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.
Our pledge regarding your medical information
Galt Medical Center understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at our practice. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Galt Medical Center, including records of Dr. Ayman G. Damen, MD and Dr. Daniel Damen, DO.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- Make sure that medical information that identifies you is kept private.
- Give you this notice of our legal duties and privacy practices with respect to medical information about you.
- Follow the terms of the notice that is currently in effect.
- Notify you following a breach of your unsecured protected health information.
How we may use and disclose medical information about you
For treatment
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to physicians, nurses, technicians, medical students, or other personnel who are involved in taking care of you. For example, Dr. Ayman G. Damen, MD may share information with Dr. Daniel Damen, DO when both physicians are involved in your care, or with a specialist to whom we refer you.
For payment
We may use and disclose medical information about you so that the treatment and services you receive at our practice may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about a service you received so your health plan will pay us.
For health care operations
We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff.
Appointment reminders, treatment alternatives, and health-related benefits
We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at our practice. We may also tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.
Individuals involved in your care
We may release medical information about you to a friend or family member who is involved in your medical care if you agree, or in limited circumstances permitted by law if you are not present or able to agree.
As required by law
We will disclose medical information about you when required to do so by federal, state, or local law.
To avert a serious threat to health or safety
We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent the threat.
Public health activities
We may disclose medical information about you for public health activities, such as preventing or controlling disease, injury, or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or problems with products; notifying people of recalls of products they may be using; and notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
Health oversight, judicial and administrative proceedings, law enforcement, coroners, and workers' compensation
We may disclose medical information to a health oversight agency for activities authorized by law; in response to a court or administrative order, subpoena, or discovery request; for law enforcement purposes as required or permitted by law; to coroners, medical examiners, and funeral directors; and as authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs.
Military and veterans, national security, and protective services
If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law, and as required for the protection of the President, other authorized persons, or foreign heads of state.
Inmates
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official as permitted by law.
Uses and disclosures that require your written authorization
The following uses and disclosures of your medical information will be made only with your written authorization:
- Most uses and disclosures of psychotherapy notes;
- Uses and disclosures of medical information for marketing purposes; and
- Disclosures that constitute a sale 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 authorization. You may revoke an authorization in writing at any time, and we will stop the use or disclosure for the future, except to the extent we have already acted in reliance on the authorization.
Your rights regarding medical information about you
Right to inspect and copy
You have the right to inspect and obtain a copy of medical information that may be used to make decisions about your care, including medical and billing records, but not certain psychotherapy notes. To inspect and copy this information, submit a written request to the Privacy Officer. We may charge a reasonable, cost-based fee for the costs of copying, mailing, or other supplies associated with your request.
Right to amend
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, submit a written request to the Privacy Officer. We may deny your request for an amendment in certain circumstances. If we deny your request, you have the right to file a statement of disagreement.
Right to an accounting of disclosures
You have the right to request an accounting of certain disclosures we made of medical information about you. To request this list, submit a written request to the Privacy Officer.
Right to request restrictions
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care. We are not required to agree to your request, except that we must agree to a request to restrict disclosure of medical information to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the medical information pertains solely to a health care item or service for which you have paid out of pocket in full.
Right to request confidential communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we only contact you at work or by mail. Submit a written request to the Privacy Officer. We will accommodate all reasonable requests.
Right to a paper copy of this notice
You have the right to a paper copy of this notice, even if you have agreed to receive this notice electronically. You may ask us to give you a copy of this notice at any time.
Right to be notified of a breach
You have the right to be notified of a breach involving your unsecured protected health information.
Changes to this notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. The current notice will be posted in our practice and on this website. The notice will contain the effective date on the front page.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the Privacy Officer at the address and phone number below. You will not be penalized for filing a complaint.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by visiting https://www.hhs.gov/ocr/privacy/hipaa/complaints/, calling 1-877-696-6775, or sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201.
Contact
Privacy Officer
Grace Anaya, Practice Manager
Galt Medical Center
150 N Lincoln Way, Galt, CA 95632
Phone: (209) 745-4633
Fax: (209) 745-4637
This notice is also available in Spanish: Aviso de Prácticas de Privacidad.