THIS NOTICE DESCRIBES HOW HEALTH 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.
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your medical information.
You may request a copy of our notice at any time. For more information about our privacy practices, of for additional copies of this notice, please contact us using the information listed at the end of this notice.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make changes in our privacy practices and the new terms of our notice effective for all medical information that we maintain, including medical information we created or received before we make the changes.
We may use and disclose medical information about you for the following purposes: Treatment, Payment and Health Care Operations:
\tTreatment: We may use your medical information to treat you or disclose your medical information to a physician or other health care provider providing treatment to you.
\tPayment: We may use and disclose your medical information to obtain payment for services we provide you.
\tHealth Care Operations: We may use and disclose your medical information in connection with the normal course of operating our practice. Health care operations may also include quality assessment activities, performance evaluations, conducting training programs accreditation, and certification, licensing or credentialing activities.
We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.
Any other uses and disclosures of your medical information will only be made with your written authorization or in response to legal requirements such as disaster relief, court orders, suspected abuse, neglect, or domestic violence, or in certain instances affecting national security.
You have the following rights with respect to your protected health information which you may exercise by written request using the contact information at the end of this notice:
\t\tThe right to request additional restrictions on the use of disclosure or your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement which must be in writing.
\t\tThe right to inspect and copy your protected health information.
\t\tThe right to request amendments to your protected health information.
\t\tThe right to receive an accounting of disclosures or your personal health information for other than treatment, payment, health care operations or pursuant to other authorized disclosures as stated above.
\t\tThe right to obtain a copy of this notice.
If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we have made to amend or restrict the use or disclosure of your medical information or to have us communicate with you by alternative means or at alternative locations, you may contact us using the contact information listed at the end of this notice. 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 upon request.
We support your right to the privacy of your medical 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.
Contact Officer: Lorena Mendoza, office manager
Telephone: (209)521-7771
Address: 1208C Floyd Ave., Modesto, CA 95350
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