Privacy Policy

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Monrovia Internal Medicine & Primary Care 

NOTICE OF PRIVACY PRACTICES 

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. 

WHAT IS THIS NOTICE ABOUT AND WHY IS IT IMPORTANT? 

This notice is required by the U.S. Department of Health and Human Services in order for you to be informed of how your health information will be used, disclosed, and protected, and about your rights regarding your health information. 

WHAT DOES THIS NOTICE COVER? 

This Notice covers the following types of information: 

1. Information about your health condition, health care treatment, or payment for health care treatment that could reasonably identify who you are. 

2. Information in the possession of any MIMPC department or service area wherever it may be. It also applies to all MIMPC employees, volunteers, contractors, or anyone working at MIMPC who might have access to your health information. In accordance with Title 45 of the Code of Federal Regulations §164.501, Monrovia Internal Medicine & Primary Care, including members of its Medical Staff, are legally separate covered entities, complying with the Privacy Regulations of the Health Insurance Portability and Accountability Act of 1996. These entities will share information necessary for their joint health care activities. 

HOW MIMPC WILL USE YOUR HEALTH INFORMATION 

MIMPC is permitted to use your health information or to disclose to others outside MIMPC without permission from you for three basic types of activities: 

• Treatment – We are permitted to use your health information or disclose it to others outside MIMPC in order to provide proper medical care to you. This means we can provide your health information to nurses, technicians, doctors, medical students, or outside laboratories involved in your care. 
• Payment – We are permitted to use your health information or disclose it to others outside MIMPC in order to submit bills for the care and services you received. For example, information about your care or services may be sent to your insurance company, a government insurance program, or another company that process the information and submits it for payment. We may also send information to your health plan about treatment you may receive so they may approve or disapprove whether you are covered for that care. 
• Health care operations – We are also permitted to use your health information or disclose it to others outside MIMPC in order run the hospital and assure high quality care. For example, we may use your information to review how we provide care to you; we may disclose it to consultants to help us improve how we operate the hospital; we may also disclose it to certain organizations to meet compliance or licensing requirements. 

MIMPC may also use your information or disclose it to others outside MIMPC without your permission under certain other specific circumstances as described below: 

• Appointment Reminders – We may use or disclose your health information to send you reminders that you have an appointment for treatment or medical care. 
• Treatment Alternatives – We may use or disclose your health information to tell you about or recommend possible treatment-related options, activities, or alternatives that may be helpful to you. 
• Health-Related Benefits and Services – We may use or disclose your health information to tell you about health-related benefits or services that may be of interest to you. 
• Fundraising Activities – We may use or disclose certain health information (such as your name, address, phone number, age, gender, and dates you received treatment) to contact you in the future to raise funds for MIMPC. The money raised will be used to expand and improve the services and programs we provide the community. 
• Individuals Involved in Your Care or Payment for Your Care – During times of treatment, we disclose your health information only to your personal representative. We may also disclose your health information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. 
• Research – Under certain circumstances, we may use and disclose your health information for research purposes. For example, we may, disclose your information to researchers preparing to conduct an investigation to help them look for patients with specific medical conditions. But, in nearly all other cases, we will need your written authorization for research. 
• As Required By Law – We will disclose your information when required by law. 
• To Avoid a Serious Threat to Health or Safety – We may use and disclose your health information to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. 

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION 

• Authorization to Use Your Information – In order for us to use or disclose your information, other than as described above, we will nearly always need to obtain your written authorization which you may revoke at any time to stop any future uses and disclosures. 
• Right to Have Access to Your Information – In most cases, you have the right to look at or have a copy of your health information that we have. Your request for a copy of your health information must be in writing. A nominal fee will be charged for copying costs. 
• Right to Amend Your Information – If you believe the information we have about you is incorrect or if important informationis missing, you have the right to request that we correct the existing information or add the missing information. 
• Right to Request Your Information be Provided in Certain Way – You may request that when we send your information to you, we do so in a specific way that is convenient for you. We are not required to follow your request, but we will make every reasonable effort to do so or find a mutually satisfactory alternative. 
• Right to an Accounting of Our Disclosures of Your Information – You also have the right to receive a list of instances where we have disclosed your health information to others for reasons other than treatment, payment or health care operations. 
• Right to Limit Our Use or Disclosure of Your Information – You may request in writing that we not use or disclose your information for treatment, payment operations, or any other purpose except when specifically authorized by you, when required by law, or in emergency circumstances. We will consider your request and respond, but we are not legally required to accept it. 

MIMPC’s DUTIES REGARDING YOUR HEALTH INFORMATION 

We are required to protect the privacy of your information, establish Policies and Procedures that do so, provide this notice about our privacy practices, and to follow the practices described in this Notice. 

We reserve the right to change our Policies and Procedures for protecting health information. When we make a significant change in how we use or disclose your health information, we will also change this Notice and post the new Notice in the waiting and admissions areas. You can also request a written copy of the most recent version of this Notice at any time. 

HOW TO MAKE A COMPLAINT ABOUT HOW YOUR INFORMATION IS USED 

If you believe we have not properly protected your privacy, violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the MIMPC Privacy Officer at the address listed below. You also may send a written complaint to the U.S. Department of Health and Human Services, Office of the Secretary, Federal Office Building, 50 United Nations Plaza, Room 322, San Francisco, California 94102. We will not retaliate against you if you file a complaint with us or the U.S. Department of Health and Human Services. 

HOW TO GET MORE INFORMATION ABOUT CHLA’s PRIVACY PRACTICES 

To act on any of the information provide in this Notice or for more information about our privacy practices, you may contact the MIMPC Privacy Officer: Phone: (877) 254-4495; e-mail: team_mimpc@mimpc2.com or mail: Dr. Ulin Sargeant, MIMPC Privacy Officer, Monrovia Internal Medicine & Primary Care, PO Box 2063, Monrovia, California 91017