Patient Privacy Rights

Your Patient Privacy Rights.


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.

The complete 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 in Spanish.

Haga clíc 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:

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 – We 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

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: 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:

  • Proof of Income (paystub, unemployment check, letter from Social Security, tax return)
  • Proof of Address in Los Angeles County (utility bill, lease agreement, California driver’s license or ID)
  • Proof of Citizenship or residency (birth certificate, green card, passport, certificate of naturalization). You will not be denied services based on your income or citizenship status.
  • Appointment card and BIC medical card

In order to protect our patients’ identities, photo IDs are required before services can be provided. Acceptable forms of photo IDs include a California Driver’s License, California Identification Card, an ID from your country of origin, the Marticular Consular ID from Mexico, a passport and school ID.

Make an appointment (323) 653-1990