NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
This notice describes how health information about you may be used and disclosed and how you can get access to this information.
Please review it carefully.
Our pledge regarding your health information
Evolve Healthcare (Evolve) is committed to protecting your personal information. This includes your Medical, Mental health and personal information. We are required by law to maintain the privacy of your Health Information, provide you information about our legal duties and privacy practices, inform you of your rights and the ways in which we may use Health Information and disclose it to other entities and persons.
Uses and Disclosures
The following section will describe different ways that we may use and disclose your information. Not every use will be listed.
- Your doctor or a staff member may have to disclose your health information (up to and including all of your clinical records) to another health care provider or a hospital if it is necessary to refer you to them for diagnosis, assessment, or treatment of your health condition.
- It may be necessary for our insurance and/or billing staff to disclose your examination and treatment records and your billing records to another party, such as an insurance carrier, your employer, a family member, other relative or close personal friend, who is involved in our care or to facilitate the payment related to your care.
- It may be necessary for the doctor and members of the staff to use your health information, examination, and treatment records and your billing records for quality control purposes or for other administrative purposes to efficiently and effectively run our practice.
- Your doctor and members of the practice staff may need to use your information (e.g. Name, address, phone number, and your clinical records) to contact you to provide appointment reminders, information about treatment alternatives, or other health related information that may be of interest to you. If you are not at home to receive an appointment reminder, a message will be left on your answering machine.
- We may release medical information to anyone that is involved in your general medical care. Such individuals may include personal representative, family member, friend, or any individual that you may identify. We may inform your family members regarding your general condition and in the event you get admitted to the hospital or any other care facility.
- Evolve is dedicated to the education of various students that you may encounter at the clinic e.g. Residents, medical students, nursing students, medical assistants, phlebotomists, and other healthcare related students. Some information may be shared with the students for teaching purposes.
- We may be required by law to disclose your health information. In the event such request is made disclosure will be done by federal or state law.
- We may disclose your health information as necessary to prevent any serious injury to you, family members or friends. Information may be also shared with health and safety departments as required by law e.g. reportable diseases such as Chlamydia and gonorrhea.
- We may disclose some health information to workers compensation agencies or other programs as authorized/required by law.
- We may disclose your health information to public health agencies for the following reasons: preventing or controlling disease such as cancer or tuberculosis. Reporting abuse of adults or children including neglect. Reporting deaths and vital events such as birth. Contacting the person who may have been exposed to a disease and may be at risk at spreading the disease to others or contracting individually.
- We may release your information to law enforcement agencies as required by law.
- In the event of a death information will be shared with medical examiners office including corners and funeral directors. These may be necessary in order to expedite funeral services and to determine the cause of death.
- Most uses and disclosures of your health information for marketing purposes of any sales or health information would require your written approval.
Other than the circumstances described in the above examples, any other use or disclosure of your health information will only be made with your written consent.
Right to revoke authorization
You may revoke (take away) your privacy release authorization from us at any time; however, your revocation must be in writing. You can call for information about revoking your authorization during normal business hours, or send your request to the address listed below. There are two circumstances under which we will not be able to honor you revocation request.
- If we have already released your health information before we received your request to revoke your authorization. 164.508(b)(5)(i).
- If you were required to give your authorization as a condition of obtaining insurance, the insurance company may have a right to your health information if they decide to contest any of your claims. If you wish to revoke your authorization, please write to us at:
20301 Ventura Blvd. Suite 210
Woodland Hills, CA 91364
Right to limit uses or disclosures
If there are health care providers, hospitals, employers, insurers, or other individuals or organizations to whom you do not want us to disclose your health information, please let us know, in writing, what individuals or organizations to whom you do not want us to disclose your health care information. We are not required to agree with your request. However, if we agree with your written request, the restriction is binding on us. If we do not agree with such restrictions, you may drop your request, or you are free to seek care form another health care provider.
Right to receive confidential communication regarding health information
We normally provide information about your health to you in person at the time of visit. We may also mail you information regarding your health or about the status of your account. We will do our best to accommodate any reasonable request if you would like to receive information in a different form. To help us respond to your needs, please make any request in writing.
Right to inspect and copy health information
You may inspect a copy of your health information including all data that is used to contact you. An attempt will be make to provide electronic copies. Otherwise you will be contacted regarding an alternative method of providing the records requested. Only at certain times you may be denied access to your health information. At that point you at the right for an appeal. Medical records will be kept for seven years as described by law. Rules and regulations may change based on current law requirements. All requests must be made in writing.
Right to amend health information
You have the right to request amendment of your health information files. All requests must be made in writing and submitted to the address listed above.
Right to receive an accounting of the disclosures we have made of your records
Accounting request must be done in writing. Your request may not be longer than six years from the date the request. Fees for aggregation of data and reporting may apply.
Information that we use or disclose may be subject to re-disclosure by the person to whom we provide the information and may no longer be protected by the federal privacy rules.
For more information or to report a problem
If you have questions and would like additional information, you may contact Evolve at 818-346-4300. If you believe your privacy rights have been violated, you can either file a complaint with this office, or with the office for Civil Rights, U.S. Department of Health and Human Services (OCR). There will be no retaliation for filing a complaint with either our practice or the OCR. The address for the OCR regional office for North Carolina is as follows:
California Department of Public Health
Office of Civil Rights, MS 0504
PO Box 997377
Sacramento, CA 95899-7377
Changes in privacy practices and this page
Questions or complaints
At Evolve we are committed to patient care and protecting your health information. If you have any questions or concerns please contact our office at: 818-346-4300. You may also communicate in writing with a mailed correspondence to our office:
20301 Ventura Blvd. Suite 210
Woodland Hills, CA 91364
Please note, you will not be penalized for filing a complaint.