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Notice of Privacy Practices Effective April 14, 2003

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.

This is a summary of your rights and our responsibilities regarding your medical information and its privacy. A full version of this Notice is posted in the main lobby of Simi Valley Hospital, the Simi Valley Hospital North and South Campuses, as well as the Aspen Outpatient Center. You may have a copy of the full version by requesting one at patient registration areas. If you have any questions about this notice, please contact the HIPAA Privacy Officer, Medical Records Department.

WHO WILL FOLLOW THIS NOTICE?

All health professionals, employees and volunteers of Simi Valley Hospital and any related clinics and agencies. (For a listing, consult the full version of the Notice.)

OUR PLEDGE REGARDING MEDICAL INFORMATION

We are committed to protecting the privacy of medical information about you.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we may use and disclose your medical information (for examples, consult the full version of the Notice):

  • For Treatment. To provide you with medical treatment or services.
  • For Payment. So that you and your insurance carrier may be billed.
  • For Health Care Operations. For business operations to support your care.
  • Appointment Reminders. To remind you of appointments.
  • Treatment Alternatives. To tell you about possible treatment options.
  • Health-Related Benefits and Services. To tell you about health-related benefits or services.
  • Fundraising Activities. To contact you to raise money for the hospital.
  • Hospital Directory. To place limited information about you in the hospital directory (a daily list of patients in our facility).
  • Individuals Involved in Your Care. To a friend or family member who is involved in your medical care.
  • Disaster Relief. To those assisting in a disaster relief effort (e.g., the Red Cross).
  • Research. For research purposes, when approved by our Institutional Review Board.
  • As Required By Law. When required to do so by federal, state, or local law.
  • To Avert a Serious Threat to Health or Safety. To prevent a serious threat to your health and safety or the health and safety of the public or another person.

SPECIAL SITUATIONS

If any of the following categories describe you, we may use and disclose your medical information as indicated (for examples, consult the full version of the Notice).

  • Organ and Tissue Donation. If you are an organ or tissue donor, to organizations that handle procurement or transplantation, or to a donation bank.
  • Military and Veterans. If you are a member of the armed forces or a veteran, as required by military command authorities.
  • Workers’ Compensation. To your workers’ compensation program, for work-related injuries or illness.
  • Public Health Risks. For a wide variety of public health activities.
  • Health Oversight Activities. To a health oversight agency for activities authorized by law (e.g., audits, investigations, inspections, and licensure).
  • Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, to a court or lawyer in response to a subpoena, discovery request, or other lawful process.
  • Law Enforcement. If asked to do so by a law enforcement official, in specific situations.
  • Coroners, Medical Examiners and Funeral Directors. To a coroner or medical examiner (and/or to funeral directors) as necessary to carry out their duties.
  • National Security and Intelligence Activities. To authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
  • Protective Services for the President and Others. To authorized federal officials so they may provide protection to the President and others.
  • Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, to the correctional institution or law enforcement official.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you (for details, consult the full version of the Notice):

  • Right to Inspect and Copy. To inspect and receive a copy of your medical information.
  • Right to Amend. You may ask us to amend the information you consider incorrect or incomplete.
  • Right to an Accounting of Disclosures. To request an “accounting of disclosures” (a list of certain disclosures we made of medical information about you).
  • Right to Request Restrictions. To request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations.
  • Right to Request Confidential Communications. To request that we communicate with you about medical matters in a certain way or at a certain location.
  • Right to a Paper Copy of This Notice. To receive a paper copy of this notice.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We will post a dated copy of the current notice in the facility. (For additional information, consult the full version of the Notice.)

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with this facility or with the Secretary of the Department of Health and Human Services (consult the full version of the Notice). You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission.

Remember: this is a summary of your rights and our responsibilities regarding your medical information and its privacy. A full version of this Notice is posted in the main lobby of Simi Valley Hospital, the Simi Valley Hospital North and South Campuses, and the Aspen Outpatient Center. If you have any questions about this notice, please contact the HIPAA Privacy Officer, Medical Records Department.