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Patient Privacy
Notice of Information Practices

This notice describes how your medical information may be used and disclosed by this office and how you can get access to this information. Please review it carefully.

Understanding Your Health Record Information

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a(n):

Basis for planning your care and treatment

  • Means of communication among the many health care professionals who contribute to your care
  • Legal document describing the care you receive
  • Means by which you or a third-party payer can verify that services billed were actually provided
  • A source of information for public health officials charged with improving the health of the nation
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding of what is in your record and how your health information is used to help you to
  • Ensure its accuracy
  • Better understand who, what, when, where and why others may access your health information
  • Make more informed decisions when authorizing disclosure to others

Your Health Information Rights

Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. You have the right to:

  • Request a restriction on certain uses and disclosures of your information as provided by law
  • Obtain a paper copy of this notice of information practices upon request
  • Inspect and copy your health record
  • Amend your health record as provided by law
  • Obtain an accounting of disclosures of your health information
  • Revoke your authorization or use or disclose health information except to the extent that action has already been taken
Our Responsibilities

This organization is required to:

  • Maintain the privacy of your health information
  • Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
  • Abide by the terms of this notice
  • Notify you if we are unable to agree to a requested restriction
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you have supplied us.

We will not use or disclose your health information without your authorization, except as described in this notice.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the Privacy Officer, Dr. Carol Nishikubo, at (310)453-5654.

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

How Your Health Information Will Be Used

Disclosures for Treatment, Payment, and Health Operations

1. We will use your health information for treatment.

For example, information obtained by a member of your healthcare team will be recorded and used to determine your treatment. This information will be shared by all of the healthcare team (physicians, nurses, radiology, laboratory staff, office staff) only as needed to provide your care. We will also provide your other physicians or subsequent health care providers with copies of various reports that should assist him or her in treating you now or in the future. You may request a copy of your medical records to be sent to yourself or to another healthcare provider.

2. We will use your health information for payment.

For example, a bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you as well as your diagnosis, procedures and supplies used.

3. We will use your health information for regular health operations. For example:

  • Business Associates

    There are some services provided in our organization through contacts with Business Associates. Examples include diagnostic services, lab tests, and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our Business Associates so that it can perform the job we have requested and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

  • Communication with Family

    Your physician and nurses may disclose to a family member, close personal friend or any other person you identify, health information relevant to that person's involvement in your care ONLY with your permission.

  • Food and Drug Administration (FDA)

    We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.

  • Workers compensation

    We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

  • Public Health

    As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

  • Legal Issues
We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or as required on legal documents and certificates.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

  • Research

    Only with your permission will information be disclosed to researchers whose research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

  • Practice Notices
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 or as part of fund-raising efforts.

Effective date: January 2003