Privacy Notice
Note: This Notice of Privacy Practices is provided for educational and
informational purposes only. This Notice is not intended as legal advice,
and is not provided for adoption or publication by any party. The publication
of any such notice may create legal obligations or liabilities which may
vary depending upon the legal status and business operations of different
organizations. The form and content of any Notice of Privacy Practices
should be determined only upon informed consultation with qualified legal
counsel.
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.
THIS NOTICE IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.
Right to Notice
As a patient, you have the right to adequate notice of the uses and
disclosures of your protected health information. Under the Health Insurance
Portability and Accessibility Act (HIPAA), Richard A. Portillo, O.D. can use your
protected health information for treatment, payment and health care
operations.
a) Treatment - We may use or disclose your health information to a
physician or other healthcare provider providing treatment to you.
b) Payment - We may use and disclose your health information to obtain
payment for services we provide you.
c) Health care operations - We may use and disclose your health information
in connection with our healthcare operations. Healthcare operations include
quality assessment and improvement activities, reviewing the competency or
qualifications of healthcare professionals, evaluating provider performance,
conducting training programs, accreditation, certification, licensing or
credentialing activities.
Your Authorization
Most uses and disclosures that do not fall under treatment, payment, health
care operations will require your written authorization. Upon signing, you
may revoke your authorization (in writing) through our practice at any time.
Emergency Situations
In the event of your incapacity or an emergency situation, we will disclose
health information to a family member, or another person responsible for
your care, using our professional judgment. We will only disclose health
information that is directly relevant to the person's involvement in your
healthcare.
Marketing
We will not use your health information for marketing communications
without your written authorization.
Required by Law
We may also use or disclose your health information when we are required
to do so by law.
Abuse or Neglect
We may disclose your health information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse, neglect, or
domestic violence or the victim of other crimes. We may disclose your health
information to the extent necessary to avert a serious threat to your or other
people's health or safety.
National Security
We may disclose the health information of Armed Forces personnel to
military authorities under certain circumstances. We may disclose health
information to authorized federal officials required for lawful intelligence,
counterintelligence and other national security activities. We may disclose
health information of inmates or patients to the appropriate authorities under
certain circumstances.
Appointment Reminders
We may use or disclose your health information to provide you with
appointment reminders via phone, e-mail or letter.
Your Rights as a Patient
You have the right to restrict the disclosure of your protected health
information (in writing). The request for restriction may be denied if the
information is required for treatment, payment or health care operations.
-You have the right to receive confidential communications regarding your
protected health information.
-You have the right to inspect and copy your protected health information.
-You have the right to amend your protected health information.
-You have the right to receive an account of disclosures of your protected
health information.
-You have the right to a paper copy of this notice of privacy practices.
Legal Requirements
Richard A. Portillo, O.D. is required by law to maintain the privacy of your
protected health information. We are required to abide by the terms of this
notice as it is currently stated, and reserve the right to change this notice.
The policies in any new notice will not be in effect until they are posted to
this site, or are available within our office.
Complaints
If you have complaints regarding the way your protected health information
was handled, you may submit a complaint in writing to our office. You will not
be retaliated against in any manner for a complaint.
Contact Information
For further information about [Practice Name here]'s privacy policies, please
contact [Doctor's name here] at the following address or phone number:
Richard A. Portillo, O.D.
1624 I St.
Modesto, CA. 95354
(209) 578-4885
informational purposes only. This Notice is not intended as legal advice,
and is not provided for adoption or publication by any party. The publication
of any such notice may create legal obligations or liabilities which may
vary depending upon the legal status and business operations of different
organizations. The form and content of any Notice of Privacy Practices
should be determined only upon informed consultation with qualified legal
counsel.
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.
THIS NOTICE IS EFFECTIVE 12/12/02 UNTIL FURTHER NOTICE.
Right to Notice
As a patient, you have the right to adequate notice of the uses and
disclosures of your protected health information. Under the Health Insurance
Portability and Accessibility Act (HIPAA), Richard A. Portillo, O.D. can use your
protected health information for treatment, payment and health care
operations.
a) Treatment - We may use or disclose your health information to a
physician or other healthcare provider providing treatment to you.
b) Payment - We may use and disclose your health information to obtain
payment for services we provide you.
c) Health care operations - We may use and disclose your health information
in connection with our healthcare operations. Healthcare operations include
quality assessment and improvement activities, reviewing the competency or
qualifications of healthcare professionals, evaluating provider performance,
conducting training programs, accreditation, certification, licensing or
credentialing activities.
Your Authorization
Most uses and disclosures that do not fall under treatment, payment, health
care operations will require your written authorization. Upon signing, you
may revoke your authorization (in writing) through our practice at any time.
Emergency Situations
In the event of your incapacity or an emergency situation, we will disclose
health information to a family member, or another person responsible for
your care, using our professional judgment. We will only disclose health
information that is directly relevant to the person's involvement in your
healthcare.
Marketing
We will not use your health information for marketing communications
without your written authorization.
Required by Law
We may also use or disclose your health information when we are required
to do so by law.
Abuse or Neglect
We may disclose your health information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse, neglect, or
domestic violence or the victim of other crimes. We may disclose your health
information to the extent necessary to avert a serious threat to your or other
people's health or safety.
National Security
We may disclose the health information of Armed Forces personnel to
military authorities under certain circumstances. We may disclose health
information to authorized federal officials required for lawful intelligence,
counterintelligence and other national security activities. We may disclose
health information of inmates or patients to the appropriate authorities under
certain circumstances.
Appointment Reminders
We may use or disclose your health information to provide you with
appointment reminders via phone, e-mail or letter.
Your Rights as a Patient
You have the right to restrict the disclosure of your protected health
information (in writing). The request for restriction may be denied if the
information is required for treatment, payment or health care operations.
-You have the right to receive confidential communications regarding your
protected health information.
-You have the right to inspect and copy your protected health information.
-You have the right to amend your protected health information.
-You have the right to receive an account of disclosures of your protected
health information.
-You have the right to a paper copy of this notice of privacy practices.
Legal Requirements
Richard A. Portillo, O.D. is required by law to maintain the privacy of your
protected health information. We are required to abide by the terms of this
notice as it is currently stated, and reserve the right to change this notice.
The policies in any new notice will not be in effect until they are posted to
this site, or are available within our office.
Complaints
If you have complaints regarding the way your protected health information
was handled, you may submit a complaint in writing to our office. You will not
be retaliated against in any manner for a complaint.
Contact Information
For further information about [Practice Name here]'s privacy policies, please
contact [Doctor's name here] at the following address or phone number:
Richard A. Portillo, O.D.
1624 I St.
Modesto, CA. 95354
(209) 578-4885