HIPAA NOTICE, PRIVACY POLICY & TERMS OF USE
HIPAA NOTICE
NEEMA MALHOTRA, M.D. USCIS Clinic, Milpitas, San Jose CA
Notice of Privacy
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Introduction
We are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information.
It also describes your rights as they relate to your protected health information. This
Notice is effective April 14, 2020 and applies to all protected health information as defined by federal regulations such as HIPAA.
Understanding Your Health Record/Information
Each time you visit our office, a record of your visit and medical history records 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 basis for planning your care and treatment, and a means of communication with other health care professionals, your health insurance company, legal entities, and public health officials in order to promote your general health and that of the general public.
Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of Neema Malhotra M.D.
the information belongs to you. You have the right to:
• Obtain a paper copy of this Notice of information practices upon request.
• Inspect and copy your health record by written request.
• Request an Amendment your health record.
• Obtain an accounting of disclosures of your health information.
• Request communications of your health information by alternative means or at alternative locations.
• Request a restriction on certain uses and disclosures of your information.
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
Our Responsibilities
We are required to:
• Maintain the privacy of your health information,
• Provide you with this 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,
Neema Malhotra, MD, USCIS Clinic 2730 Union Ave, Ste B, San Jose CA, 95124 408-684-8600
• Notify you if we are unable to agree to a requested restriction, and
• 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 post, and if you request, mail you a revised notice.
We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact the practice’s Privacy Officer, Vino Malhotra at 408-684-8600
If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below:
Office for Civil Rights
U.S. Department of Health and Human Services 200 Independence Avenue, S.W.
Room 509F, HHH Building Washington, D.C. 20201
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment.
For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.
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.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
Business associates: There are some services provided in our organization through contacts with business associates. Examples include certain laboratory tests, radiology services, progress notes, insurance info, past medical history that we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do
Neema Malhotra, MD. 2730 Union Ave, Ste B, San Jose, CA 95124 Tel: 408-684-8600
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: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. This includes appointment reminders, and lab or other test results.
Research: We may disclose information to researchers when their 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.
Funeral directors: We may disclose health information to funeral directors consistent with applicable law to perform their duties.
Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide information about treatment alternatives or other health- related benefits and services that may be of interest to you.
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, disability, or abuse prevention, including but limited to Covid-19 infections.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
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.
As always, it is a pleasure to provide your healthcare needs. Thank you.
Neema Malhotra, MD. 2730 Union Ave, Ste B, San Jose, CA 95124 Tel: 408-684-8600
RECEIPT OF Neema Malhotra, M.D. or USCIS Clinic, Inc. PRIVACY NOTICE
Please sign below that you have received or seen a copy of our Privacy Notice.
Patient or Guardian Name (please print)
Signature Date
Patient was provided a copy of our Privacy Notice in waiting area and on our website but did not wish to sign verification of receipt.
Patient name
Staff member sign and date
Privacy Officer for Neema Malhotra M.D.
Alternate Privacy Officer: Vino Malhotra
Clinic Administrator/Alternate Privacy Officer - Vino Malhotra
Contact Phone: 408-684-8600 Email: [email protected]
