you $25.00 for
each page or $10.00 per hour to locate and copy your protected health information,
and postage if you want the copies mailed to you. If you prefer, we will prepare
a summary or an explanation of your protected health information for a fee. Contact
us using the information listed at the end of this notice for a full explanation
of our fee structure.
Accounting of Disclosures: You have the right to receive a list
of instances in which we or our business associates disclosed your protected health
information for purposes other than treatment, payment, health care operations
and certain other activities after April 14, 2003. After April 14, 2009, the accounting
will be provided for the past six (6) years. We will provide you with the date
on which we made the disclosure, the name of the person or entity to whom we disclosed
your protected health information, a description of the protected health information
we disclosed, the reason for the disclosure, and certain other information. If
you request this list more than once in a 12-month period, we may charge you a
reasonable, cost-based fee for responding to these additional requests. Contact
us using the information listed at the end of this notice for a full explanation
of our fee structure.
Restriction Requests: You have the right to request that we place
additional restrictions on our use or disclosure of your protected health information.
We are not required to agree to these additional restrictions, but if we do, we
will abide by our agreement (except in an emergency). Any agreement we may make
to a request for additional restrictions must be in writing signed by a person
authorized to make such an agreement on our behalf. We will not be bound unless
our agreement is so memorialized in writing.
Confidential Communication: You have the right to request that
we communicate with you in confidence about your protected health information
by alternative means or to an alternative location. You must make your request
in writing. We must accommodate your request if it is reasonable, specifies the
alternative means or location, and continues to permit us to bill and collect
payment from you.
Amendment: You have the right to request that we amend your protected
health information. Your request must be in writing, and it must explain why the
information should be amended. We may deny your request if we did not create the
information you want amended or for certain other reasons. If we deny your request,
we will provide you a written explanation. You may respond with a statement of
disagreement to be appended to the information you wanted amended. If we accept
your request to amend the information, we will make reasonable efforts to inform
others, including people or entities you name, of the amendment and to include
the changes in any future disclosures of that information.
Electronic Notice: If you receive this notice on our website
or by electronic mail (e-mail), you are entitled to receive this notice in written
form. Please contact us using the information listed at the end of this notice
to obtain this notice in written form.
Questions and Complaints
If you want more information about our privacy practices or have questions or
concerns, please contact us using the information below. If you believe that we
may have violated your privacy rights, or you disagree with a decision we made
about access to your protected health information or in response to a request
you made, you may complain to us using the contact information below. You also
may submit a written complaint to the U.S. Department of Health and Human Services.
We will provide you with the address to file your complaint with the U.S. Department
of Health and Human Services upon request.
We support your right to protect the privacy of your protected health information.
We will not retaliate in any way if you choose to file a complaint with us or
with the U.S. Department of Health and Human Services
Name of Contact Person:
Gary S. McCarter, DPM
Telephone:
949-631-4099
Address:
1501 Superior Ave, Suite 110, Newport Beach, CA 92663
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