THE POSTING OF THIS “HIPAA” NOTICE IS REQUIRED BY FEDERAL LAW, AND DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED.

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives you, the patient, the right to understand and control how your “Protected Health Information” (PHI) is used. HIPAA provides penalties for covered entities that misuse personal health information.

WE MAY USE AND DISCLOSE YOUR MEDICAL RECORDS ONLY FOR THE FOLLOWING PURPOSES: TREATMENT, PAYMENT, AND HEALTH CARE OPERATION.

THE FOLLOWING OFFICE POLICIES ARE LISTED FOR YOUR UNDERSTANDING:

YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR “PROTECTED HEALTH INFORMATION” (PHI):

If you have paid for services “out of pocket,” in full and in advance, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.

We are required by law to maintain the privacy of your Protected Health Information and to provide you the notice of our legal duties and our privacy practice with respect to PHI.

This notice if effective as of September 23, 2013 and it is our intention to abide by the terms of the Notice of Privacy Practices and HIPAA Regulations currently in effect. We reserve the right to change the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI that we maintain. We will post and you may request a written copy of the revised Notice of Privacy Practice from our office.

You have recourse if you feel that your protections have been violated by our office. You have the right to file a formal, written complaint with office and with the Department of Health and Human Services, Office of Civil Rights.

Innesa Lagen is available to address any privacy concerns, and may be reached by telephone at 650-529-0304, in person or in writing.

THIS OFFICE WILL MAKE EVERY EFFORT TO RESPECT AND HONOR YOUR PRIVACY.

PLEASE LET US KNOW IF YOU HAVE ANY CONCERNS.