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.

Questions or complaints

Privacy Officer
Saban Community Clinic
8405 Beverly Blvd., Los Angeles, CA 90048
Phone: (323) 330-1687
Email: patientrelations@sabancommunityclinic.org
Website: www.sabancommunityclinic.org

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities.

Get an electronic or paper copy of your medical record

You may ask to inspect or obtain an electronic or paper copy of your medical record and other health information we maintain about you. We will generally make records available for inspection within five working days and transmit requested copies within 15 days, as required by California law. We may charge a reasonable, cost-based fee as permitted by law.

Ask us to correct your medical record

You may ask us to correct health information that you believe is incorrect or incomplete. We may deny the request, but we will explain the reason in writing, generally within 60 days. California law may allow you to submit a written addendum of up to 250 words for each item or statement you believe is incomplete or incorrect.

Request confidential communications

You may ask us to contact you in a specific way or at a different address. We will accommodate reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or share certain information for treatment, payment, or health care operations. We are generally not required to agree. If you pay for an item or service out of pocket in full, you may ask us not to share information about that item or service with your health plan for payment or health care operations. We will agree unless the law requires disclosure.

Get a list of disclosures

You may ask for an accounting of certain disclosures made during the six years before your request. The accounting will not include disclosures for treatment, payment, or health care operations and certain other disclosures. One accounting in any 12-month period is free. We may charge a reasonable, cost-based fee for another accounting within the same 12-month period.

Get a copy of this notice

You may ask for a paper copy at any time, even if you agreed to receive it electronically.

Choose someone to act for you

A personal representative, such as a legal guardian or a person with medical power of attorney, may exercise your rights when authorized by law. We will verify that authority before taking action. If you are a minor and consented to your own care, such as reproductive health, mental health, or substance use treatment, your parent or guardian generally cannot see those records.

File a complaint

You may complain to us using the contact information above. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by visiting www.hhs.gov/hipaa/filing-a-complaint, calling 1-877-696-6775, or writing to 200 Independence Avenue, S.W., Washington, D.C. 20201. We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you may tell us your choices about what we share. Tell us your preference and we will follow your instructions when the law allows.

You may tell us to:

• Share information with family, close friends, or others involved in your care or payment for your care.
• Share information in a disaster relief situation.

If you cannot tell us your preference, we may share information if we believe it is in your best interest or if needed to lessen a serious and imminent threat to health or safety.

We generally need your written authorization for:

• Marketing purposes, except as permitted by law.
• The sale of your health information.
• Most uses and disclosures of psychotherapy notes.

Fundraising

We may contact you about fundraising, but you may tell us not to contact you again. If we use substance use disorder patient records protected by 42 CFR Part 2 for fundraising, we will first give you clear notice and a choice about whether to receive those communications.

How We Use and Share Your Information

We typically use or share your health information in these ways:

Treat you

We may use your information and share it with professionals involved in your treatment. For example, a specialist treating you may ask us about your medical history.

Run our organization

We may use and share your information to operate the clinic, improve quality, coordinate care, train staff, and contact you when necessary, including for appointment reminders and information about treatment alternatives or health-related services. For example, we may review patient records to evaluate the quality of our services.

Bill for services

We may use and share your information to bill and obtain payment from health plans or others responsible for payment. For example, we may give information to your health plan so it can pay for your visit.

We may also use or share information as permitted or required by law for:

• Public health and safety activities, including disease prevention, product recalls, adverse event reporting, suspected abuse or neglect, and preventing a serious threat to health or safety.
• Health research when legal requirements are met.
• Compliance with federal or state law, including disclosures to the U.S. Department of Health and Human Services for HIPAA compliance review.
• Organ and tissue donation requests.
• Coroners, medical examiners, and funeral directors when an individual dies.
• Workers' compensation claims.
• Health oversight activities authorized by law.
• Law enforcement and special government functions when legal requirements are met.
• Court or administrative orders, subpoenas, lawsuits, and other legal proceedings when legal requirements are met.

Substance use disorder records protected by 42 CFR Part 2

Substance use disorder treatment records that we receive from programs subject to 42 CFR Part 2, or testimony describing the contents of those records, will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide written consent or a court issues an order after you or the holder of the record receives notice and an opportunity to be heard, as required by law. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the records are used or disclosed.

Specially protected information

Some information has extra protection under California law, including HIV test results, mental health records, substance use disorder records, and information about reproductive health care. We will only share this information as those laws allow. California law also limits sharing information about abortion or gender-affirming care in response to out-of-state subpoenas or law enforcement requests.

OCHIN and health information exchange

Saban Community Clinic participates in an organized health care arrangement that includes OCHIN participants. OCHIN provides health information technology and related services and supports quality improvement and care coordination. We may share your health information with OCHIN participants and health information exchanges for treatment, payment, and health care operations as permitted by law. A current list of OCHIN participants is available at www.ochin.org.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and provide you with a copy.
• We will not use or share your information other than as described here unless you authorize us in writing. You may revoke an authorization in writing at any time, but the revocation will not affect actions already taken in reliance on it.
• We may change this notice and make the revised notice effective for information we already have and information we receive in the future. The current notice will be posted at our offices and on our website.

For more information about this notice or our privacy practices, contact the Privacy Officer using the information at the top of this notice.