Health Care Partners Medical Group

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.

HealthCare Partners (HCP) and its affiliates, are required by law to maintain the privacy of your health information and to provide you with notice of their legal duties and privacy practices with respect to your Protected Health Information (PHI). PHI is any health information, which is identifiable to you. If you have questions about any part of this notice or if you want more information about the privacy practices at HCP, please contact the Site Administrator.

Effective Date of This Notice: April 14, 2003

I. How HCP may Use or Disclose Your Health Information

HCP collects PHI from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of HCP, but the information in the medical record belongs to you. HCP protects the privacy of your PHI. The law permits HCP to use or disclose without written authorization your PHI for the following purposes:

1. Treatment. HCP is a primary care medical group that offers a full spectrum of health care treatment and services, using a provider network of employed and contracted physicians, as well as contracted hospitals and specialty medical/surgical services ("Business Associates"). Medical treatment includes but is not limited to:

2. Payment. We may use and disclose PHI to provide payment for services that we provide to you. Payors are: insurance companies (including HMOs, PPOs, Medicare, etc.) employers, and others who arrange or pay the cost of some or all of your health care. Your insurance company may release some or all of your PHI to the primary policy holder.

3. Regular Health Care Operations. Your PHI will be provided to HCP employees or "business associates" who participate in meeting your health care needs. This includes but is not limited to: scheduling appointments, appointment reminders, greeting you on arrival, assisting your physician during the office visit, arranging referrals, and transcribing and maintaining your records. We may use your PHI to evaluate the quality and competence of our physicians, nurses, and other health care workers.

4. Information Provided to You. Upon your signed authorization, information will be released to you.

5. Notification and Communication with Family. We may disclose your PHI to a family member, your personal/legal representative (one who has a valid Power of Attorney for Health Care, a conservator, or a guardian) or another person responsible for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

6. Required by Law. As required by law, we may use and disclose your PHI.

7. Public Health. As required by law, we may disclose your PHI to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

8. Health Oversight Activities. We may disclose your PHI to health agencies during the course of audits, investigations, in If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:

Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201

You may also address your complaint to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.