Sudha Moola, MD Obstetrics · Gynecology · Wellness Women caring for women

Notice of Privacy Practices

How your medical information may be used and disclosed, and how you can get access to it (HIPAA).

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.

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable us to meet our professional and legal obligations to operate this medical practice properly. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). A more detailed version of this notice is available. Please ask the privacy officer for our full Notice of Privacy Practices. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer listed above.

Our commitment to your privacy:

Our practice is dedicated to maintaining the privacy of your health information. We are required by law to maintain the confidentiality of your health information. We realize that these laws are complicated, but we must provide you with the following important information:

Use and disclosure of your health information in certain special circumstances

The following circumstances may require us to use or disclose your health information:

  1. To public health authorities and health oversight agencies that are authorized by law to collect information.
  2. Lawsuits and similar proceedings in response to a court or administrative order.
  3. If required to do so by a law enforcement official.
  4. When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public, we will only made disclosures to a person or organization able to help prevent the threat.
  5. If you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
  6. To federal officials for intelligence and national security activities authorized by law.
  7. To correctional institutions or law enforcement, if you are and inmate or under the custody of a law enforcement official.
  8. For Workers Compensation and similar programs.

Your rights regarding your health information

  1. Communications: you can request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. We will accommodate reasonable requests.
  2. You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information of only certain individuals involved in your care of the payment of your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law in emergencies, or when the information is necessary to treat you.
  3. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to your physician.
  4. You may ask us to amend your health information if you believe it is incorrect or incomplete, as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to your physician. You must provide us with a reason that supports your request for amendment.
  5. You are entitled to receive a copy of this Notice of Privacy Practices. You may ask us to give you a copy of the Notice at any time.
  6. Right to file a complaint: If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Department of Health and Human Services. To file a complaint with our practice, contact: Privacy Officer, 818 Magnolia Ave 102 Corona CA 92879. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
  7. Right to provide an authorization for other uses and disclosures: our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.