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.
70:30 Health is required by law to maintain the privacy of your Protected Health Information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of this Notice currently in effect.
We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. For example, we may share your information with other healthcare providers involved in your care, such as specialists, laboratories, or pharmacies.
We may use and disclose your PHI to bill and collect payment for the services we provide. For example, we may share information with your insurance company, health plan, or other third-party payer to obtain payment or determine coverage.
We may use and disclose your PHI for our healthcare operations, which include quality assessment, staff training, business management, and other activities necessary to run our practice.
We may use or disclose your PHI when required to do so by federal, state, or local law, including for public health activities, reporting abuse or neglect, health oversight activities, judicial or administrative proceedings, and law enforcement purposes.
Other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time by submitting a written request, except to the extent that we have already acted on the authorization.
You have the right to inspect and obtain a copy of your PHI maintained by our practice. To request access, submit a written request to our office. We may charge a reasonable fee for copying and mailing.
You have the right to request an amendment to your PHI if you believe it is incorrect or incomplete. Submit a written request explaining your reason. We may deny the request under certain circumstances and will provide a written explanation if denied.
You have the right to request a list of certain disclosures we have made of your PHI. This does not include disclosures made for treatment, payment, healthcare operations, or disclosures you authorized. Submit a written request to our office
You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to your request, except that we must agree to restrict disclosures to a health plan for services you have paid for in full out of pocket.
You have the right to request that we communicate with you about your health information in a specific way or at a specific location. For example, you may ask that we contact you only at a certain phone number. We will accommodate reasonable requests.
You have the right to obtain a paper copy of this Notice, even if you have agreed to receive it electronically. You may request a copy at any time by contacting our office.
We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as any information we receive in the future. The current notice will be posted on our website and available at our clinic.
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the U.S. Department of Health and Human Services Office for Civil Rights.
To file a complaint with our practice, contact us in writing at the address below. You will not be retaliated against for filing a complaint.
To file a complaint with the Office for Civil Rights, visit www.hhs.gov/ocr/privacy/hipaa/complaints or call (800) 368-1019.
Privacy Officer
70:30 Health
10959 North Wolfe Road, Cupertino, CA 95014