Privacy Policy

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Conejo Pain Specialists Medical Group, Inc.

NOTICE OF PRIVACY PRACTICES
Effective Date: 25 August 2008

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.

If you have any questions about this notice, please contact the Facility Privacy Officer.

Each time you visit a medical clinic, ambulatory surgical center, hospital, physician, or other healthcare provider, (each a Facility) a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information.  This notice applies to all of the records of your care generated by the Facility, whether made by Facility personnel, agents of the Facility, or your personal doctor.  Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your health information created in the doctor's office or clinic.

Our Responsibilities

We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices.  We will abide by the terms of this notice.

Use and Disclosures

How we may use and disclose Health Information about you.

The following categories describe examples of the way we use and disclose health information.

For Treatment:  We may use health information about you to provide you treatment or services.  We may disclose health information about you to doctors, nurses, technicians, or other Facility personnel who are involved in taking care of you.  For example: a doctor treating you for back pain may need to know about your previous back surgery, as this information may help your treatment plan.  Different Facilities also may share health information about you in order to coordinate the different things you may need, such as prescriptions, lab, work, meals, and x-rays.

We may also provide your physician or subsequent healthcare provider with copies of various reports that should assist her or him in treating you once you're discharged from this Facility.

For Payment:  We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information about your surgery/procedure so they will pay us or reimburse you for the treatment.  We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover it.

For Health Care Operations:  Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it.  The results will then be used to continually improve the quality of care for all patients we serve.  For example, we may combine health information about many patients to evaluate the need for new services or treatment.  We may disclose information to doctors, nurses, and other students for educational purposes.  And we may combine health information we have with another Facility to see where we can make improvements.  We may remove information that identifies you from this set of health information to protect your privacy.

We may also use and disclose health information:

Business Associates: There are some services provided in our organization through contracts with business associates.  Examples include physician services in the emergency department and radiology, certain laboratory 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 they can perform the job we've asked them to do and bill you or your third-party payer for the services rendered.  To protect you health information, however, we require the business associate to appropriately safeguard your information.

Individuals Involved in Your Care or Payment for Your Care:  We may release health information about you to a friend or family member who is involved in your medical care or who helps pay for your case.  In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

Research:  We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research and granted a waiver of the authorization requirement.

Future Communications:  We may communicate to you via newsletters, mail outs or other means regarding treatment options or health related information.

Organized Health Care Arrangement:  This facility and its medical staff members have organized and are presenting you this document as a joint notice.  Information will be shared as necessary to carry out treatment, payment and health care operations.  Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time.

As Required by Law:  We may also use and disclose health information for the following types of entities, including but not limited to:

Law Enforcement/Legal Proceedings:  We may disclose health information for law enforcement purposes as requires by law or in response to a valid subpoena.

State-Specific Requirements:  Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs.  Some states have separate privacy laws that may apply additional legal requirements.  If the state privacy laws are more stringent than federal privacy laws, then state law preempts the federal law.

YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, you have the Right to:

Inspect and Copy:  You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care.  Usually, this includes medical and billing records, but does not include psychotherapy notes.  We may deny your request to inspect and copy certain records in certain very limited circumstances.  If you are denied access to health information, you may request that the denial be reviewed. 
Another licensed health care professional chosen by the Facility will review your request and the denial.  The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Amend:  If you feel the health information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for the Facility.  We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.

An Accounting of disclosures:  You have the right to request an accounting of disclosures.  This is a list of certain disclosures we make of your health information for purposes other than treatment, payment, or health care operations where an authorization was not required.

Request Restrictions:  You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations.  You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  For example, you could ask that we not uses or disclose information about an examination or procedure which you had.

We are not required to agree to your request.  If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Request for Confidential Communication:  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you may ask that we contact you at work instead of your home.  The facility will grant reasonable requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where the individual will receive bills for services rendered by the facility and related correspondence regarding payment for services.  Please realize we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response.  We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.

A Paper Copy of This Notice:  You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

To exercise any of your rights, please obtain the required forms from the Privacy Officer and submit your request in writing.

CHANGES TO THIS NOTICE
We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future.  The current notice will be posted by the Facility and include the effective date.  Each time you visit a Facility for treatment we will offer you a copy of the current notice in effect.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with: 1) the Facility Privacy Official, or 2) with Secretary of the Department of Health and Human Services.  To file a complaint with the Facility, contact the Facility Privacy Official. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.

OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission.  If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

FACILITY PRIVACY OFFICIAL
Rosemary Gonzalez, Privacy Official
Telephone Number: (805) 497-8616
Fax Number: (805) 496-5585

CONEJO PAIN SPECIALISTS MEDICAL GROUP, INC.
Practice Office:
3366 E. Thousand Oaks Blvd, 2nd Floor
Thousand Oaks, CA 91362

Legal Service Address:
430 East Avenida de Los Arboles, Suite 101
Thousand Oaks, CA

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Our multidisciplinary pain practice is
interventional and comprehensive.

"I am committed to designing a program that will reduce your specific pain and its cause, allowing you to continue to live your life to the fullest."

 

Some Conditions We Treat