HIPAA NOTICE OF PRIVACY PRACTICES
Patients’ health records contain personal health information, the
confidentiality of which is protected under both state and federal law.
Saban Community Clinic complies with the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) and California Civil Code 56-56.37
Confidentiality of Medical Information Act (CMIA) to protect confidential
health care information.
HIPAA Notice of Privacy Practices is available for your review by clicking
here or by asking for it at the registration desk. The form is also available
aquí para obtener la
Notificación de Prácticas de Privacidad en español.
Summary of Your Privacy Rights
Following is a summary of how medical information about you may be used
and disclosed, and how you can get access to this information:
YOUR RIGHTS - You have a right to:
- Get a copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of the Notice of Privacy Practices
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
YOUR CHOICES - You have some choices in the way we use and share information, such as:
- Sharing information with your family, close friends, or others involved
in your care
- Sharing information in a disaster relief situation
- Including your information in a hospital directory
USE AND DISCLOSURE - Saban Community Clinic may use and share your information as we:
- Treat you
- Run our Organization
- Help with public health and safety issues
- Do research
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Respond to lawsuits and legal actions
Note: we will never share any substance abuse treatment records without
your written permission.
If you have any questions about the Notice of Privacy Practices or wish
to submit a privacy complaint, contact Summer Masayesva, Health Information
Manager/Privacy Officer at 323-297-1332 or email: firstname.lastname@example.org.
You can also send it to her via mail at our Beverly Health Center address
8405 Beverly Blvd. Los Angeles, CA 90048. All complaints must be submitted
in writing; we will not retaliate against you for filing a complaint.
In addition, you can file a complaint with the U.S. Department of Health
and Human Services Office for Civil Rights, by sending a letter to 200
Independence Ave., S.W., Washington, DC 20201, or call 1-877-696-6775,
or visit: https://www.hhs.gov/hipaa/for-individuals/index.html.