ima

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.

OUR PLEDGE

The protection of our patients’ privacy and the confidentiality of their medical information has always been important to us. We understand that you trust us to safeguard your personal information and respect your right to privacy. This notice represents our commitment to maintain the privacy of your protected health information and to inform you of our legal duties and privacy practices, as well as your rights, as required by California and federal law. We are legally required to provide you a copy of this notice and to follow the terms of this notice currently in effect.

YOUR PERSONAL INFORMATION

We keep records of the medical care we provide you and we may receive similar records from others. We use this information so that we, or other health care providers, can render quality medical care, obtain payment for services and enable us to meet our professional and legal responsibilities to operate our medical practice. We may store this information in a chart and in our computers. This information makes up your medical record. The medical record is our property, however this notice explains how we use information about you and when we are allowed to share that information with others.

OUR PRIVACY PRACTICES

It is our policy to maintain reasonable and feasible physical, electronic and process safeguards to restrict unauthorized access and to protect the availability and integrity of your health information. Our protective measures may include secure office facilities.

Access to health information is only granted on a “need-to-know” basis. Once the need is established the access is limited to the minimum necessary information to accomplish the intended purpose.

Our staff are required to comply with the policies and procedures designed to protect the confidentiality of your health information. Any staff that violate our privacy policy are subject to disciplinary action.

HOW WE MAY USE OR SHARE YOUR INFORMATION

The following categories describe situations where the law allows us to use and share your health information. Not every use or disclosure is listed, but the ways in which we are legally permitted to use and share your health information will fall into one of these categories.

Treatment

We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing your care. For example, we may share your medical information with other physicians who will provide services which we do not provide. We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.

Payment

We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other healthcare providers to assist them in obtaining payment for services they provide you.

Health Care Operations

We may use and disclose medical information about you to properly operate and manage our medical practice. For example, we may use and disclose this information to review and improve the quality of the care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information to get your health plan to authorize service or referrals. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud, waste and abuse detection, compliance programs and business planning and management. We may also share your health information with our business associates, such as our billing service, that perform services for us. However we will not share your health information with them unless they agree in writing to protect the privacy of that information. Under California law, all recipients of health care information are prohibited from re-disclosing it except as specifically required or permitted by law.

Notifications

We may disclose your information to someone who is involved with your care or helps pay for your care. We may disclose your health information to notify, or assist in notifying, a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. In the event of a disaster, we may also disclose information to a relief organization so that they may coordinate these notification efforts.

Marketing

We may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments or health-related benefits and services that may be of interest to you.

Research

Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one treatment to those who received another, for the same condition. All research projects, however, are subject to a special approval process.

Law

We may disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances or in response to valid judicial or administrative orders.

Public Health

We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, disability, abuse, etc. as required by law.

Food and Drug Administration (FDA)

We may disclose to the FDA health information relative to adverse events.

Worker’s Compensation

We may disclose health information necessary to comply with laws relating to Worker’s Compensation or other similar programs established by law.

Correctional Institution

Should you be an inmate of a correctional institution, we may disclose to the institution or its agents health information necessary for your health and the health and safety of other individuals.

State Requirements

Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs.

YOUR WRITTEN PERMISSION

In any other situation not covered by this notice, we will ask you for your written authorization before using or disclosing medical information about you. If you choose to authorize us to use or disclose your health information, you can later revoke that authorization by notifying us in writing of your decision, except to the extent that action has already been taken by us upon authorization given to us.

Except as specified above, under California law we may not share your health information with your employer or benefit plan unless you provide us an authorization.

YOUR RIGHTS

Although your health record is the property of ima Sleep Disorder Center, Inc., you have the right to:

Ask us to restrict how we use or share your health information for treatment, payment or health care operations. Please note that while we will try to honor your requests, we are not required by law to agree to those types of restrictions.

Request confidential communications of health information.

Inspect and copy your health information, with limited exceptions.

Request an amendment to your health information that you believe is incorrect or incomplete. We could deny your request to amend a record if the information was not created by us, maintained by us, or if we determine the record is accurate. You may appeal, in writing, a decision by us not to amend a record.

Receive an accounting of certain disclosures of your health information stating who and where your health information has been disclosed for purposes other than treatment, payment, health care operations or where you specifically authorized a use or disclosure in the last six (6) years, not prior to April 14, 2003.

CHANGES TO THIS NOTICE

Should any of our privacy practices change, we reserve the right to change the terms of this notice and to make the new notice effective for all the health information that we maintain, regardless of when it was created or received. We will provide you a copy of the revised notice and we will post it publicly as required by law.

QUESTIONS OR COMPLAINTS

If you have any questions regarding this notice of privacy practices, if you require additional information, or you believe your privacy rights have been violated, please contact our Privacy Officer at: 125 Baker Street #110, Costa Mesa, CA 92626, or call (714) 979-2581.

You may also direct your complaints to the Secretary of the United States Department of Health and Human Services. Filing a complaint will not negatively affect the treatment or coverage that you receive.