Privacy Policy

Notice of Privacy Practices

Effective Date: January 1, 2024

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. If you have any questions about this notice, please contact our Privacy Officer at VALLEY OAKS MEDICAL GROUP.

Our Obligations:

We are required by law to:

How we may use and disclose health information:

The following describes the ways we may use and disclose health information that identifies you
(“Health Information”). Except for the purposes described below, we will use and disclose Health
Information only with your written permission. You may revoke such permission at any time by writing
to our practice Privacy Officer.

For Treatment. We may use and disclose Health Information for your treatment and to provide you
with treatment-related health care services. For example, we may disclose Health Information to
doctors, nurses, technicians, or other personnel, including people outside our office, who are involved
in your medical care and need the information to provide you with medical care.

For Payment. We may use and disclose Health Information so that we or others may bill and receive
payment from you, an insurance company or a third party for the treatment and services you
received. For example, we may give your health plan information about you so that they will pay for
your treatment.

For Health Care Operations. We may use and disclose Health Information for health care
operations purposes. These uses and disclosures are necessary to make sure that all of our patients
receive quality care and to operate and manage our office. For example, we may use and disclose
information to make sure the obstetrical or gynecological care you receive is of the highest
quality. We also may share information with other entities that have a relationship with you (for
example, your health plan) for their health care operation activities.

Appointment Reminders, Treatment Alternatives and Health Related Benefits and
Services.
We may use and disclose Health Information to contact you to remind you that you have
an appointment with us. We also may use and disclose Health Information to tell you about treatment
alternatives or health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share
Health Information with a person who is involved in your medical care or payment for your care, such
as your family or a close friend. We also may notify your family about your location or general
condition or disclose such information to an entity assisting in a disaster relief effort.

Research. Under certain circumstances, we may use and disclose Health Information for
research. For example, a research project may involve comparing the health of patients who
received one treatment to those who received another, for the same condition. Before we use or
disclose Health Information for research, the project will go through a special approval process. Even
without special approval, we may permit researchers to look at records to help them identify patients
who may be included in their research project or for other similar purposes, as long as they do not
remove or take a copy of any Health Information.

Special Situations:

As Required by Law. We will disclose Health Information when required to do so by international,
federal, state or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when
necessary to prevent a serious threat to your health and safety or the health and safety of the public
or another person. Disclosures, however, will be made only to someone who may be able to help
prevent the threat.

Business Associates. We may disclose Health Information to our business associates that perform
functions on our behalf or provide us with services if the information is necessary for such functions or
services. For example, we may use another company to perform billing services on our behalf. All of
our business associates are obligated to protect the privacy of your information and are not allowed to
use or disclose any information other than as specified in our contract.

Organ and Tissue Donation. If you are an organ donor, we may use or release Health Information
to organizations that handle organ procurement or other entities engaged in procurement, banking or
transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and
transplantation.

Military and Veterans. If you are a member of the armed forces, we may release Health Information
as required by military command authorities. We also may release Health Information to the
appropriate foreign military authority if you are a member of a foreign military.
Workers’ Compensation. We may release Health Information for workers’ compensation or similar
programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose Health Information for public health activities. These
activities generally include disclosures to prevent or control disease, injury or disability; report births
and deaths; report child abuse or neglect; report reactions to medications or problems with products;
notify people of recalls of products they may be using; a person who may have been exposed to a
disease or may be at risk for contracting or spreading a disease or condition; and the appropriate
government authority if we believe a patient has been the victim of abuse, neglect or domestic
violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities. We may disclose Health Information to a health oversight agency for
activities authorized by law. These oversight activities include, for example, audits, investigations,
inspections, and licensure. These activities are necessary for the government to monitor the health
care system, government programs, and compliance with civil rights laws.

Data Breach Notification Purposes. We may use or disclose your Protected Health Information to
provide legally required notices of unauthorized access to or disclosure of your health information.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health
Information in response to a court or administrative order. We also may disclose Health Information
in response to a subpoena, discovery request, or other lawful process by someone else involved in
the dispute, but only if efforts have been made to tell you about the request or to obtain an order
protecting the information requested.

Law Enforcement. We may release Health Information if asked by a law enforcement official if the
information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2)
limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3)
about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain
the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about
criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime
or victims, or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors. We may release Health Information to a
coroner or medical examiner. This may be necessary, for example, to identify a deceased person or
determine the cause of death. We also may release Health Information to funeral directors as
necessary for their duties.

National Security and Intelligence Activities. We may release Health Information to authorized
federal officials for intelligence, counter-intelligence, and other national security activities authorized
by law.

Protective Services for the President and Others. We may disclose Health Information to
authorized federal officials so they may provide protection to the President, other authorized persons
or foreign heads of state or to conduct special investigations.

Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release Health Information to the correctional institution
or law enforcement official. This release would be if necessary: (1) for the institution to provide you
with health care; (2) to protect your health and safety or the health and safety of others; or (3) the
safety and security of the correctional institution.

Uses and disclosures that require us to give you an opportunity to object and opt:

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose
to a member of your family, a relative, a close friend or any other person you identify, your Protected
Health Information that directly relates to that person’s involvement in your health care. If you are
unable to agree or object to such a disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional judgment.

Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations
that seek your Protected Health Information to coordinate your care, or notify family and friends of
your location or condition in a disaster. We will provide you with an opportunity to agree or object to
such a disclosure whenever we practically can do so.

Your written authorization is required for other uses and disclosures:

The following uses and disclosures of your Protected Health Information will be made only with your
written authorization:

  1. Uses and disclosures of Protected Health Information for marketing purposes,
  2. Disclosures that constitute a sale of your Protected Health Information; and,
  3. Disclosures of psychotherapy notes

Other uses and disclosures of Protected Health Information not covered by this Notice or the laws
that apply to us will be made only with your written authorization. If you do give us an authorization,
you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no
longer disclose Protected Health Information under the authorization. But disclosure that we made in
reliance on your authorization before you revoked it will not be affected by the revocation.

Your Rights:

You have the following rights regarding Health Information we have about you:

Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be
used to make decisions about your care or payment for your care. This includes medical and billing
records, other than psychotherapy notes. To inspect and copy this Health Information, you must
make your request, in writing, to Privacy Officer at Valley Oaks Medical Group. We have
up to 30 days to make your Protected Health Information available to you and we may charge you a
reasonable fee for the costs of copying, mailing or other supplies associated with your request. We
may not charge you a fee if you need the information for a claim for benefits under the Social Security
Act or any other state of federal needs-based benefit program. We may deny your request in certain
limited circumstances. If we do deny your request, you have the right to have the denial reviewed by
a licensed healthcare professional who was not directly involved in the denial of your request, and we
will comply with the outcome of the review.

Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information
is maintained in an electronic format (known as an electronic medical record or an electronic health
record), you have the right to request that an electronic copy of your record be given to you or
transmitted to another individual or entity. We will make every effort to provide access to your
Protected Health Information in the form or format you request, if it is readily producible in such form
or format. If the Protected Health Information is not readily producible in the form or format you
request your record will be provided in either our standard electronic format or if you do not want this
form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the
labor associated with transmitting the electronic medical record.

Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your
unsecured Protected Health Information.

Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask
us to amend the information. You have the right to request an amendment for as long as the
information is kept by or for our office. To request an amendment, you must make your request, in
writing, to Privacy Officer at Valley Oaks Medical Group.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures
we made of Health Information for purposes other than treatment, payment and health care
operations or for which you provided written authorization. To request an accounting of disclosures,
you must make your request, in writing, to Privacy Officer at Valley Oaks Medical Group.

Right to Request Restrictions. You have the right to request a restriction or limitation on the Health
Information we use or disclose for treatment, payment, or health care operations. You also have the
right to request a limit on the Health Information we disclose to someone involved in your care or the
payment for your care, like a family member or friend. For example, you could ask that we not share
information about a particular diagnosis or treatment with your spouse. To request a restriction, you
must make your request, in writing, to Privacy Officer at Valley Oaks Medical Group. We
are not required to agree to your request unless you are asking us to restrict the use and disclosure of
your Protected Health Information to a health plan for payment or health care operation purposes and
such information you wish to restrict pertains solely to a health care item or service for which you
have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the
information is needed to provide you with emergency treatment.

Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we
not bill your health plan) in full for a specific item or service, you have the right to ask that your
Protected Health Information with respect to that item or service not be disclosed to a health plan for
purposes of payment or health care operations, and we will honor that request.

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 can ask that we only contact you by mail or at work. To request confidential communications,
you must make your request, in writing, to Privacy Officer at Valley Oaks Medical Group. Your request must specify how or where you wish to be contacted. We will
accommodate reasonable requests.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may
ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice
electronically, you are still entitled to a paper copy of this notice. You may request a paper notice at
any time during our regular business hours, Monday through Friday, 8:30 AM until 5 PM.

Changes to this Notice:

We reserve the right to change this notice and make the new notice apply to Health Information we
already have as well as any information we receive in the future. We will post a copy of our current
notice at our office. The notice will contain the effective date on the first page, in the top right-hand
corner.

Complaints:

If you believe your privacy rights have been violated, you may file a complaint with our office or with
the Secretary of the Department of Health and Human Services. To file a complaint with our office,
contact Privacy Officer at Valley Oaks Medical Group. All complaints must be made in
writing.

You will not be penalized for filing a complaint.